Cost-effectiveness of organized versus opportunistic cervical cytology screening in Hong Kong.
BACKGROUND
To assess the cost-effectiveness of alternative cervical cancer screening strategies to inform the design and implementation of a government-sponsored population-based screening programme in Hong Kong.


METHODS
Cost-effectiveness analysis using a computer-based model of cervical carcinogenesis was performed. Strategies included no screening, opportunistic screening (status quo), organized screening using either conventional or liquid-based cytology conducted at different frequencies. The main outcome measures were cancer incidence reduction, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios. Data were from local hospitals and laboratories, clinical trials, prospective studies and other published literature.


RESULTS
Compared with no screening, a simulation of the current situation of opportunistic screening using cervical cytology produced a nearly 40 per cent reduction in the lifetime risk of cervical cancer. However, with organized screening every 3, 4 and 5 years, corresponding reductions with conventional (and liquid-based) cytology were 90.4 (92.9), 86.8 (90.2) and 83.2 per cent (87.3 per cent) compared with no screening. For all cytology-based screening strategies, opportunistic screening was more costly and less effective than an organized programme of screening every 3, 4 and 5 years. Every 3-, 4- and 5-year screening cost $12,300, $7100 and $800 per YLS, each compared with the next best alternative.


CONCLUSIONS
Compared with the status quo of opportunistic screening, adopting a policy of organized, mass cervical screening in Hong Kong can substantially increase benefits and reduce costs.
Kim
Jane J
JJ
Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
Leung
Gabriel M
GM
Woo
Pauline P S
PP
Goldie
Sue J
SJ
D000206:Actuarial Analysis; D000328:Adult; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*