Unaided visual examination of the cervix versus pap-smears for early detection of cervical cancer

Unaided visual inspection of the cenix can be applied as an alternative to pap smear testing for the prevention of mortality from cervical cancer. We investigated the comparative cost-effectiveness of these two modalities for early detection of cervical cancer for a situation in India. We estimate that per 100 pap smears taken at age 45 the expected number of life years gained by prevention of mortality from cervical cancer is 7.3. Screening an equal number of women two times by unaided visual examination at ages 39 and 51 is expected to gain slightly more life years. The estimated cost of a pap smear in India is 37.3 rupees. The cost of a visual examination is 11.8 rupees, but due to low specificity this examination generates much more diagnostic costs. Therefore pap smear taking may be more cost-effective than unaided visual examination of the cervix, also in a developing country like India.