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WISH Costing Team

By Libby Dotson

Our Costing Team is considering the fact that, when the various implementation factors that can minimize success are not evaluated or considered, there may be little uptake of the new technology by providers and patients.

Pocket Colposcope

Consider the Pocket Colposcope device, which is a significantly more affordable and easier to use technology than the standard-of-care colposcopes that can be found in Duke Clinics without comprising on the efficacy of the service delivered. Lower unit costs of the device should lead to a lower cost of service to the patient, in theory. However, this logic fails to account for how health systems, insurance databases, and provider payment are actually structured.

In Peru, providers are reimbursed for procedures or services using devices that have been cleared through their regulatory institutions and given an official reimbursable code through their insurance databases. In order to be reimbursed, this requires several steps:

  • The documentation of validation and efficacy data

  • The submission of an exhaustive list of documents

  • A cost.

When thinking about this reimbursement process, the WISH Costing Team is asking themselves these questions:

  • If this reimbursement process is not complete, would providers receive a pay cut for using the Pocket versus the standard-of-care?

  • Would the providers then need to charge the patient more to make up the difference?

It is not enough for providers to be able to purchase a Pocket colposcopy device in Peru, our team must ensure that it is correctly integrated within the current health system structure. They have spent this semester addressing these issues and will continue to expand upon potential solutions and next steps in the Spring 2021 semester.


Dr. Nimmi Ramanujam, Andrea Thoumi, and Libby Dotson are leading efforts around evaluating the cost-effectiveness and policy considerations that might impact the integration of the WISH model (HPV self-sampling, Pocket Colposcopy, and thermal ablation) in the Andean region of Cajamarca Peru in collaboration with Dr. Patricia Garcia and her HOPE team.

Stay tuned for future updates from the WISH Bass Connections Team!



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