Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests

Shalini L. Kulasingam, Evan R. Myers, Herschel W. Lawson, K. John McConnell, Karla Kerlikowske, Joy Melnikow, A. Eugene Washington, George F. Sawaya

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

OBJECTIVE: Annual cervical cancer screening in women with many prior normal Pap tests is common despite limited evidence on the cost-effectiveness of this strategy. We estimated the cost-effectiveness of screening women with 3 or more prior normal tests compared with screening those with no prior tests. METHODS: We used a validated cost-effectiveness model in conjunction with data on the prevalence of biopsy-proven cervical neoplasia in women enrolled in the Centers for Disease Control and Prevention National Breast and Cervical Cancer Early Detection Program. Women were grouped according to age at the final Program Pap test (aged < 30, 30-44, 45-59, and 60-65 years) and by screening history (0, 1, 2, and 3+ consecutive prior normal Program tests) to estimate cost per life-year and quality-adjusted life-year associated with annual, biennial, and triennial screening. RESULTS: For women aged 30-44 years with no prior tests, incremental cost-effectiveness ratios ranged from $20,533 for screening triennially (compared with no further screening) to $331,837 for screening annually (compared with biennially) per life-year saved. Among same-aged women with 3 or more prior normal Program tests, incremental cost-effectiveness ratios for the same measures ranged from $60,029 to $709,067 per life-year saved. Inclusion of the most conservative utility estimates resulted in incremental cost-effectiveness ratios in excess of $100,000 per quality-adjusted life-year saved associated with annual screening of same-aged women with 3 or more prior normal tests compared with biennial screening. CONCLUSION: As the number of prior normal Pap tests increases, the costs per life-year saved increase substantially. Resources should be prioritized for screening those never or rarely screened women.

Original languageEnglish (US)
Pages (from-to)321-328
Number of pages8
JournalObstetrics and Gynecology
Volume107
Issue number2 I
DOIs
StatePublished - Feb 2006

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Papanicolaou Test
Early Detection of Cancer
Uterine Cervical Neoplasms
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Centers for Disease Control and Prevention (U.S.)
History
Quality of Life
Breast Neoplasms
Biopsy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Kulasingam, S. L., Myers, E. R., Lawson, H. W., McConnell, K. J., Kerlikowske, K., Melnikow, J., ... Sawaya, G. F. (2006). Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests. Obstetrics and Gynecology, 107(2 I), 321-328. https://doi.org/10.1097/01.AOG.0000196500.50044.ce

Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests. / Kulasingam, Shalini L.; Myers, Evan R.; Lawson, Herschel W.; McConnell, K. John; Kerlikowske, Karla; Melnikow, Joy; Washington, A. Eugene; Sawaya, George F.

In: Obstetrics and Gynecology, Vol. 107, No. 2 I, 02.2006, p. 321-328.

Research output: Contribution to journalArticle

Kulasingam, SL, Myers, ER, Lawson, HW, McConnell, KJ, Kerlikowske, K, Melnikow, J, Washington, AE & Sawaya, GF 2006, 'Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests', Obstetrics and Gynecology, vol. 107, no. 2 I, pp. 321-328. https://doi.org/10.1097/01.AOG.0000196500.50044.ce
Kulasingam, Shalini L. ; Myers, Evan R. ; Lawson, Herschel W. ; McConnell, K. John ; Kerlikowske, Karla ; Melnikow, Joy ; Washington, A. Eugene ; Sawaya, George F. / Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests. In: Obstetrics and Gynecology. 2006 ; Vol. 107, No. 2 I. pp. 321-328.
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AB - OBJECTIVE: Annual cervical cancer screening in women with many prior normal Pap tests is common despite limited evidence on the cost-effectiveness of this strategy. We estimated the cost-effectiveness of screening women with 3 or more prior normal tests compared with screening those with no prior tests. METHODS: We used a validated cost-effectiveness model in conjunction with data on the prevalence of biopsy-proven cervical neoplasia in women enrolled in the Centers for Disease Control and Prevention National Breast and Cervical Cancer Early Detection Program. Women were grouped according to age at the final Program Pap test (aged < 30, 30-44, 45-59, and 60-65 years) and by screening history (0, 1, 2, and 3+ consecutive prior normal Program tests) to estimate cost per life-year and quality-adjusted life-year associated with annual, biennial, and triennial screening. RESULTS: For women aged 30-44 years with no prior tests, incremental cost-effectiveness ratios ranged from $20,533 for screening triennially (compared with no further screening) to $331,837 for screening annually (compared with biennially) per life-year saved. Among same-aged women with 3 or more prior normal Program tests, incremental cost-effectiveness ratios for the same measures ranged from $60,029 to $709,067 per life-year saved. Inclusion of the most conservative utility estimates resulted in incremental cost-effectiveness ratios in excess of $100,000 per quality-adjusted life-year saved associated with annual screening of same-aged women with 3 or more prior normal tests compared with biennial screening. CONCLUSION: As the number of prior normal Pap tests increases, the costs per life-year saved increase substantially. Resources should be prioritized for screening those never or rarely screened women.

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