Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia.
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.
Coupé
V M H
VM
Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands. v.coupe@vumc.nl
Berkhof
J
J
Verheijen
R H M
RH
Meijer
C J L M
CJ
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