The cost-effectiveness of cervical screening in Australia: what is the impact of screening at different intervals or over a different age range?
OBJECTIVE
To estimate the cost-effectiveness of altering the currently recommended interval and age range for cervical screening of Australian women.


METHODS
The cost and effectiveness estimates of alternative screening strategies were generated using an established decision model. This model incorporated a Markov model (of the natural history of cervical cancer and pre-cancerous lesions) and decision trees which: 'mapped' the various pathways to cervical cancer screening; the follow-up of abnormal Pap test results; and the management of confirmed lesions. The model simulated a hypothetical large cohort of Australian women from age 15 to age 85 and calculated the accumulated costs and life-years under each screening strategy.


RESULTS
Our model estimated that moving from the current two-yearly screening strategy to annual screening (over the same age range) would cost $379,300 per additional life-year saved. Moving from the current strategy to three-yearly screening would yield $117,100 of savings per life-year lost (costs and effects both discounted at 5% per year), with a relatively modest (<5%) reduction in the total number of life-years saved by the program.


CONCLUSIONS
Although moving to annual screening would save some additional lives, it is not a cost-effective strategy. Consideration should be given to increasing the recommended interval for cervical screening. However, the net value of any such shift to less effective (e.g. less frequent) and less costly screening strategies will require better evidence about the cost-effectiveness of strategies that encourage non-screeners or irregular screeners to have a Pap test more regularly.
Anderson
Rob
R
Peninsula Technology Assessment Group (PenTAG) and Institute for Health Services Research, Peninsula Medical School, Universities of Exeter and Plymouth, United Kingdom. Rob.Anderson@PenTAG.nhs.uk
Haas
Marion
M
Shanahan
Marian
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015397:Program Evaluation; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics