title: A cost-effectiveness analysis of screening strategies for cervical intraepithelial neoplasia.
abstract: 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.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. jmstraughn@yahoo.com
authors.forename: J Michael
authors.initials: JM
authors.lastname: Straughn
authors.forename: T Michael
authors.initials: TM
authors.lastname: Numnum
authors.forename: Rodney P
authors.initials: RP
authors.lastname: Rocconi
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
authors.forename: Edward E
authors.initials: EE
authors.lastname: Partridge