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Increasing cervical cancer screening intervals is cost-effective for women with three consecutive normal Pap smears

Screening women for cervical cancer can be cost-effectively done every 2 to 3 years, instead of every year, once women over the age of 30 have had three or more normal Pap smear tests, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS07373). Despite clinical guidelines to do this, many physicians continue to screen these women each year.

Researchers found the most cost-effective strategies for cervical cancer screening involved screening previously unscreened women younger than 30 years of age every 2 or 3 years and those 30 years of age and older with three consecutive normal Pap smears every 3 years. For women aged 30-44 years with no prior Pap 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 three or more prior normal Pap tests, incremental cost-effectiveness ratios for the same measures were much higher, ranging from $60,029 to $709,067 per life-year saved.

These findings were based on a cost-effectiveness model along with data on prevalence of cervical cancer in a large national sample of diverse women enrolled in a national trial. The researchers grouped women according to age at the final Pap test (age less than 30, 30-44, 45-49, and 60-65 years) and by screening history (zero, one, two, and three or more consecutive prior normal Pap tests) to estimate cost per life-year and quality-adjusted life-year associated with annual, biennial, and triennial screening.

More details are in "Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal Pap tests," by Shalini L. Kulasingam, Ph.D., Evan R. Myers, M.D., M.P.H., Herschel W. Lawson, M.D., and others, in the February 2006 Obstetrics & Gynecology 107(2), pp. 321-328.

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