Cost-effectiveness of the conventional Papanicolaou test with a new adjunct to cytological screening for squamous cell carcinoma of the uterine cervix and its precursors

Objective: To estimate costs and outcomes of conventional annual Papanicola ou (Pap) test screening compared with biennial Pap test plus speculoscopy ( PPS) screening for cervical neoplasms. Design: A Markov model compared cost-effectiveness and outcomes of annual P ap tests with biennial PPS. The model includes direct costs of screening, d iagnostic testing, and treatment for squamous intraepitheial lesions and in vasive cancers; indirect costs (eg, lost productivity because of cervical c ancer); and newer management practices, including human papillomavirus DNA testing. Patients: Women aged 18 to 64 years. Intervention: Screening for cervical neoplasms with either annual Pap smear test or biennial PPS. Main Outcome Measure: Marginal cost per life-year gained. Results: The probability of women having squamous intraepithelial lesions, cervical cancer, or death from cervical cancer was lower among women underg oing PPS biennially. A total of 12 additional days of life per woman was ga ined with biennial PPS during the 47-year model period. Total average cumul ative direct medical costs per patient were $1419 for biennial PPS compared with $1489 for annual Pap tests. Total costs, including direct medical cos ts and indirect costs, were $2185 for PPS compared with $3179 for Pap tests alone. Increased savings and patient outcomes were observed in high-risk p opulations. Conclusion: Our simulations indicate that biennial screening with PPS is ex pected to provide cost savings for women older than 18 years compared with annual Pap test screening, especially for those in high-risk populations.