An article in JAMA by Mandelblatt and colleagues (2002) compared the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer. The paper studied 18 different population screening strategies- Pap testing alone, HPV testing alone, and Pap plus HPV testing every 2 or 3 years for women beginning at age 20 and continuing to 65 years, 75 years and death. The table below summarizes some of the results (low cost to high cost) Costs include screening and treatment costs, discounted over the individuals expected lifetime.

Strategy	Cost ($)	QALYs Saved	Incremental cost	Incremental QALY	ICER
No Screening	5,000	26.87
Pap every 3 years to age 75	6,825	27.02
HPV every 3 years to age 75	6,950	27.02
Pap every 2 years to age 75	7,275	27.04
Pap + HPV every 3 years to age 75	7,400	27.04
HPV every 2 years to age 75	7,450	27.04
Pap + HPV every 2 years to age 75	7,925	27.05

1. Identify all dominant screening strategies. Explain why each is dominant