A cost-effectiveness analysis of screening strategies for cervical intraepithelial neoplasia.
OBJECTIVE
To assess the costs and usefulness of colposcopy using three screening strategies for cervical intraepithelial neoplasia (CIN).


METHODS
A decision model compared three screening strategies for CIN: (1) patients were screened annually with a conventional Pap smear, (2) patients were screened annually with a liquid-based cytologic method and reflex human papillomavirus testing for atypical squamous cells of undetermined significance results, and (3) patients were screened biennially with a liquid-based cytologic method and reflex human papillomavirus testing for atypical squamous cells of undetermined significance results.


RESULTS
Biennial liquid-based screening was the least expensive strategy with a cost of $9.5 million per 100,000 patients. Annual liquid-based screening was the most expensive strategy at $13.7 million. Annual conventional screening had an intermediate cost of $11.6 million. Biennial liquid-based screening referred the fewest patients to colposcopy (11.8%), followed by annual conventional screening and annual liquid-based screening (15.2% and 15.6%, respectively).


CONCLUSIONS
Each of these treatment strategies is reasonable; however, biennial liquid-based screening would reduce medical costs significantly.
Straughn
J Michael
JM
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. jmstraughn@yahoo.com
Numnum
T Michael
TM
Rocconi
Rodney P
RP
Leath
Charles A
CA
Partridge
Edward E
EE