title: Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests.
abstract: OBJECTIVE
  Annual cervical cancer screening in women with many prior normal Pap tests is common despite limited evidence on the cost-effectiveness of this strategy. We estimated the cost-effectiveness of screening women with 3 or more prior normal tests compared with screening those with no prior tests.
  
  
  METHODS
  We used a validated cost-effectiveness model in conjunction with data on the prevalence of biopsy-proven cervical neoplasia in women enrolled in the Centers for Disease Control and Prevention National Breast and Cervical Cancer Early Detection Program. Women were grouped according to age at the final Program Pap test (aged < 30, 30-44, 45-59, and 60-65 years) and by screening history (0, 1, 2, and 3+ consecutive prior normal Program tests) to estimate cost per life-year and quality-adjusted life-year associated with annual, biennial, and triennial screening.
  
  
  RESULTS
  For women aged 30-44 years with no prior tests, incremental cost-effectiveness ratios ranged from 20,533 US dollars for screening triennially (compared with no further screening) to 331,837 US dollars for screening annually (compared with biennially) per life-year saved. Among same-aged women with 3 or more prior normal Program tests, incremental cost-effectiveness ratios for the same measures ranged from 60,029 US dollars to 709,067 US dollars per life-year saved. Inclusion of the most conservative utility estimates resulted in incremental cost-effectiveness ratios in excess of 100,000 US dollars per quality-adjusted life-year saved associated with annual screening of same-aged women with 3 or more prior normal tests compared with biennial screening.
  
  
  CONCLUSIONS
  As the number of prior normal Pap tests increases, the costs per life-year saved increase substantially. Resources should be prioritized for screening those never or rarely screened women.
  
  
  METHODS
  II-2.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA. kulas002@mc.duke.edu
authors.forename: Shalini L
authors.initials: SL
authors.lastname: Kulasingam
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.forename: Herschel W
authors.initials: HW
authors.lastname: Lawson
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Joy
authors.initials: J
authors.lastname: Melnikow
authors.forename: A Eugene
authors.initials: AE
authors.lastname: Washington
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D014626:Vaginal Smears / Q000191:economics* / Q000706:statistics & numerical data*