The cost-effectiveness of treating women with a cervical vaginal smear diagnosis of atypical squamous cells of undetermined significance.
OBJECTIVE
The purpose was to determine the optimal treatment protocol for women with a cervical vaginal diagnosis of atypical squamous cells of undetermined significance.


METHODS
By means of decision analysis, 8 strategies were compared in terms of cost, life expectancy, cost-effectiveness, and the number of cancers and complications from treatment. Data were obtained from the medical literature and the University of Iowa Hospitals and Clinics.


RESULTS
Compared with more aggressive strategies, such as those that use immediate colposcopy, strategies featuring repeated smears were less expensive and carried fewer complications but had lower life expectancies per patient and more cancers. The strategy of repeating a smear annually had a lower cost per patient than did the other strategies, ranging from $112 to $989, and had a similar discounted life expectancy to that of the strategy with the longest discounted life expectancy.


CONCLUSIONS
In most clinical scenarios strategies that used repeated smears were the most cost-effective.
Raab
S S
SS
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, USA.
Steiner
A L
AL
Hornberger
J
J
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008017:Life Expectancy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000628:therapy*; D014626:Vaginal Smears