Authors' objectives:

The overall objective of the project was to assess the immediate effects, the wider consequences and costs, and overall cost-effectiveness and cost-utility of introducing automated image analysis to a screening programme with characteristics similar to those currently operating in the UK.

Authors' results and conclusions: The predominant finding from the systematic reviews was the very limited amount of rigorously conducted primary research. For instance, concerning test performance, only two studies (approximately 13,000 slides) assessing impact on sensitivity and specificity of automated image analysis were included; even relaxing these criteria only allowed another five studies (approximately 51,000 slides) to be considered. The results of these studies were difficult to interpret, but debatably were most compatible with automated image analysis being equivalent in test performance to manual screening. Several studies provided information on reproducibility of assessments, which was often surprisingly poor. Two evaluations of impact on health outcomes were identified, and although they did not contribute directly to the conclusions, they point to a type of evaluation that should be considered more often. Concerning process, there was evidence that automated image analysis does lead to reductions in average slide processing times. In the PRISMATIC trial this was reduced from 10.4 to 3.9 minutes using PAPNET, a statistically significant and practically important difference. There are two important provisos to these findings. First, none of the included studies above refers to the only currently commercially available automated image analysis device, the AutoPap GS System. The majority of evaluations on test performance and impact on processing times have been performed on PAPNET. Second, detailed searches for UK unpublished literature on the test performance of automated image analysis revealed 13 studies, two of which appeared to be similar in quality to the studies included. This suggests that the findings are possibly highly susceptible to publication bias.

Authors' recommendations: As in previous health technology assessments on this subject, the conclusion is that the available evidence on test performance, impact on process and cost-effectiveness is still insufficient to recommend implementation of automated image analysis systems. The priority for action remains further research. An important difference is that previously the insufficiency of evidence was general. Now, a general case for automated image analysis has probably just been made, but is specifically absent for the single device currently commercially available. The findings with respect to other and in many cases older automated image analysis devices need to be confirmed for the AutoPap GS System.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/1147

Year Published: 2005

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

Copyright: 2009 Queen's Printer and Controller of HMSO