Evaluation of three cervical cancer detection programs in Japan with special reference to cost-benefit analysis

Abstract

Three screening programs for early cervical cancer currently in use in Japan were evaluated according to the following criteria: (1) economic effectiveness; (2) screening efficiency; and (3) access to medical care. The mobile program has the highest benefit-cost ratio (BCR, 1.20) and is hence most cost-effective; its detection rate, rescreening rate, and early cancer detection rate (proportion of Stage-O patients to all patients with cancer) are moderately high (0.09%, 2.07%, 55%, respectively). It is obviously suited to rural areas, especially where residents have a positive attitude toward local health services. The detection center program is less cost-effective than the mobile program (BCR, 0.83) but diagnostically the most effective with highest detection, rescreening, and early cancer detection rate (0.15%, 5.08%, 61%, respectively). It is suitable to large cities (population over 1 million) with efficient public transportation. The private physician program is economically and in terms of screening efficiency least effective of the three; its BCR being 0.40 and detection, rescreening, and early cancer detection rate being the lowest (0.08%, 0.29%, 33%, respectively). However, the private physician program is increasingly employed, presumably because of easy access to medical care, better rapport between the patient and physician, and, in addition, successful lobbying by private physicians.