Overview of important cervical cancer screening process values in European Union (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness.
The objective was the evaluation of the (cost-)effectiveness of cervical cancer screening in the European Union (EU) countries. Data were collected on recommended screening age ranges and intervals, coverage, proportion of non-negative smears and smear use. Estimates reported by representatives of each participating Member State were compared, and used as input for model based on (using the MISCAN simulation model for cancer screening) effectiveness and cost-effectiveness calculations. Differences in coverage from below 50 to 82% resulted in more or less proportional differences in expected percentage life-years lost reduction, almost regardless of differences in 7-50+ smears recommended in a lifetime. Differences in screening intensity (resulting from the recommended number of smears per lifetime and the number of excess smears on top of these recommendations) resulted in more than 2-fold difference in the expected number of smears per percentage life-years lost reduction. (Cost-)effectiveness predictions would have greatly improved if estimates of long-term coverage had also been available. To conclude, estimates for a restricted set of well defined parameters - a few for short and long-term coverage and one for the total number of smears - are quite useful for country-specific (cost-)effectiveness evaluations. The main, and to some extent, unsolvable problem for further improvement of the analysis is the lack of reliable country-specific estimates for the background risk of cervical cancer in women eligible for screening in the near future.
van Ballegooijen
M
M
Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. vanmarle@mgz.fgg.eur.nl
van den Akker-van Marle
E
E
Patnick
J
J
Lynge
E
E
Arbyn
M
M
Anttila
A
A
Ronco
G
G
Dik
J
J
Habbema
F
F
D017677:Age Distribution; D003362:Cost-Benefit Analysis; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000401:mortality / Q000458:organization & administration*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data