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Cost-effectiveness of Extending Cervical Cancer Screening Intervals Among Women With Prior Normal Pap Tests

From the Departments of ¹Obstetrics, Gynecology and Reproductive Sciences, and ²Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; ³Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; ⁴Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; ⁵General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, California; ⁶Department of Medicine, University of California, San Francisco, San Francisco, California; and ⁷Department of Family and Community Medicine, University of California, Davis, Sacramento, California.

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.

LEVEL OF EVIDENCE: II-2

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