Cost effectiveness of a program to promote screening for cervical cancer in the Vietnamese-American population

To conduct a randomized controlled trial to evaluate the cost effectiveness of a lay health worker-administered cervical cancer screening intervention for Vietnamese-American women.

The study group included 234 Vietnamese women in the Seattle, Washington area who had not received a Pap test in the last three years. Experimental group participants received a lay health worker home visit. The travel distance and time spent at each visit were recorded. Our trial end-point was Pap smear receipt within six months of randomization. Pap testing completion was ascertained through medical record reviews.

For all Vietnamese women, regardless of their prior history of screening, the cost per intervention was $104.0 (95% CI: $89.6-$118.4). The change in quality-adjusted life days per intervention was 1.26 (95% CI: -5.43-7.96), resulting in an incremental cost-effectiveness ratio (ICER) of $30,015 per quality-adjusted life year. The probability that the ICER exceeds $100,000 is 9.1%.

The degree of cost effectiveness of such interventions is sensitive to the assumed duration of behavioral change and the participants' prior history of screening.