EVALUATION OF COSTS AND BENEFITS OF ADVANCES IN CYTOLOGIC TECHNOLOGY - IAC TASK-FORCE SUMMARY

Issues Uterine cervical cytology smears are among the most cost-effect ive cancer prevention interventions available, but they are not infall ible, and new or mollified technologies have been and will be proposed to improve diagnostic accuracy. Before these new technologies are acc epted, their performance attributes will be carefully studied and defi ned. Equally important in this era of fiscal constraints are cost/bene fit analyses, certain guidelines. Consensus Position In an effort to c ontrol rising costs in the health care sector, there has been a strong incentive to move toward a market system, and a variety of forces are acting to drive down expenditures. These same pressures will continue to be brought to bear on the providers of cervical cytology services. It must be emphasized that the technical knowledge required to define cost-effective medical practice lies within the medical profession it self, which must recognize the following: (a) Resources are finite; (b ) Elimination of fraud, abuse and waste is not enough to bring health care expenditures down to levels considered acceptable to government a nd business; (c) The medical profession must take the responsibility t o identify the health and economic consequences of the services it pro vides and make wise recommendations for allocation of resources to opt imize health consequences. The analysis of costs and benefits must be viewed from a societal perspective and presented in terms of the margi nal impact on current practice. This does not mean that new technologi es must reduce cost; on the contrary, improvements in health can be ex pected to come at a price, but at a price commensurate with value gain ed in lives saved or in added quality adjusted life years. To be of va lue, a new technology for cervical cytology must be more effective in preventing cervical carcinoma. Dysplasia is considered a precursor of carcinoma, and detection of dysplasia has been a surrogate for prevent ion of cervical carcinoma, but dysplasia does not always lead to carci noma, least of all mild dysplasia, and policy makers ultimately will i nsist that a favorable change in health outcome be effected by new tec hnology before it is allocated resources. Alternatively, new technolog ies may lower cost, perhaps by modifying screening or rescreening proc edures according to known risk; by improved cytopreparatory techniques that simplify, improve or speed screening; or by monitoring devices t hat minimize screening error. In each case the performance attributes of the instrument or human instrument process should be evaluated in t he intended use environment. Ongoing Issues While current cervical cyt ology methodology is one of the most effective means of cancer prevent ion, there continues to be development of new techniques to increase t he sensitivity and specificity of this test. With present fiscal const raints, these will be subject to stringent cost/benefit analyses in wh ich the medical profession must play a key role. Such analyses can be quite complicated, considering the additional costs or cost savings of clinical follow-up procedures and the reliability of dysplasias detec ted by cytology as a surrogate for cervical carcinoma in calculating q uality of life years saved.