title: Cost--effectiveness of pap smear in Kermanshah, Iran.
abstract: OBJECTIVE
  To determine the incidence of pre invasive and invasive cervical lesions and also cost- effectiveness of Pap smears in Kermanshah, Iran (2004-2007).
  
  
  METHODS
  A descriptive, cross sectional study was performed between March 2004-March 2007 with all cytological smears analyzed according to the Bethesda II system. Efficacy was estimated as the ratio of HSIL and invasive carcinomas detected to all Pap smears. Data were analyzed with SPSS software and mean+/-SD for cost in each age.
  
  
  RESULTS
  148,472 smears were analyzed of which 99.7 % were negative, only 0.3% having cytological abnormalities. ASCUS, LSIL, HSIL and carcinoma positive rates were 205.4, 73.4, 21.6 and 5.4 per 100,000 Pap smears respectively. The incidence of HSIL and carcinoma in total was 26.9 per 100,000 women. Before age 35 there were no such lesions so that the effectiveness of Pap smear before age 35 was zero. The cost for one smear was 5 Euros and the cost for detection per HSIL or carcinoma was 18,559 Euros. The mean age of women for HSIL was 52.0+/-10.7 and for carcinoma 48.1+/-1.81 years.
  
  
  CONCLUSIONS
  Since no HSIL or carcinomas were detected before age 35, and since for changing one LSIL to HSIL or carcinoma should take more than 5 years , the results of this study suggest that Pap smears before 35 years old is not effective and we suggest commencement of Pap smear in Iran from age 30.
authors.affiliation: Kermanshah University of Medical Sciences, Iran.
authors.forename: Fariba Almassi
authors.initials: FA
authors.lastname: Nokiani
authors.forename: Hossein
authors.initials: H
authors.lastname: Akbari
authors.forename: Mansour
authors.initials: M
authors.lastname: Rezaei
authors.forename: Hamid
authors.initials: H
authors.lastname: Madani
authors.forename: Mohsen Emami
authors.initials: ME
authors.lastname: Ale Agha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D002584:Cervix Uteri / Q000473:pathology*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology