Clinical and cost implications of new technologies for cervical cancer screening: the impact of test sensitivity.
OBJECTIVE
To compare the available techniques for cervical cancer screening, including several new technologies, using actual program utilization patterns.


METHODS
Longitudinal cohort model.


METHODS
The model followed a cohort of 100,000 women who underwent screening from age 20 through 65 years. The model was run with a weighted average of screening intervals to model the actual utilization of the cervical cancer screening program in the United States.


RESULTS
The model demonstrated that new technologies with significantly increased test sensitivity have the potential to reduce the number of cancers by 45% to 60% depending on the screening frequency in fully compliant populations. At screening intervals of 2 years or more, these new technologies had cost-effectiveness ratios below $50,000 per life-year saved. Assuming existing utilization patterns, the model predicted there would be 13.2 cancers per year in the 100,000 women screened with the conventional Pap smear, and new technologies with increased test sensitivity could reduce the annual incidence to 9.5 cancers per 100,000 women screened.


CONCLUSIONS
The model suggests that to achieve further dramatic reduction in cervical cancer mortality, significant improvements in test sensitivity, as reflected in the new screening technologies, may be the most realistic and cost-effective approach.
Hutchinson
M L
ML
Department of Pathology and Laboratory Medicine, Woimen and Infants' Hospital of Rhode Island, Providence, USA. mhutchin@earthlink.net
Berger
B M
BM
Farber
F L
FL
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D008828:Microbiological Techniques; D008875:Middle Aged; D015233:Models, Statistical; D065006:Papanicolaou Test; D010349:Patient Compliance; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D014600:Utilization Review / Q000191:economics* / Q000706:statistics & numerical data; D014626:Vaginal Smears / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D026712:Value of Life