A Cost Effectiveness Analysis of Cervical Cancer Screening in Sweden

Abstract: The thesis deals with the problem of how to effectively the prevalence of cervical cancer in Sweden. A cost effectiveness study with a societal perspective is undertaken comparing three alternatives: the current practice of organized cytological screening offered every third year, an alternative screening technology called liquid based cytology and finally a primary screening for HPV-DNA with a reflex test for cytology, using the LBC technique. The cost effectiveness is calculated through a markov cohort model. The results indicate that the LBC strategy is dominated by the HPV-DNA primary screening. The HPV-DNA screening is cost effective, leading to an incremental cost effectiveness ration of approximately 4700 SEK/Life Year gained. The conclusion is robust to univariate and multivariate sensitivity analysis. Hence, it is concluded that the initial investment in the new screening practice will lead to a large enough decline in incidence and mortality of cervical cancer, to be motivated from a societal point of view.