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

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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‐0 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.

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