Cost-effectiveness of 3 methods to enhance the sensitivity of Papanicolaoutesting

Context ThinPrep, AutoPap, and Papnet are 3 new technologies that increase the sensitivity and cost of cervical cancer screening. Objective To estimate the cost-effectiveness of these technological enhance ments to Papanicolaou (Pap) tests, Design We estimated the increase in sensitivity from using these technologi es by combining results of 8 studies meeting defined criteria. We used publ ished literature and additional sources for cost estimates. To estimate ove rall cost-effectiveness, we applied a 9-state time-varying transition state model to these data and information about specific populations. Setting A hypothetical program serving a cohort of 20- to 65-year-old women who begin screening at the same age and are representative of the US popul ation. Results The new technologies increased life expectancy by 5 hours to 1.6 da ys, varying with the technology and the frequency of screening. All 3 techn ologies also increased the cost per woman screened by $30 to $257 (1996 US dollars). AutoPap dominated ThinPrep in the base case. At each screening in terval, AutoPap increased survival at the lowest cost, The cost per year of life saved rose from $7777 with quadrennial screening to $166 000 with ann ual screening. Papnet produced more life-years at a higher cost per year of life saved. However, when used with triennial screening, each of them prod uced more life-years at lower cost than conventional Pap testing every 2 ye ars. The cost-effectiveness ratio of each technology improved with increase s in the prevalence of disease, decreases in the sensitivity of conventiona l Pap testing, and increases in the improvement in sensitivity produced by the technology. Conclusions Technologies to increase the sensitivity of Pap testing are mor e cost-effective when incorporated into infrequent screening. Increases in sensitivity and de creases in cost may eventually make each technology more cost-effective.