A cost-benefit analysis of colposcopy for cervical squamous intraepithelial lesions found on Papanicolaou smear
M. J. Chesebro and W. D. Everett
Family Practice Program, University of Alabama, School of Medicine, Huntsville, USA.
BACKGROUND: We performed a cost-benefit analysis of a protocol for studying
patients with squamous intraepithelial lesions (SIL) on Papanicolaou smears
to determine whether it compared favorably with resources spent on other
health programs for screening and treatment. METHODS: During a 3-year
period, 424 patients with dysplastic Papanicolaou smears were examined,
studied by biopsy, and treated. We calculated costs based on a model
protocol and derived a cost per year of life saved for preventing death
from invasive cervical carcinoma. A sensitivity analysis was performed on
selected assumptions of the analysis. RESULTS: The marginal, or
incremental, cost of colposcopic evaluation and treatment of Papanicolaou
smears with low-grade SIL, high-grade SIL (moderate), and high-grade SIL
(severe), depending on assumptions, ranged from $406 to $5746, $160 to
$2263, and $85 to $1197 per year of life saved, respectively. Depending on
the assumption of the rate of Papanicolaou smears with SIL in the screened
population being 1.8%, 5.1%, or 11.5%, the estimated total cost of
screening and treating the referral base was $1.3 million, $538,126, and
$307,037, respectively. This results in the average cost per year of life
saved to screen and treat low-grade SIL, high-grade SIL (moderate), and
high-grade SIL (severe) to be $1105 to $68,909, $375 to $21,673, and $177
to $8831, respectively. CONCLUSIONS: Both marginal cost and average
screening costs of evaluating and treating abnormal Papanicolaou smears by
the protocol described in this article compare favorably with costs per
year of life saved for other health care screening and treatment strategies
for many assumptions. The marginal cost to perform colposcopy on patients
with a Papanicolaou smear with low-grade SIL is so low that it is
relatively a very effective strategy.
