title: Strategic Distributional Cost-Effectiveness Analysis for Improving National Cancer Screening Uptake in Cervical Cancer: A Focus on Regional Inequality in South Korea.
abstract: OBJECTIVE
  The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities.
  
  
  METHODS
  Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio.
  
  
  RESULTS
  All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the 'strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis.
  
  
  CONCLUSIONS
  The 'strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.|Institute of Health Services Research, Yonsei University, Seoul, Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.|Institute of Health Services Research, Yonsei University, Seoul, Korea.
authors.forename: Woorim
authors.initials: W
authors.lastname: Kim
authors.affiliation: Institute of Health Services Research, Yonsei University, Seoul, Korea.|Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jaeyong
authors.initials: J
authors.lastname: Shin
authors.affiliation: Institute of Health Services Research, Yonsei University, Seoul, Korea.|Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.affiliation: Institute of Health Services Research, Yonsei University, Seoul, Korea.|Graduate School of Public Heath, Yonsei University, Seoul, Korea.
authors.forename: Sohee
authors.initials: S
authors.lastname: Park
authors.affiliation: Institute of Health Services Research, Yonsei University, Seoul, Korea.|Graduate School of Public Heath, Yonsei University, Seoul, Korea.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D056910:Republic of Korea; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000473:pathology; D055815:Young Adult
keywords: Cost-benefit analysis; Distributional cost effectiveness analysis; Healthcare disparities; National cervical cancer screening; Screening uptake regional disparities