Economic Analysis of Liquid-Based Cytology for Cervical Cancer Prevention in Women in Austria

OBJECTIVES: Since the introduction of cytological examinations in the 1950s, the Pap-smear has significantly reduced the mortality rate of cervical cancer (CxCa). Austria is among the European countries with an opportunistic screening program, where annual Pap-smears are reimbursed for women aged 18 and over. Liquid-based cytology (LBC), available since the mid-1990s, has numerous advantages. The Austrian Society for Clinical Pathology and Molecular Pathology and the Austrian Society for Cytology advocate for LBC despite its higher costs. This economic analysis assesses the cost-effectiveness and cost-benefit of LBC compared to conventional Pap-smears in Austria.

METHODS: The analysis focuses on the adherent Austrian screening population, utilizing a decision tree and a Markov model to depict the screening pathway and long-term outcomes, including CIN health states, CxCa (FIGO stages), mortality, and quality-adjusted life years (QALYs). Resource utilization and direct costs (in 2024 euros) were sourced from published data from the Austrian payer's perspective.

RESULTS: Performing cervical-screening with LBC instead of Pap-cytology is expected to increase costs by 99 € per woman over lifetime. However, it is associated with a higher detection rate (relative benefit: 1.076) and improved quality of life (+1/3 month in perfect health). Women screened with LBC have a reduced risk of an undetected CIN, which reduce the relative risk (RR) of e.g. CIN3/CIS over lifetime (RR: 0.808). The ICUR or the additional cost per QALY gained exhibits 3,558 € and can be considered highly cost-effective. Over a 5-year period, with an anticipated market growth from 10% to 50%, the budget-impact is estimated to be an additional 1.6 million €. This leads to the detection of an additional 10 cases of CxCa and the prevention of 4 deaths.

CONCLUSIONS: The analysis demonstrates that LBC is a cost-effective screening-strategy compared to Pap cytology in Austria, as it improves CxCa detection rates and reduces related mortality.