Expenditure and resource utilisation for cervical screening in Australia
1 Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia
2 Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
3 Victorian Cytology Service, 752 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
4 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2000, Australia
5 Centre for Women’s Health, Gender and Society, University of Melbourne, 3/207 Bouverie Street, Carlton, Melbourne, 3053, Australia
6 School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
7 NHMRC Clinical Trials Centre, University of Sydney, Locked bag 77, Camperdown, Sydney, NSW, 1450, Australia
8 Royal Women’s Hospital, Melbourne, Locked Bag 300, Grattan St & Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia
9 Present address: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, P.O. Box 281, SE-171 77, Stockholm, Sweden
10 Present address: School of Public Health and Community Medicine, University of NSW, Sydney, Australia
BMC Health Services Research 2012, 12:446 doi:10.1186/1472-6963-12-446Published: 5 December 2012
The National Cervical Screening Program in Australia currently recommends that women aged 18–69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010.
A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination.
The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing $96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing $21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that $20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities.
Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new technologies, increasing the interval and changing the age range of screening is expected to have a substantial impact on this expenditure, as well as having some impact on follow-up and management costs. These estimates provide a benchmark for future assessment of the impact of changes to screening program recommendations to the costs of cervical screening in Australia.