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.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street S., OHB Room 340, Birmingham, AL 35249, USA.
Marc J
MJ
Kleinberg
J Michael
JM
Straughn
Jeffery S A
JS
Stringer
Edward E
EE
Partridge
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*