Modeling Cost-Effectiveness of Cervical Cancer Screening in Hungary

Objectives: Our aim was to compare the cost-effectiveness of two national cervical cancer screening programs aiming to involve those who do not regularly participate in the screening program in Hungary with no screening, using a public health-care payer's perspective and a 20-year time horizon. Methods: We built a Markov model based on disease progression. The health-care costs of screening and treatment were received from real-word data. Other input data were obtained from the literature. The cost-effectiveness of the current screening program (a screening test that combines cytology and colposcopy in gynecological outpatient services) and of a planned new screening program (only cytology, and Pap smear is taken locally by public health nurses), both supported with a more active communication campaign, were compared with no screening. Results: The incremental cost-effectiveness ratio of the intensified current screening practice was $33,100 per quality-adjusted life-year compared with no screening, whereas the incremental cost-effectiveness ratio of the renewed program was $18,990 per quality-adjusted life-year compared with no screening. The most influential parameters in the deterministic analysis were the quality-of-life weights of undetected stage I or IIA cancer. In the probabilistic sensitivity analysis, 99.9% of the simulations were below the incremental cost-effectiveness ratio of $30,000 per quality-adjusted life-year in the case of the renewed strategy. Conclusions: Providing services closer to the population is a rational economic option for the reform of the Hungarian cervical cancer screening program. The other policy aspects of this development, human resource need, stakeholders' interests, organizational aspects, and attitude of the target population need to be carefully considered.