Impact of increasing Papanicolaou test sensitivity and compliance: A modeled cost and outcomes analysis

Objective: To model the impact of increasing screening compliance or implem enting liquid-based cytology in populations with known compliance patterns and risk profiles on rates of detection of cervical precancers. Methods: An adaptation of a time-varying Markov model was used to follow a theoretic cohort of 100,000 women from age 20 through age 80. Separate anal yses of all women, white, and black women were completed using three compli ance rates (self-reported, Healthy People 2000, and Healthy People 2010 com pliance) and two Papanicolaou test sensitivities (conventional Papanicolaou smear and liquid-based cytology). Results: All populations benefited from both increased compliance and liqui d-based cytology use. Increasing compliance to Healthy People 2010 goals re sulted in 23%, 21.7%, and 17% reductions in cervical cancer incidence for a ll women, white, and black women, respectively. Substituting liquid-based c ytology for traditional Papanicolaou smear collection and processing with n o change in compliance resulted in 32%, 32%, and 33% reductions in cervical cancer incidence for the same three subpopulations. In addition, cost-effe ctiveness of the liquid-based technology indirectly related to the risk pro file of the population: for black women, the cost-effectiveness ratio was $ 10,335 per life year saved, whereas for white women, the ratio was $17,967 per life year saved. Conclusion: Using liquid-based cytology in all populations would be cost-ef fective in improving outcomes from cervical cancer. In high-risk population s, this new technology may represent the most cost-effective approach to im prove cervical cancer outcomes, (Obstet Gynecol 2001; 97:781-8. (C) 2001 by The American College of Obstetricians and Gynecologists.).