OBJECTIVES: Cervical cancer incidence in Serbia has been identified as one of the highest in Europe, showing slow but steady increase during the last decade. Despite the National Programme for Prevention of Cervical Cancer that has recently been established, an organised Pap screening is far from full implementation. This study aims to assess the effectiveness and cost effectiveness of absolute adherence to the proposed policy compared to the current practice. METHODS: A Markov model simulating the natural history of cervical cancer was developed. Calibration was performed using country specific data, sourcing incidence and mortality from Serbian cancer registries. Accordingly, the screening algorithm incorporated in the model was based on the local guidelines. We followed a hypothetical cohort of 100,000 15-year old girls until the end of their lifetime. Subsequently, the actual cytological screening practice covering only 20% of the targeted population was compared to a scenario of absolute adherence to the national screening programme. A discount rate of 1.5% for health and 4% for cost outcomes was applied. RESULTS: The natural history model showed that limited benefit is currently being achieved from cytological screening. The hypothetical cohort analysis indicated that absolute guidelines adherence would result in 422 deaths averted and an incremental cost effectiveness ratio (ICER) of 3272 €/LYG. The ICER estimate did not exceed the national annual GDP (3857 €/capita) - a commonly used informal threshold. CONCLUSIONS: This research identified that full adherence to the screening policy is very likely to be cost effective. In general, the low screening coverage that has been observed appeared as the most serious obstacle to the prevention of cervical cancer. The new methods in cervical cancer prevention, however, such as HPV vaccination and HPV testing, require further pharmacoeconomic assessment.