Adult ; Aged ; Cost-Benefit Analysis* ; Early Detection of Cancer/economics* ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; National Health Programs/economics* ; Neoplasm Staging ; Prognosis ; Republic of Korea ; Survival Rate ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/economics* ; Uterine Cervical Neoplasms/mortality
Keywords
Cost-Effectiveness ; mass screening ; cervical cancer ; Pap smear ; Korea
Abstract
Background: Cervical cancer, which is common in developing countries, is also a major health issue in
Korea. Our aim was to evaluate the cost-effectiveness of Korea’s National Cancer Screening Program (NCSP),
implemented in 1999. Materials and Methods: The target population was Korean women 30 years or over who
were invited to take part in the NCSP in 2002–2007. By merging NCSP records with Korean Central Cancer
Registry data, patients diagnosed with cervical cancer who had been screened were assigned to a “screened group,”
while patients diagnosed elsewhere were assigned to a “non-screened group.” Clinical outcomes were measured
in terms of life-years saved (LYS), derived from 5-year mortality rates supplied by the Korean National Health
Insurance Corporation and National Statistical Office. Direct and travel costs associated with screening were
evaluated from the perspective of the payer, the NCSP. Results: A diagnosis via screening was associated with 2.30
LYS, and the incremental cost-effectiveness ratio (ICER) estimate for screening was 7,581,679 KW/LYS (6,727
USD/LYS). ICER estimates were lower for older patients (≥ 50 years) than younger patients (4,047,033 KW/
LYS vs 5,680,793 KW/LYS). The proportion of early-stage cancers detected was 16.3% higher in the screened
group. Conclusions: In light of Korea’s per capita gross domestic product (32,272 USD in 2012), the current
NCSP’s incremental cost per LYS appears acceptable.