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

  • Nahvijou, Azin (Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences) ;
  • Hadji, Maryam (Cancer Research Center of Cancer Institute of Iran) ;
  • BaratiMarnani, Ahmad (Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences) ;
  • Tourang, Fatemeh (Cancer Research Center of Cancer Institute of Iran) ;
  • NedaBayat, NedaBayat (Cancer Research Center of Cancer Institute of Iran) ;
  • Weiderpass, Elisabete (Department of Medical Epidemiology and Biostatistics, Karolinska Institutet) ;
  • Daroudi, Rajabali (Department of Health Economics and Management, School of Public Health, and Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences) ;
  • AkbariSari, Ali (Department of Health Economics and Management, School of Public Health, and Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences) ;
  • Zendehdel, Kazem (Cancer Research Center of Cancer Institute of Iran)
  • Published : 2014.10.23


Background: Organized cervical screening has decreased the incidence of cervical cancer. However, screening strategies vary in different countries. Objectives: We performed a systematic review to evaluate the economic aspects of different screening methods. Materials and Methods: We searched databases and then data were abstracted from each study. We evaluated articles based on different types of screening tests as well as screening age 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) of each study using GDP per capita. Furthermore, we compared national guidelines with recommendations of cost-effectiveness studies in different countries. Results: A total of 21 articles met our criteria, of which 19 studies showed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at least a 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines did not match the recommendations of the cost-effectiveness studies. Conclusions: HPV testing, starting at age 30 years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closer collaboration with health economists is required during guideline development.


Cervical cancer screening;economic evaluation;cost effectiveness;systematic review


Supported by : Iran University of Medical Sciences


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