Clinical and cost implications of new technologies for cervical cancer screening: The impact of test sensitivity

Objective: To compare the available techniques for cervical cancer screenin g, including several new technologies, using actual program utilization pat terns. Study Design: Longitudinal cohort model. Patients and Methods: The model followed a cohort of 100,000 women who unde rwent screening from age 20 through 65 years. The model was run with a weig hted average of screening intervals to model the actual utilization of the cervical cancer screening program in the United States. Results: The model demonstrated that new technologies with significantly in creased test sensitivity have the potential to reduce the number of cancers by 45% to 60% depending on the screening frequency in fully compliant popu lations. At screening intervals of 2 years or more, these new technologies had cost-effectiveness ratios below $50,000 per life-year saved. Assuming e xisting utilization patterns, the model predicted there would be 13.2 cance rs per year in the 100,000 women screened with the conventional Pap smear, and new technologies with increased test sensitivity could reduce the annua l incidence to 9.5 cancers per 100,000 women screened. Conclusions: The model suggests that to achieve further dramatic reduction in cervical cancer mortality, significant improvements in test sensitivity, as reflected in the new screening technologies, may be the most realistic and cost-effective approach.