The cost-effectiveness of cervical-vaginal rescreening.
Although most laboratories practice 10% manual rescreening, the cost-effectiveness of this and other rescreening strategies rarely has been evaluated. Using data obtained from the medical literature, a decision model was created in which rescreening strategies were compared with nonrescreening strategies for the number of false-negative and false-positive diagnoses, cancers, life expectancy, and cost-effectiveness. The strategy of 10% rescreening with a repeated cervical-vaginal smear yielded almost no gain in life expectancy compared with an equivalent strategy with no rescreening. With 100% rescreening, the gain in life expectancy was only 0.24 days per patient. A 100% rescreening strategy generally was more cost-effective than a no-rescreening strategy at costs of rescreening varying from $2 to $10 per patient. A 10% rescreening strategy has limited utility. In addition, 100% rescreening strategies are more cost-effective than nonrescreening strategies, but only if the rescreening cost is low.
Raab
S S
SS
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, 52242-1009, USA.
D000328:Adult; D003127:Colposcopy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008403:Mass Screening / Q000191:economics* / Q000592:standards*; D011336:Probability; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D014626:Vaginal Smears / Q000191:economics* / Q000592:standards*