Cervical screening interval: Costing the options in one health authority

Abstract

Background: This is a study of the costs of the cervical screening programme in one health authority with a mixed three and five year, and thus inequitable, cervical screening interval, the costs of three year and five yearly screening are compared, and considered in terms of likely numbers of averted cases of and deaths from cervical cancer. Methods: The study uses an activity-based costing procedure to calculate the component and total costs of the cervical screening programme. Results: The main costs of the cervical screening programme are the costs of taking and processing smears. In 1994-1995 the total cost of a three year recall policy was £768,570 per 100,000 eligible women and that of a five year recall policy was £476,768 per 100,000 eligible women. Best estimates of the numbers of cases of and deaths from invasive cervical cancer averted by three over five yearly screening are 1.4 and 0.7 per 100 000 eligible women, respectively. Because of uncertainty regarding colposcopy costs a sensitivity analysis was carried out, giving a range of cost differences between three and five yearly screening of £278,477 and £351,768. Conclusions: The health service costs of three yearly screening are considerably greater than those of five yearly screening. Despite this, a significant proportion of smear-takers are screening more frequently than five yearly, with implications for anxiety of screened women, as well as health service costs.