Cost-effectiveness analysis of liquid-based cytology and human papillomavirus testing in cervical cancer screening

Michael A. Bidus, G. Larry Maxwell, Shalini Kulasingam, G. Scott Rose, John C. Elkas, Mildred Chernofsky, Evan R. Myers

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


OBJECTIVE: To compare the outcomes of several cervix cancer screening strategies in a military population using a model that considers both direct and indirect costs of health care. METHODS: A Markov model of the natural history of cervical cancer was used to simulate an age-stratified cohort of 100,000 active duty women in the U.S. Army. Total costs and incremental cost-effectiveness ratios were estimated for different modalities of screening: liquid-based cytology with testing for human papillomavirus (HPV) irrespective of cytologic results compared with liquid-based cytology with HPV detection for cytologic results of atypical cells of undetermined significance (reflex HPV). The costs and outcomes of these screening methods were evaluated separately as well as in combination (liquid-based cytology and reflex HPV before age 30 years and DNA and Pap test every 3 years thereafter). Each of these screening methods was evaluated at 1-, 2-, and 3-year intervals. RESULTS: A screening strategy of liquid-based cytology and reflex HPV every 2 or 3 years is the least costly strategy among active duty women irrespective of age, especially when accounting for time costs associated with screening, diagnosis, and treatment of cervix cancer. A strategy of liquid-based cytology and HPV testing irrespective of cytology results is the most effective strategy; however, it is also the most costly of the strategies tested, even when performed in patients older than 30 years of age. CONCLUSION: In the U.S. Army, cervix cancer screening performed with liquid-based cytology and reflex HPV testing of atypical squamous cells of undetermined significance performed every 2 years is cost-effective, especially when indirect costs are considered.

Original languageEnglish (US)
Pages (from-to)997-1005
Number of pages9
JournalObstetrics and gynecology
Issue number5
StatePublished - May 1 2006
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynecology


Dive into the research topics of 'Cost-effectiveness analysis of liquid-based cytology and human papillomavirus testing in cervical cancer screening'. Together they form a unique fingerprint.

Cite this