Cost-effectiveness of cervical cytologic examination during pregnancy.
BACKGROUND
We undertook a study to determine the cost-effectiveness of performing routine cervical cytologic examination during pregnancy.


METHODS
The costs generated by doing routine prenatal cervical cytologic examination were calculated based on chart review in a family practice setting. A consecutive sample of 523 patients giving birth during 1990 was used. Analysis was done on 423 of those patients with prenatal Papanicolaou smear results recorded. Cost savings from detection of curable disease and utility of the test in terms of well-years saved were calculated from published statistics using a single-step Markov process to model the population at risk.


RESULTS
For patients of all ages using a discount rate of 5 percent, the cost generated by prenatal cervical cytologic examination was $146,400 per well-year of life saved. Age stratification showed cost per well-year to range from $321,600 for patients aged 15 to 19 years to $48,800 for those aged 35 to 39 years.


CONCLUSIONS
Routine prenatal cervical cytologic examination is significantly less cost-effective than the most commonly done medical procedures. If medical funding is limited, elimination of this test should be considered for women with normal findings on cervical cytologic examinations within the previous 2 to 3 years.
Carter
P M
PM
Department of Family and Community Medicine, Silas B. Hays Army Community Hospital, Fort Ord, California.
Coburn
T C
TC
Luszczak
M
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005194:Family Practice; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D017059:Models, Econometric; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics*; D015995:Prevalence; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics*; D026712:Value of Life; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*