The cost-effectiveness of cervical cancer screening for low-income elderly women
J. S. Mandelblatt and M. C. Fahs
Department of Ambulatory Care, City Hospital Center, Elmhurst, NY.
Controversy surrounds prevention policy for the elderly. While some
cost-effectiveness analyses have been done for the general elderly
population, to our knowledge no study has examined the provision of
preventive services to a low-income elderly population. We conducted a
study of the cost-effectiveness of a cervical cancer screening program for
infrequently screened elderly women attending an urban municipal hospital
clinic. The results of Papanicolaou testing were abnormal (malignant or
premalignant) in 11 of 816 women screened. This early detection of cervical
neoplasia saved +5907 and 3.7 years of life per 100 Papanicolaou tests.
When average medical costs per year of life extended by screening were
included, the program cost +2874 per year of life saved. Comprehensive
sensitivity analyses performed on competing medical and economic points of
view did not change the conclusion of a favorable cost-effectiveness ratio
for screening. Our findings indicate that the benefits from some prevention
programs for the elderly can offset the costs of these programs. More
research is needed to guide public policy on prevention for selected
population groups.
