RESUMO
OBJECTIVE: To model the impact of increasing screening compliance or implementing liquid-based cytology in populations with known compliance patterns and risk profiles on rates of detection of cervical precancers. METHODS: An adaptation of a time-varying Markov model was used to follow a theoretic cohort of 100,000 women from age 20 through age 80. Separate analyses of all women, white, and black women were completed using three compliance rates (self-reported, Healthy People 2000, and Healthy People 2010 compliance) and two Papanicolaou test sensitivities (conventional Papanicolaou smear and liquid-based cytology). RESULTS: All populations benefited from both increased compliance and liquid-based cytology use. Increasing compliance to Healthy People 2010 goals resulted in 23%, 21.7%, and 17% reductions in cervical cancer incidence for all women, white, and black women, respectively. Substituting liquid-based cytology for traditional Papanicolaou smear collection and processing with no change in compliance resulted in 32%, 32%, and 33% reductions in cervical cancer incidence for the same three subpopulations. In addition, cost-effectiveness of the liquid-based technology indirectly related to the risk profile of the population: for black women, the cost-effectiveness ratio was $10,335 per life year saved, whereas for white women, the ratio was $17,967 per life year saved. CONCLUSION: Using liquid-based cytology in all populations would be cost-effective in improving outcomes from cervical cancer. In high-risk populations, this new technology may represent the most cost-effective approach to improve cervical cancer outcomes.
Assuntos
Modelos Econômicos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Teste de Papanicolaou , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/economia , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Simulação por Computador , Análise Custo-Benefício , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Cooperação do Paciente , Vigilância da População , Medição de Risco , Sensibilidade e Especificidade , Estados UnidosRESUMO
OBJECTIVE: To compare the available techniques for cervical cancer screening, including several new technologies, using actual program utilization patterns. STUDY DESIGN: Longitudinal cohort model. PATIENTS AND METHODS: The model followed a cohort of 100,000 women who underwent screening from age 20 through 65 years. The model was run with a weighted average of screening intervals to model the actual utilization of the cervical cancer screening program in the United States. RESULTS: The model demonstrated that new technologies with significantly increased test sensitivity have the potential to reduce the number of cancers by 45% to 60% depending on the screening frequency in fully compliant populations. At screening intervals of 2 years or more, these new technologies had cost-effectiveness ratios below $50,000 per life-year saved. Assuming existing utilization patterns, the model predicted there would be 13.2 cancers per year in the 100,000 women screened with the conventional Pap smear, and new technologies with increased test sensitivity could reduce the annual incidence to 9.5 cancers per 100,000 women screened. CONCLUSIONS: The model suggests that to achieve further dramatic reduction in cervical cancer mortality, significant improvements in test sensitivity, as reflected in the new screening technologies, may be the most realistic and cost-effective approach.
