Early withdrawal from cervical cancer screening: the question of cost-effectiveness

In countries such as the UK, mass population screening for cervical cancer has been undertaken since the 1960s. Although of established effectiveness, no formal evaluation of the screening protocol was carried out prior to it s implementation. On the basis of a published mathematical modelling exerci se, it has been speculated that withdrawing women from the screening progra mme at an earlier age than at present, whilst leading to a higher rate of i nvasive cervical cancer (ICC), could reduce resource use. Using estimates o f screening and treatment costs, and of expected life-years lost following earlier withdrawal, we simulated cost-effectiveness ratios for various scen arios described by the model. Median cost savings resulting from a life-yea r lost never exceeded pound 10 000 for any scenario, although the estimates were particularly sensitive to the assumed age at cancer presentation and the rate of cancer progression. Our findings seem to offer little economic support for the early withdrawal of subjects from the cervical screening pr ogramme. (C) 2001 Elsevier Science Ltd. All rights reserved.