Page 57 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter III. Results

conventional cytology, then costs and harms of false positives have important system and

individual implications.

The Cervical Cytology report also includes systematic review of prior literature on the

cost-effectiveness of cervical cytology. In summary:

• Published models examining the cost and effectiveness of Pap smear screening have

consistently found Pap screening to have a significant impact on the incidence and

mortality of cervical cancer and to have an acceptable range of cost-effectiveness

ratios when compared with no screening.

• Estimates of Pap test accuracy used in these models generally overestimated Pap test

performance, as determined by recent unbiased studies, the findings of the report

itself [Cervical Cytology], and a previously published meta-analysis. Best estimates

of Pap test performance fall outside the range used in sensitivity analyses of some

models.

Many of these models have results that are consistent when important parameters of the

models are varied across of broad spectrum of assumptions. Ultimately, however, all current

models are tied to the limitations in this literature and must be considered temporary substitutes

for prospective research.

Summary

Overall, the quality of this literature is limited for the purposes of making decisions about

choice of screening modality in the US population. We identified no randomized trials or

prospective cost-effectiveness comparisons in suitable populations. In the absence of studies that

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