Cost Effectiveness

An analysis by Montz et al., published in the May 2001 issue of Obstetrics & Gynecology¹, addresses the issue of improved diagnostic sensitivity versus increased compliance related to cervical cancer screening. The study, "Impact of increasing Papanicolaou test sensitivity and compliance: A modeled cost and outcomes analysis," concludes that combining the use of the ThinPrep® Pap Test with increased compliance would be more cost-effective at decreasing cervical cancer incidence than increasing the present rates of screening using the conventional Pap smear.

The study used an adaptation of a time-varying, Markov model to follow a theoretic cohort of 100,000 women from age 20 through age 80. Separate analyses of all women, white women, and African American women, were completed utilizing three compliance rates (self reported, Healthy People 2000, and Healthy People 2010 compliance) and two Pap test sensitivities (conventional Pap smear and liquid-based cytology).

All populations benefited from both increased compliance and liquid-based cytology utilization. Increasing compliance to Healthy People 2010 goals resulted in 23%, 22%, and 17% reductions in cervical cancer incidence for all women, white women, and African American women, respectively. Substituting liquid-based cytology for conventional Pap smear collection and processing with no change in compliance resulted in 32%, 32%, and 33% reductions in cervical cancer incidence for the same three sub-populations.

In addition, cost-effectiveness of the liquid-based technology indirectly related to the risk profile of the population; for African American women, the cost-effectiveness ratio was $10,335/life year saved, while for white women, the ratio was $17,967/life year saved.

The authors concluded, "The use of liquid-based cytology in conjunction with increased compliance may provide a more cost-effective approach than increasing compliance alone. Therefore, the choice of increasing compliance versus using liquid-based cytology is an artificial distinction. Efforts should be made to use both approaches in parallel."