Clinical impact (cost-effectiveness) of qualifying atypical squamous cells of undeterminate significance (ASCUS) in cases favoring a reactive or dysplastic process.
The cost-effectiveness of qualifying ASCUS cases into two different subcategories, favoring a reactive (ASCUS-R) or dysplastic process (ASCUS-S), was evaluated at the Centro per lo Studio e la Prevenzione Oncologica of Florence in a prospective study. The study determined the positive predictive value (PPV) for histologically confirmed cervical intraepithelial neoplasia grade 2 (CIN2) or more (CIN>) severe lesion of the two ASCUS subgroups. ASCUS-S had a PPV (10.78%) comparable to low-grade squamous intraepithelial lesions (LSIL) (11.40%). For ASCUS-R cases, the recommendation of 6-mo repeat cytology prompting colposcopy in cases of persistent ASCUS or more severe cytology was also effective, as it selected a subgroup with a relatively high PPV (10.34%). The cost-effectiveness of a protocol based on ASCUS qualification was compared with two other possible options for nonqualified ASCUS cases: immediate colposcopy and colposcopy in persistent ASCUS at 6-mo repeat cytology. The detection rate of CIN2> was substantially higher using ASCUS qualification (35.9 vs 14.8 or 17.1). The cost per ASCUS subject was euro 24.99, 27.11, or 25.14 and that per CIN2> detected was euro 697, 1,831 or 1,470 for the three options, respectively. The evidence that ASCUS detection option implies a higher detection rate of CIN2> and subsequently a lower cost per CIN2> detection must be considered with caution and deserves confirmation by other comparative studies.
Carozzi
F M
FM
Analytical and Biomolecular Cytology Unit, Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
Cariaggi
M P
MP
Bonardi
L
L
Bulgaresi
P
P
Cecchini
S
S
Ciatto
S
S
Cipparrone
I
I
Galanti
L
L
Maddau
C
C
Matucci
M
M
Rubeca
T
T
Troni
G M
GM
Turco
P
P
Zappa
M
M
Confortini
M
M
D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000473:pathology; D014626:Vaginal Smears / Q000191:economics*