title: Cost analysis of PAPNET-assisted vs. conventional Pap smear evaluation in primary screening of cervical smears.
abstract: OBJECTIVE
  To assess the difference in costs between PAPNET-assisted and conventional microscopy of cervical smears when used as a primary screening tool.
  
  
  METHODS
  We performed time measurements of the initial screening of smears by four cytotechnologists in one laboratory. Time was measured in 816 conventionally screened smears and in 614 smears with PAPNET-assisted screening. Data were collected on the components of initial screening, clerical activities and other activities in the total work time of cytotechnologists in the routine situation and on resource requirements for both techniques.
  
  
  RESULTS
  PAPNET saved an average of 22% on initial screening time per smear. Due to costs of processing and additional equipment, the costs of PAPNET-assisted screening were estimated to be $2.85 (and at least $1.79) higher per smear than conventional microscopy. The difference in costs is sensitive to the rate of time saving, the possibility of saving on quality control procedures and the component of the initial screening time in the total work time of cytotechnologists.
  
  
  CONCLUSIONS
  Although PAPNET is time saving as compared with conventional microscopy, the associated reduction in personnel costs is outweighed by the costs of scanning the slides and additional equipment. This conclusion holds under a variety of assumptions. Using PAPNET instead of conventional microscopy as a primary screening tool will make cervical cancer screening less cost-effective unless the costs of PAPNET are considerably reduced and its sensitivity and/or specificity are considerably improved.
authors.affiliation: Department of Public Health, Faculty of Medicine, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands. meerding@mgz.fgg.eur.nl
authors.forename: W J
authors.initials: WJ
authors.lastname: Meerding
authors.forename: H
authors.initials: H
authors.lastname: Doornewaard
authors.forename: M
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: A
authors.initials: A
authors.lastname: Bos
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: J G
authors.initials: JG
authors.lastname: van den Tweel
authors.forename: Y T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: J D
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016571:Neural Networks, Computer; D065006:Papanicolaou Test; D012680:Sensitivity and Specificity; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000473:pathology*; D014626:Vaginal Smears / Q000191:economics*