Healthcare and lifestyle practices of healthcare workers: do healthcare workers practice what they preach?

Comment. Our analysis has 2 main findings: (1) compared with current practice, screening all eligible women every 2 or 3 years can yield equal or greater health benefits at a significant cost savings, and (2) routine screening more often than every 3 years exceeds conventional thresholds for cost-effectiveness in the United States. Together, these findings support recent guidelines recommending routine cytologic screening at 3-year intervals. Investments in programs to achieve high coverage of 3-year screening can be considerable, up to $1200 per screen-eligible woman, before spending on cervical cancer screening reaches current levels. Programs, such as call/recall systems and community-based outreach— likely to be less than $1200 per woman—can focus not only on removing barriers for underscreened women but also on decreasing use in women who unnecessarily get annual routine screening. Attaining high coverage across all eligible women has the added advantage of promoting equity in health gains across subgroup populations, such as minorities and the uninsured, known to have high rates of cervical cancer incidence and mortality. Our analysis has limitations. Because we did not explicitly model heterogeneous subgroups, our estimates may be conservative if improved access to screening leads to the reduction of cases that otherwise would have differentially worse outcomes and/or higher costs than average. We also did not assess the impact of improving compliance to diagnostic visits and access to timely treatment among women who are screened appropriately, efforts that are paramount to reducing cervical cancer burden in the United States. We conclude that improving cervical cancer screening does not necessitate increased expenditures in the United States. Indeed, shifting away from the status quo, with at least half of women getting screened too frequently and over a quarter not frequently enough, can likely reduce current expenditures without compromising the tremendous health gains already achieved in cervical cancer prevention. This cost savings can be invested in more prudent ways to improve health, whether through cervical cancer prevention or other health interventions.