Cost-effectiveness of the conventional papanicolaou test with a new adjunct to cytological screening for squamous cell carcinoma of the uterine cervix and its precursors.
OBJECTIVE
To estimate costs and outcomes of conventional annual Papanicolaou (Pap) test screening compared with biennial Pap test plus speculoscopy (PPS) screening for cervical neoplasms.


METHODS
A Markov model compared cost-effectiveness and outcomes of annual Pap tests with biennial PPS. The model includes direct costs of screening, diagnostic testing, and treatment for squamous intraepitheial lesions and invasive cancers; indirect costs (eg, lost productivity because of cervical cancer); and newer management practices, including human papillomavirus DNA testing.


METHODS
Women aged 18 to 64 years.


METHODS
Screening for cervical neoplasms with either annual Pap smear test or biennial PPS.


METHODS
Marginal cost per life-year gained.


RESULTS
The probability of women having squamous intraepithelial lesions, cervical cancer, or death from cervical cancer was lower among women undergoing PPS biennially. A total of 12 additional days of life per woman was gained with biennial PPS during the 47-year model period. Total average cumulative direct medical costs per patient were $1419 for biennial PPS compared with $1489 for annual Pap tests. Total costs, including direct medical costs and indirect costs, were $2185 for PPS compared with $3179 for Pap tests alone. Increased savings and patient outcomes were observed in high-risk populations.


CONCLUSIONS
Our simulations indicate that biennial screening with PPS is expected to provide cost savings for women older than 18 years compared with annual Pap test screening, especially for those in high-risk populations.
MEDTAP International, Inc, Bethesda, MD 20814, USA.
L A
LA
Taylor
S V
SV
Sorensen
N F
NF
Ray
M T
MT
Halpern
D M
DM
Harper
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D065006:Papanicolaou Test; D012306:Risk; D013997:Time Factors; D014481:United States; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000191:economics*; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics*