title: A systematic review of economic aspects of cervical cancer screening strategies worldwide: discrepancy between economic analysis and policymaking.
abstract: BACKGROUND
  Organized cervical screening has decreased the incidence of cervical cancer. However, screening strategies vary in different countries.
  
  
  OBJECTIVE
  We performed a systematic review to evaluate the economic aspects of different screening methods.
  
  
  METHODS
  We searched databases and then data were abstracted from each study. We evaluated articles based on different types of screening tests as well as screening age and intervals, and using incremental cost effectiveness ratio via calculating quality adjusted life years (QALY), or life years gained (LYG) per cost. We compared the incremental cost-effectiveness ratio (ICER) of each study using GDP per capita. Furthermore, we compared national guidelines with recommendations of cost- effectiveness studies in different countries.
  
  
  RESULTS
  A total of 21 articles met our criteria, of which 19 studies showed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at least a 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines did not match the recommendations of the cost-effectiveness studies.
  
  
  CONCLUSIONS
  HPV testing, starting at age 30 years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closer collaboration with health economists is required during guideline development.
authors.affiliation: Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran E-mail : baratimarnani@gmail.com, kzendeh@tums.ac.ir.
authors.forename: Azin
authors.initials: A
authors.lastname: Nahvijou
authors.forename: Maryam
authors.initials: M
authors.lastname: Hadji
authors.forename: Ahmad Barati
authors.initials: AB
authors.lastname: Marnani
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Tourang
authors.forename: Neda
authors.initials: N
authors.lastname: Bayat
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.forename: Rajabali
authors.initials: R
authors.lastname: Daroudi
authors.forename: Ali Akbari
authors.initials: AA
authors.lastname: Sari
authors.forename: Kazem
authors.initials: K
authors.lastname: Zendehdel
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006291:Health Policy / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000517:prevention & control