title: Human papillomavirus testing for triage of women referred because of abnormal smears. a decision analysis considering outcomes and costs.
abstract: The objective of this article was to evaluate the utility of high-risk human papillomavirus (HR-HPV) testing for triage of women referred for colposcopy because of abnormal smears. We considered women with persistent mild or moderate dyskaryosis and women with severe dyskaryosis who were referred for colposcopy. For both patient groups we evaluated three alternative management policies: (1) conventional management based on histological assessment; (2) HR-HPV-triage with direct treatment without prior histologic assessment for HR-HPV-positive women and conventional management for HR-HPV-negative women; and (3) direct treatment without histologic assessment for all referred women. For each policy the average number of medical procedures, doctor visits, and the costs per referred woman were calculated. Based on a literature review, the results were tested and translated to other patient groups. Per woman with persistent mild or moderate dyskaryosis and compared with conventional policy, HR-HPV-triage will avoid 0.51 colposcopically directed biopsies, but adds 0.05 local treatments of the cervix (i.e., loop excision of the transformation zone) and 0.09 outpatient visits, and will cost $134 US dollars extra. HPV triage is less efficient in women with borderline or mildly dyskaryotic cytology. In women with severe dyskaryosis, direct treatment is more efficient as conventional management or HPV triage. The decision to introduce HPV testing or direct treatment in women with persistent mild or moderate dyskaryosis strongly depends on the relative burden attributed to a colposcopically directed biopsy and an outpatient visit compared to loop excision of the transformation zone treatment of the cervix. For women with severe dyskaryosis, direct treatment should be seriously considered.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. meerding@mgz.fgg.eur.nl
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: Meerding
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Matthé P M
authors.initials: MP
authors.lastname: Burger
authors.forename: M Elske
authors.initials: ME
authors.lastname: van den Akker-van Marle
authors.forename: Wim G V
authors.initials: WG
authors.lastname: Quint
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011446:Prospective Studies; D014218:Triage; D014412:Tumor Virus Infections / Q000175:diagnosis*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000517:prevention & control; D014594:Uterine Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears