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.
Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
Jane J
JJ
Kim
Gabriel M
GM
Leung
Pauline P S
PP
Woo
Sue J
SJ
Goldie
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*