Cost-effectiveness of a cervical cancer screening programme in the Algarve region, Portugal

Abstract

Background: Economic evaluation of health care is an instrument of support to decision-making in the allocation of resources between different options. The current study was conducted with a view to implement an organised mass-screening programme. The objective was to evaluate the cost-effectiveness of three options: two programmes to be implemented that are called Pap screening and Thin-prep screening, and the strategy currently in place called Spontaneous screening. Methods: The analysis was undertaken from the Health Care System perspective. The analytic horizon was 10 years. Direct medical costs were estimated and discounted at a rate of 5 %. Effectiveness was estimated as number of preinvasive carcinomas detected and life years gained. The cost-effectiveness ratio was estimated for the three options and incremental cost-effectiveness was estimated by comparison of the options to be implemented with the current strategy. A sensitivity analysis was conducted on the key variables. Results: The average cost per carcinoma detected was 1,199 euros with Pap screening, 3,148 euros with spontaneous screening and 4,619 euros with Thin-prep screening. The average cost per life year gained was 29 euros with Pap screening, 77 euros with Spontaneous screening and 114 euros with Thin-prep screening. Pap screening had an additional cost of 623 euros per additional carcinoma detected and 15 euros per additional life year gained. Thin-prep screening had an additional cost of 6,350 euros per additional carcinoma detected and 156 euros per additional life year gained. Conclusions: Pap screening had the best cost-effectiveness relation and the lowest additional cost-effectiveness.