Overview of important cervical cancer screening process values in EuropeanUnion (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness

The objective was the evaluation of the (cost-)effectiveness of cervical ca ncer screening in the European Union (EU) countries. Data were collected on recommended screening age ranges and intervals, coverage, proportion of no n-negative smears and smear use, Estimates reported by representatives of e ach participating Member State were compared, and used as input for model b ased on (using the MISCAN simulation model for cancer screening) effectiven ess and cost-effectiveness calculations. Differences in coverage from below 50 to 82% resulted in more or less proportional differences in expected pe rcentage life-years lost reduction, almost regardless of differences in 7-5 0+ smears recommended in a lifetime. Differences in screening intensity (re sulting from the recommended number of smears per lifetime and the number o f excess smears on top of these recommendations) resulted in more than 2-fo ld difference in the expected number of smears per percentage life-years lo st reduction. (Cost-)effectiveness predictions would have greatly improved if estimates of long-term coverage had also been available. To conclude, es timates for a restricted set of well defined parameters - a few for short a nd long-term coverage and one for the total number of smears - are quite us eful for country-specific (cost-)effectiveness evaluations. The main, and t o some extent, unsolvable problem for further improvement of the analysis i s the lack. of reliable country-specific estimates for the background risk of cervical cancer in women eligible for screening in the near future. (C) 2000 Elsevier Science Ltd. All rights reserved.