Pap Test After Total Hysterectomy Questioned.

DENVER -- Pap screening for vaginal cancer after total hysterectomy for benign disease is so non-cost-effective as to constitute an "absurd" practice, Dr. Michael Fetters said at the annual meeting of the Society of Teachers of Family Medicine.

Yet this screening is routinely done. And it's covered by Medicare and other third-party payers.

Indeed, an estimated 13% of all Pap smears collected nationally each year are vaginal smears in women who have no cervix because they've undergone hysterectomy for benign disease. The cost of this screening has been estimated at up to $350 million annually, said Dr. Fetters of the University of Michigan, Ann Arbor.

He presented a decision analysis using Markov modeling to calculate the estimated cost-effectiveness of various strategies of Pap screening in women after hysterectomy for benign disease. For onetime screening at age 50, the cost came to $422,493 per year of life saved.

And that was the good news.

Pap screening at age 50 and again at age 60 cost an estimated $469,482 per year of life saved. Screening every 3 years starting at age 50, a practice followed by many physicians, cost $485,312 per year of life saved.

And the cost-effectiveness of screening every 3 years beginning at age 40--a time when a substantial number of women undergo hysterectomy--worked out to a staggering $15.8 million per year of life saved.