Comparison of the Cost-Effectiveness of Pap Smear, HPV Testing, and HPV Vaccination in Cervical Cancer Prevention: A Narrative Review

Abstract

Context: Screening programs are a cost-effective way to reduce cervical cancer. Economic evaluation helps health policymakers prioritize high-benefit or more effective healthcare interventions, given the disagreement about the cost-effectiveness of Pap smear, human papillomavirus (HPV) testing, and HPV vaccination in cervical cancer screening. The aim of this study was to compare the cost-effectiveness of Pap smear, HPV test, and HPV vaccination in cervical cancer prevention. Evidence Acquisition: To access the studies, a search was conducted between 1990 and 2025 in the electronic databases of SID, Google Scholar, PubMed, Cochrane, Scopus, and Web of Science. Keywords used were: HPV test, Pap smear, HPV Vaccine, Cervical Cancer. Then, the full texts of seemingly related articles were reviewed using the STROBE checklist, and finally, the six articles with the highest scores that were included in the study were selected. Results: The results of the review of studies showed that in most studies, the cost-effectiveness of co-testing is higher than a Pap smear test or the initial HPV test alone. In some studies, the cost-effectiveness was noted to be 2000 euros, and in others, $20,000 per quality-adjusted life year (QALY). There is disagreement about the cost-effectiveness of an annual Pap smear, the HPV test alone, and HPV vaccination in cervical cancer prevention. Conclusions: In most studies, using co-testing has a higher cost-effectiveness than Pap smear alone, so the use of this method is recommended as the most cost-effective approach for the prevention of cervical cancer. However, more studies need to be conducted on the cost-effectiveness of HPV vaccination.