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To the Editor: Dr Goldie and colleagues¹ suggested that, in resource-poor countries, direct visual inspection (DVI) of the cervix and testing for human papillomavirus (HPV) may be reasonable alternatives to Pap smears in screening for cervical cancer. We have several concerns about this conclusion. First, the cost of a Pap smear is of central importance to cost-effectiveness analyses of cervical screening. Because Pap screening is labor intensive, salaries are a central component of its costs. Because of differences in professional fees, a Pap smear costs $15 in the United States² and less than $0.40 in developing countries such as Vietnam.³

Second, the Pap smear fee of $10 that Goldie et al assumed for South Africa seems high to us, and requires better documentation. The article by Goldie et al may reinforce incorrect beliefs that Pap screening in developing countries is prohibitively expensive. It is our impression that such beliefs have . . . [Full Text of this Article]

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Sue J. Goldie, Louise Kuhn, Lynette Denny, Amy Pollack, and Thomas C. Wright
JAMA. 2001;285(24):3107-3115.
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