The value of improving failures within a cervical cancer screening program: an example from Norway

Area of Science:

• Public Health
• Oncology
• Health Economics

Background:

• Cervical cancer (CC) screening failures include nonparticipation, underscreening, and loss to follow-up.
• Current cytology-based screening in Norway faces challenges in compliance.
• Mathematical modeling is crucial for evaluating screening intervention cost-effectiveness.

Purpose of the Study:

• To estimate long-term health benefits of interventions improving CC screening compliance.
• To determine maximum cost-effective investments for these interventions.
• To compare interventions targeting different sources of noncompliance and screening methods.

Main Methods:

• A mathematical model simulating CC natural history in Norway was used.
• Scenarios compared current cytology-based screening to interventions addressing noncompliance (follow-up, underscreening, absence of screening).
• A secondary analysis incorporated human papillomavirus (HPV)-based screening.

Main Results:

• Improving compliance across all noncompliance sources yielded significant health gains and positive incremental net monetary benefits (INMB).
• A 2% compliance increase reduced lifetime CC risk by 1-3%.
• Interventions improving follow-up of abnormal results (cytology) and recruiting nonscreeners (HPV-based) showed highest INMB.

Conclusions:

• Policies enhancing screening compliance are cost-effective under current cytology-based programs.
• Adoption of primary HPV-based screening is also a cost-effective strategy.
• Significant funds can be allocated to improve CC screening compliance and outcomes.