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Impact of Increasing Papanicolaou Test Sensitivity and Compliance: A Modeled Cost and Outcomes Analysis

From the Kelly Gynecologic Oncology Service, The Johns Hopkins Hospital and Medical Institutions, Baltimore, Maryland.

Address reprint requests to: F. J. Montz, MD, KM The Kelly Gynecologic Oncology Service Departments of Obstetrics and Gynecology, and Oncology The Johns Hopkins Hospital and Medical Institutions 600 North Wolfe Street, Phipps 248 Baltimore, MD 21287-1248 E-mail: fmontz{at}jhmi.edu

Objective: To model the impact of increasing screening compliance or implementing 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 analyses of all women, white, and black women were completed using three compliance rates (self-reported, Healthy People 2000, and Healthy People 2010 compliance) and two Papanicolaou test sensitivities (conventional Papanicolaou smear and liquid-based cytology).

Results: All populations benefited from both increased compliance and liquid-based cytology use. Increasing compliance to Healthy People 2010 goals resulted in 23%, 21.7%, and 17% reductions in cervical cancer incidence for all women, white, and black women, respectively. Substituting liquid-based cytology for traditional Papanicolaou smear collection and processing with no change in compliance resulted in 32%, 32%, and 33% reductions in cervical cancer incidence for the same three subpopulations. In addition, cost-effectiveness of the liquid-based technology indirectly related to the risk profile 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-effective in improving outcomes from cervical cancer. In high-risk populations, this new technology may represent the most cost-effective approach to improve cervical cancer outcomes.

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