Authors' objectives:

This review aims to assess the effectiveness and cost-effectiveness of liquid-based cytology (LBC)in cervical screening. It updates the original HTA rapid review of LBC (Payne et al. Health Technol Assess 2000;4(18):173) to reflect any new evidence, including the results of the pilot studies implemented as a result of the previous review.

Authors' results and conclusions: There were no randomised trials using an outcome such as invasive cancer or mortality as outcome measures. A few studies attempted to compare the sensitivity and specificity of the existing technique with LBC by using a histological examination gold standard. Most comparisons were split-sample studies comparing cytological results. From the evidence available, it is likely that the LBC technique will reduce the number of false-negative test results. Modelling analyses undertaken as part of this study indicate that this would reduce the incidence of invasive cancer. There is now more evidence to support improvements emanating from the use of LBC screening in terms of a reduced number of unsatisfactory specimens and a decrease in the time needed to obtain the smear samples.

Authors' recommendations: It is clear that increasing coverage of the cervical screening programme is also an important way of reducing the burden of invasive cervical cancer. Given the low cost-effectiveness ratios for moving from no screening to any form of screening, it is likely that any effective intervention aimed at increasing coverage will be a cost-effective use of resources. Such interventions will also be equitable, as non-uptake of a screening programme is likely to be due to inequities in access to healthcare (whether they be defined as differences in the relative costs of screening, or through inequities in education or health information). In addition, a range of economic evaluations was identified in the updated systematic search (19992002) that assessed the economic impact of cervical screening approaches other than conventional Pap smear testing and LBC techniques, including semi-automated slide analysis, human papilloma virus testing as an adjunct or alternative to Pap smear testing, and protocols for the management of atypical screening results. The aggregate analysis of the cost-effectiveness of potential combinations of these approaches to screening for cervical cancer is outside the scope of this review, although it is noted that the relative cost-effectiveness of all relevant screening programme configurations should be analysed simultaneously.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/1350

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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