title: Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice: A Cost-Effectiveness Analysis.
abstract: BACKGROUND
  Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of nonadherence in the screening process compared with recommended guidelines are uncertain.
  
  
  OBJECTIVE
  To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements.
  
  
  METHODS
  Model-based cost-effectiveness analysis.
  
  
  METHODS
  New Mexico HPV Pap Registry; medical literature.
  
  
  METHODS
  Cohort of women eligible for routine screening.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  Current cervical cancer screening practice; improved adherence to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals.
  
  
  METHODS
  Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios, and incremental net monetary benefits (INMBs).
  
  
  RESULTS
  Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect adherence to screening every 3 years with cytologic testing and adherence to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1645.
  
  
  RESULTS
  Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds.
  
  
  CONCLUSIONS
  The effect of human papillomavirus vaccination was not considered.
  
  
  CONCLUSIONS
  The added health benefit of improving adherence to guidelines, especially the 3-year interval for cytologic screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice.
  
  
  BACKGROUND
  U.S. National Cancer Institute.
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Nicole G
authors.initials: NG
authors.lastname: Campos
authors.forename: Stephen
authors.initials: S
authors.lastname: Sy
authors.forename: Emily A
authors.initials: EA
authors.lastname: Burger
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: William C
authors.initials: WC
authors.lastname: Hunt
authors.forename: Alan
authors.initials: A
authors.lastname: Waxman
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D012042:Registries; D012307:Risk Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000821:virology