The Cost-effectiveness of Cervical Cancer Screening for Low-Income Elderly Women

Abstract

Controversy surrounds prevention policy for the elderly. While some cost-effectiveness analyses have been done for the general elderly population, to our knowledge no study has examined the provision of preventive services to a low-income elderly population. We conducted a study of the cost-effectiveness of a cervical cancer screening program for infrequently screened elderly women attending an urban municipal hospital clinic. The results of Papanicolaou testing were abnormal (malignant or premalignant) in 11 of 816 women screened. This early detection of cervical neoplasia saved +5907 and 3.7 years of life per 100 Papanicolaou tests. When average medical costs per year of life extended by screening were included, the program cost +2874 per year of life saved. Comprehensive sensitivity analyses performed on competing medical and economic points of view did not change the conclusion of a favorable cost-effectiveness ratio for screening. Our findings indicate that the benefits from some prevention programs for the elderly can offset the costs of these programs. More research is needed to guide public policy on prevention for selected population groups.

Cost-effectiveness analysis.

“…A similar measure was adopted by Mandelblatt and Fahs, who reported that the early detection of cervical cancer through Pap tests saved 3-7 years of life per 100 tests and represented a cost of $2874 per life year saved. 4 Oster and Epstein also used years of life saved as a measure of effectiveness in their study of antihyperlipaemic therapy in the prevention of coronary heart disease.5…”

Is Cost-Effectiveness Analysis Unfair?

“…5 Consider the example of the Pap smear. CEA has shown that a onetime Pap smear for elderly African American women saves money, 6 whereas the annual Pap smears that are the standard for well-insured women cost-in today's dollars-more than $2 million per life year compared with less frequent screening. 7 If CEAs were used to allocate resources, the annual Pap smear would be a thing of the past, and women who rarely or never receive Pap smears would get them at least every 5 years.…”