A Systematic Review of Economic Aspects of Cervical Cancer creening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Abstract

<b>Background:</b> Organized cervical screening has decreased the incidence of cervical cancer. However, screeningstrategies vary in different countries. <br/><b>Objectives</b>: We performed a systematic review to evaluate the economicaspects of different screening methods. Materials and <br/><b>Methods</b>: We searched databases and then data wereabstracted from each study. We evaluated articles based on different types of screening tests as well as screeningage and intervals, and using incremental cost effectiveness ratio via calculating quality adjusted life years(QALY), or life years gained (LYG) per cost. We compared the incremental cost-effectiveness ratio (ICER) ofeach study using GDP per capita. Furthermore, we compared national guidelines with recommendations of costeffectivenessstudies in different countries. <br/><b>Results</b>: A total of 21 articles met our criteria, of which 19 studiesshowed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at leasta 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines didnot match the recommendations of the cost-effectiveness studies. <br/><b>Conclusions</b>: HPV testing, starting at age 30years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closercollaboration with health economists is required during guideline development.