title: Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia.
abstract: OBJECTIVE
  To compare current cytological follow up of women treated for high-grade cervical intraepithelial neoplasia (CIN) with follow up by high-risk human papillomavirus (HPV) testing together with cytology.
  
  
  METHODS
  A cost-effectiveness modelling study.
  
  
  METHODS
  Gynaecology clinics in the Netherlands.
  
  
  METHODS
  Women treated for high-grade CIN.
  
  
  METHODS
  A Markov model was developed to compare six follow-up strategies with HPV testing with current cytological follow up at 6, 12, and 24 months. Model parameter estimation was based on three Dutch follow-up studies and a Dutch population-based screening cohort.
  
  
  METHODS
  The number of CIN2/3 cases missed after 5 years follow up, the number of diagnostic procedures, and costs involved.
  
  
  RESULTS
  Strategies with adjunct HPV testing were more effective than current follow up (reduction in missed CIN2/3 cases 32-77%, corresponding to a number needed to treat of 192-455) and less inconvenient (reduction in repeat smears 28-65%). A particularly attractive strategy was HPV testing alone at 6 months and both HPV and cytological testing at 24 months after treatment. This strategy yielded a high detection rate of post-treatment CIN, did not lead to an increase in colposcopy rate, and was 49 Euro per woman cheaper than the current strategy.
  
  
  CONCLUSIONS
  Our model supports the use of high-risk HPV testing for monitoring women treated for high-grade CIN.
authors: Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands. v.coupe@vumc.nl
authors: V M H
authors: VM
authors: Coupé
authors: J
authors: J
authors: Berkhof
authors: R H M
authors: RH
authors: Verheijen
authors: C J L M
authors: CJ
authors: Meijer
mesh_terms: D003127:Colposcopy / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008954:Models, Biological; D009426:Netherlands; D030361:Papillomavirus Infections / Q000191:economics*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000821:virology