The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women

Ann Intern Med. 1999 Jan 19;130(2):97-107. doi: 10.7326/0003-4819-130-2-199901190-00003.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Algorithms
  • Colposcopy / economics*
  • Cost-Benefit Analysis
  • Disease Progression
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / economics
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Markov Chains
  • Papanicolaou Test*
  • Quality-Adjusted Life Years
  • Time Factors
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / economics*
  • Uterine Cervical Neoplasms / etiology
  • Uterine Cervical Neoplasms / therapy
  • Vaginal Smears / economics*