Session: Effect of Prevention
Room: Hollister B14
Time: Wed 08:30-10:00

Presenter: Edward Okeke (London School of Hygiene and Tropical Medicine. Public Health and Policy)

Discussant: Daniel Eisenberg (University of Michigan)

Abstract

Cervical cancer is the most common cancer among women in developing countries. Of the roughly 300,000 deaths from cervical cancer worldwide in 2002, nearly 80 percent of these deaths occurred in developing countries. Even though by now it is well known that cervical cancer can be prevented through regular screening, screening rates in many developing countries remain low. A recent paper by Gakidou et al. (2008) estimated that in the 30 developing countries for which they had data, only about 19 percent of women had been screened within the last three years – compared to 63 percent of women in developed countries. In this paper we examine the importance of demand-side factors on the take- up of cervical screening. We identify the impact of the price of screening by randomly assigning women different prices; we also estimate the impact of receiving a conditional cancer treatment subsidy.
This study was implemented in southwest Nigeria where we partnered with the local primary health care department and with physicians at the regional teaching hospital to provide subsidized cervical cancer screening. We randomly selected approximately 1000 households from within the community to receive visits from trained interviewers. Eligible women in those households were interviewed and then randomly assigned to receive one of three prices: zero, N50 ($0.33) and N100 ($0.66). Prices were determined by lottery. About half of the women were in addition assigned to a treatment group that would receive an additional cancer treatment subsidy (conditional on cervical cancer being diagnosed). Women in the control group received no subsidy. Assignment was again determined via lottery.
In all, we collected data on approximately 1050 women from 912 households. The mean age of women in our sample was 36.3 years, 68 percent of them were married and the average length of schooling was nine years. The average household size was five. About a quarter of households reported owning a motor vehicle, 41 percent owned a refrigerator and nearly 60 percent of households reported that at least one member of the household has a bank account. We estimated treatment effects using a simple difference of means, and by estimating a variety of linear models. Overall, we found qualitatively and quantitatively important impacts of both interventions. A N10 increase in price reduced take-up of cervical screening by between 0.7 and 0.8 percentage points. Going from a price of zero to a price of N50 reduced participation by about 4 percentage points - a roughly 20 percent decline. These estimates imply price elasticities around -0.2. We also found that the take-up rate among women who were offered a conditional treatment subsidy was about 4 percentage points higher than for women in the control group. We found no evidence of interaction between the interventions.
Our results suggest that price as well as cost of treatment play an important role in the demand for cervical cancer screening.

Key Terms

preventive care, demand, randomized experiment

Authors:

Edward Okeke (London School of Hygiene and Tropical Medicine. Public Health and Policy)