Cost-effectiveness of organized versus opportunistic cervical cytology screening in Hong Kong

J Public Health (Oxf). 2004 Jun;26(2):130-7. doi: 10.1093/pubmed/fdh138.


Background: To assess the cost-effectiveness of alternative cervical cancer screening strategies to inform the design and implementation of a government-sponsored population-based screening programme in Hong Kong.

Methods: Cost-effectiveness analysis using a computer-based model of cervical carcinogenesis was performed. Strategies included no screening, opportunistic screening (status quo), organized screening using either conventional or liquid-based cytology conducted at different frequencies. The main outcome measures were cancer incidence reduction, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios. Data were from local hospitals and laboratories, clinical trials, prospective studies and other published literature.

Results: Compared with no screening, a simulation of the current situation of opportunistic screening using cervical cytology produced a nearly 40 per cent reduction in the lifetime risk of cervical cancer. However, with organized screening every 3, 4 and 5 years, corresponding reductions with conventional (and liquid-based) cytology were 90.4 (92.9), 86.8 (90.2) and 83.2 per cent (87.3 per cent) compared with no screening. For all cytology-based screening strategies, opportunistic screening was more costly and less effective than an organized programme of screening every 3, 4 and 5 years. Every 3-, 4- and 5-year screening cost $12,300, $7100 and $800 per YLS, each compared with the next best alternative.

Conclusions: Compared with the status quo of opportunistic screening, adopting a policy of organized, mass cervical screening in Hong Kong can substantially increase benefits and reduce costs.

MeSH terms

  • Actuarial Analysis
  • Adult
  • Computer Simulation
  • Cost-Benefit Analysis
  • Diagnostic Tests, Routine / economics*
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Female
  • Hong Kong / epidemiology
  • Humans
  • Markov Chains
  • Mass Screening / economics*
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Quality-Adjusted Life Years
  • Time Factors
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / prevention & control
  • Vaginal Smears / economics*
  • Vaginal Smears / methods
  • Vaginal Smears / statistics & numerical data*