Cost-effectiveness of pap smear screening for vaginal cancer after total hysterectomy for benign disease.
OBJECTIVE
To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease.


METHODS
Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy.


RESULTS
Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening.


CONCLUSIONS
Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not cost effective.
Fetters
Michael D
MD
Departments of Family Medicine, University of Michigan Health System, Ann Arbor, MI 48109-0708, USA. mfetters@umich.edu
Lieberman
Richard W
RW
Abrahamse
Paul H
PH
Sanghvi
Rupal V
RV
Sonnad
Seema S
SS