Cost-effectiveness Analysis of Cervical Cancer Screening Strategies Based on the Papanicolaou Smear Test in Korea

Background: Despite the increasing number of screening examinations performed for cervical cancer utilizingthe Papanicolaou smear test (Pap test), few studies have examined whether this strategy is cost-effective in Korea.
Objective: This study was conducted to evaluate the cost-effectiveness of cervical cancer screening strategiesincorporating the Pap test based on age at the start and end of screening as well as screening interval. Materialsand
Methods: We designed four alternative screening strategies based on patient age when screening was started(20 or 30 years) and discontinued (lifetime, 79 years). Each strategy was assessed at screening intervals of 1,2, 3, or 5 years. A Markov model was developed to determine the cost-effectiveness of the 16 possible cervicalcancer screening strategies, and this was evaluated from a societal perspective. The main outcome measures wereaverage lifetime cost, incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio(ICER).
Results: Compared with various strategies comprising younger starting age, discontinuation age, andlonger screening intervals, strategies employing annual screening for cervical cancer starting at a target age of30 years and above were the most cost-effective, with an ICER of 21,012.98 dollars per QALY gained (with aKorean threshold of 30,000,000 KRW or US$27,272).
Conclusions: We found that annual screening for cervicalcancer beginning at a target age of 30 years and above is most cost-effective screening strategy. Considering thepotential economic advantages, more intense screening policies for cervical cancer might be favorable amongcountries with high rates of cervical cancer and relatively low screening costs.