Allocating Costs and Benefits in Disease Prevention Programs: An Application to Cervical Cancer Screening (Part 3 of 4)

This study is an attempt to advance the state of the art of cost-effectiveness analysis (CEA) as the technique pertains to disease prevention and health promotion programs. Cervical cancer screening is used as the subject of analysis to demonstrate the application of CEA to a disease prevention program. First, the disease process is modeled using a Markov chain technique to “age” a simulated population of 30to 39-yearold women for 10 years, using disease transition probabilities reported in the literature. Then, the cost effectiveness of screening at different intervals, ranging from no screening to annual screening for the 10-year period, is calculated. The effects of the following are evaluated: 1) different migration patterns, 2) different risk groups, 3) different modes of administering Pap tests, and 4) joint production considerations. The sensitivity of the results both to various discount rates and to a range of Pap test error rates are also tested.