A cost-effectiveness analysis of management strategies for cervical intraepithelial neoplasia grades 2 and 3.
OBJECTIVE
This study was performed to compare the cost-effectiveness of strategies for the management of cervical intraepithelial neoplasia, grades 2 and 3 (CIN 2 and CIN 3).


METHODS
A decision analysis compared six management strategies. The model was applied to hypothetic cohorts of 100,000 patients with CIN 2 and CIN 3.


RESULTS
In both analyses, cryotherapy (CRYO) was the least expensive and least effective strategy; total vaginal hysterectomy was the most expensive and most effective strategy. For CIN 2, loop electrosurgical excision procedure (LEEP) was more effective than CRYO but at a cost of $31,437 per additional cure and $1.8 million per additional cancer prevented. For CIN 3, LEEP was more effective than CRYO, but at a cost of $17,592 per additional cure and $1.0 million per additional cancer prevented.


CONCLUSIONS
CRYO is a cost-effective strategy that is appropriate in resource-poor settings. LEEP is also cost-effective, but the improved efficacy compared with CRYO comes at a significant cost. Total vaginal hysterectomy is very effective but is economically unsound because of excessively high costs.
Kleinberg
Marc J
MJ
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street S., OHB Room 340, Birmingham, AL 35249, USA.
Straughn
J Michael
JM
Stringer
Jeffery S A
JS
Partridge
Edward E
EE
D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000191:economics*; D003661:Decision Support Techniques; D004598:Electrosurgery / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*