An article in JAMA by Mandelblatt et al (2002) compared the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer. The paper studied 18 different population screening strategies – Pap testing alone, HPV testing alone, and Pap plus HPV testing – every 2 or 3 years for women beginning at age 20 and continuing to 65 years, 75 years, and death. The following table summarizes some of the results (low cost to high cost). Costs include screening and treatment costs, discounted over the individual’s expected lifetime.
| Strategy | Cost ($) | QALYs Saved | Incremental Cost | Incremental QALY | ICER* |
| 0. No screening | 5,000 | 26.87 | |||
| 1. Pap every 3 years to age 75 | 6,825 | 27.02 | |||
| 2. HPV every 3 years to age 75 | 6,950 | 27.02 | |||
| 3. Pap every 2 years to age 75 | 7,275 | 27.04 | |||
| 4. Pap + HPV every 3 years to age 75 | 7,400 | 27.04 | |||
| 5. HPV every 2 years to age 75 | 7,450 | 27.04 | |||
| 6. Pap + HPV every 2 years to age 75 | 7,925 | 27.05 |
*If dominated, just put dominated (Hint: if a strategy is dominated, then you must go back to the previous one when calculating the next ICER)
1. Complete the chart above. (Hint: ICER = C/E and for this example, QALY is E)
2. After all of your calculations, suppose that a local health district asked your opinion and analyzed the best strategy. Write one to two paragraphs on which approach you recommend and why you choose it. THIS CAN BE SUBJECTIVE BUT ONLY IF IT IS BACKED BY ANALYSIS.