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In Reply: Dr Boncz suggests that short-term costs will undermine implementation of screening programs in countries with transitional economies or low resources. We appreciate the difficulties of introducing new health policies, but note that screen-and-treat strategies are more cost-effective than conventional cytology-based screening approaches. The cost-effectiveness of a variety of cervical cancer prevention strategies, including screen-and-treat, has been evaluated for India, Kenya, Peru, South Africa, and Thailand.¹ In contrast to the common notion that cervical cancer screening is too expensive for low-resource settings, this analysis found that screen-and-treat programs are as cost-effective as other widely accepted public health interventions such as hepatitis B immunization and the prevention of malaria through the use of bed nets.

Regarding the comments of Dr Suba and colleagues, comparing the true costs of screening programs must include the additional costs beyond those of the screening test. They also question the safety and effectiveness of screen-and-treat . . . [Full Text of this Article]

Thomas C. Wright, Jr, MD
tcw1@columbia.edu
College of Physicians and Surgeons of Columbia University
New York, NY

Louise Kuhn, PhD
Mailman School of Public Health
Columbia University
New York, NY

Lynette Denny, MD, PhD
University of Cape Town
Cape Town, South Africa

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