title: Cost-effectiveness analysis of human papillomavirus DNA testing and Pap smear for cervical cancer screening in a publicly financed health-care system.
abstract: OBJECTIVE
  to evaluate the long-term cost-effectiveness of different strategies for human papillomavirus (HPV) DNA testing combined with Pap smear for cervical cancer screening in Taiwan.
  
  
  METHODS
  this study adopts a perspective of Department of Health in cost-effectiveness analysis to compare a no-screening strategy with nine different screening strategies. These strategies comprise three screening tools (Pap smear alone, HPV DNA testing followed by Pap smear triage, and HPV DNA testing combined with Pap smear), and three screening intervals (annually, every 3 years, and every 5 years). Outcomes are life expectancy, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Probabilistic sensitivity analyses (PSAs) were conducted to assess parameter uncertainty.
  
  
  RESULTS
  when three times gross domestic product per capita is used as the decision threshold, all nine screening strategies were cost-effective compared with the no-screening strategy. Compared with the current screening strategy (an annual Pap smear), HPV DNA testing followed by Pap smear triage every 5 years and every 3 years were cost-effective. Results of PSA also indicated that a HPV DNA testing followed by Pap smear triage every 5 or every 3 years achieved the highest expected net benefits.
  
  
  CONCLUSIONS
  possible economic advantages are associated with extending the cervical cancer screening interval from one Pap smear annually to HPV DNA testing followed by Pap smear triage every 5 years with an ICER $1 247 000 per QALY gained, especially in a country with a publicly financed health-care system.
authors.affiliation: School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
authors.forename: I H-I
authors.initials: IH
authors.lastname: Chow
authors.forename: C-H
authors.initials: CH
authors.lastname: Tang
authors.forename: S-L
authors.initials: SL
authors.lastname: You
authors.forename: C-H
authors.initials: CH
authors.lastname: Liao
authors.forename: T-Y
authors.initials: TY
authors.lastname: Chu
authors.forename: C-J
authors.initials: CJ
authors.lastname: Chen
authors.forename: C-A
authors.initials: CA
authors.lastname: Chen
authors.forename: R-F
authors.initials: RF
authors.lastname: Pwu
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000032:analysis*; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009313:National Health Programs; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D019057:Quality-Adjusted Life Years; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality; D014626:Vaginal Smears / Q000191:economics*
chemical_list: D004279:DNA, Viral