Table 1.

Cervical Cancer Screening and Cost Parameters ^*

Variable	Input values
Test characteristics (%)
Cytology (26–28) †
Sensitivity (CIN 1/CIN 2,3)	70/80
Specificity	95
HPV DNA test (4, 28) ‡
Sensitivity (CIN 1/CIN 2,3)	83/93
Specificity	93
Costs (2006 US dollars) §
HPV vaccine (per dose) (32–35) ∥
Vaccine and wastage	134
Supplies and administration	9
Patient time and transport	24
Screening test (5, 36–39)
Cytology	32
HPV DNA test (Hybrid Capture II)	49
Office visit	27
Patient time and transport	26
Diagnostic follow-up (5, 36–38)
Colposcopy	364
Biopsy	53
Office visit	61
Patient time and transport	51
Treatment for CIN 2,3 (5) ¶	3,438
Treatment for cervical cancer (5) ¶
Local invasive cancer	26,123
Regional invasive cancer	27,958
Distant invasive cancer	44,780

^*CIN, cervical intraepithelial neoplasia, grade 1 (CIN 1) or grade 2,3 (CIN 2,3); HPV, human papillomavirus.

^†Sensitivity for detecting CIN 2,3 was calculated as the weighted average of values from two recent studies reporting conventional and liquid-based cytology sensitivities using an ASCUS+ threshold (27, 28).

^‡HPV DNA testing is assumed to be 100% sensitive (specific) in detecting the presence (absence) of high-risk HPV types. When this assumption is made, the model generates an implied clinical sensitivity for detecting CIN 1 and CIN 2,3 of 83.0% and 93.0%, respectively, and specificity of 93.0%.

^§Costs were inflation-adjusted to constant 2006 U.S. dollars (USD) using the medical component of the Consumer Price Index (40).

^∥Vaccination assumes three doses; cost per vaccinated individual is $500.

^¶Treatment costs are inclusive of cost of procedures, office visit, and woman’s time.