title: Cost-effectiveness analysis of cervical cancer screening strategies based on the Papanicolaou smear test in Korea.
abstract: BACKGROUND
  Despite the increasing number of screening examinations performed for cervical cancer utilizing the Papanicolaou smear test (Pap test), few studies have examined whether this strategy is cost-effective in Korea.
  
  
  OBJECTIVE
  This study was conducted to evaluate the cost-effectiveness of cervical cancer screening strategies incorporating the Pap test based on age at the start and end of screening as well as screening interval.
  
  
  METHODS
  We designed four alternative screening strategies based on patient age when screening was started (20 or 30 years) and discontinued (lifetime, 79 years). Each strategy was assessed at screening intervals of 1, 2, 3, or 5 years. A Markov model was developed to determine the cost-effectiveness of the 16 possible cervical cancer screening strategies, and this was evaluated from a societal perspective. The main outcome measures were average lifetime cost, incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Compared with various strategies comprising younger starting age, discontinuation age, and longer screening intervals, strategies employing annual screening for cervical cancer starting at a target age of 30 years and above were the most cost-effective, with an ICER of 21,012.98 dollars per QALY gained (with a Korean threshold of 30,000,000 KRW or US$27,272).
  
  
  CONCLUSIONS
  We found that annual screening for cervical cancer beginning at a target age of 30 years and above is most cost-effective screening strategy. Considering the potential economic advantages, more intense screening policies for cervical cancer might be favorable among countries with high rates of cervical cancer and relatively low screening costs.
authors.affiliation: Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea E-mail : jklee38@korea.ac.kr, jklee38@gmail.com.
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Ko
authors.forename: Jimin
authors.initials: J
authors.lastname: Kim
authors.forename: Younhee
authors.initials: Y
authors.lastname: Kim
authors.forename: Yoon Jae
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sung Ran
authors.initials: SR
authors.lastname: Hong
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D065006:Papanicolaou Test / Q000191:economics*; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics* / Q000821:virology; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D056910:Republic of Korea; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000821:virology; D014626:Vaginal Smears / Q000191:economics*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics* / Q000821:virology