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19 January 1999 | Volume 130 Issue 2 | Pages 97-107
Background: Women with HIV infection have a higher risk for cervical squamous intraepithelial lesions than do women without HIV infection, and the optimal regimen for cervical cancer screening in these women is uncertain.
Objective: To assess the net health consequences, costs, and cost-effectiveness of various screening strategies for cervical neoplasia and cancer in HIV-infected women.
Design: A cost-effectiveness analysis from a societal perspective done by using a state-transition Markov model. Values for incidence, progression, and regression of cervical neoplasia; efficacy of screening and treatment; progression of HIV disease; mortality from HIV infection and cancer; quality of life; and costs were obtained from the literature.
Setting: Simulated clinical practice in the United States.
Patients: HIV-infected women representative of the U.S. population.
Intervention: Six main screening strategies—no screening, annual Papanicolaou smears, annual Papanicolaou smears after two negative smears obtained 6 months apart (recommended by the Centers for Disease Control and Prevention), semiannual Papanicolaou smears, annual colposcopy, and semiannual colposcopy—were considered.
Measurements: Quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness.
Results: Annual Papanicolaou smear screening resulted in a 2.1-month gain in quality-adjusted life expectancy for an incremental cost of $12 800 per QALY saved. Annual Papanicolaou smear screening after two negative smears obtained 6 months apart provided an additional 0.04 QALYs at a cost of $14 800 per QALY saved. Semiannual Papanicolaou smear screening provided a further 0.17 QALYs at a cost of $27 600 per QALY saved. Annual colposcopy cost more but provided no additional benefit compared with that given by semiannual Papanicolaou smear screening, and semiannual colposcopy exceeded $375 000 per QALY saved. Results were most sensitive to the rate of progression of neoplasia to invasive cancer.
Conclusions: In HIV-infected women, cervical cancer screening with annual Papanicolaou smears after two negative smears obtained 6 months apart offers quality-adjusted life expectancy benefits at a cost comparable to that of other clinical preventive interventions.
Author and Article Information
From Harvard University School of Public Health, Boston Medical Center, Boston University School of Medicine, and Boston University School of Public Health, Boston, Massachusetts.
Presented in part at the Society for General Internal Medicine, 5 May 1997, Washington, D.C.
Grant Support: In part by a Postdoctoral Fellowship Award from the Agency for Health Care Policy and Research (Dr. Goldie) and by grant RO1-HS07317-01A1 from the Agency for Health Care Policy and Research.
Requests for Reprints: Sue J. Goldie, MD, MPH, Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115-5924; e-mail, sgoldie{at}hsph.harvard.edu.
Current Author Addresses: Drs. Goldie, Weinstein, and Kuntz: Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115-5924.
Dr. Freedberg: Clinical Economics Research Unit, Section of General Internal Medicine and the Clinical AIDS Program, Department of Medicine and the Evans Medical Foundation, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118. ARTICLE
The Costs, Clinical Benefits, and Cost-Effectiveness of Screening for Cervical Cancer in HIV-Infected Women
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