title: Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study.
abstract: OBJECTIVE
  To evaluate the cost effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  Economic analysis using a Markov modelling approach to combine cost and epidemiological data from the NHS Sentinel Sites Study with data from previous studies of post-treatment recurrence rates.
  
  
  METHODS
  English NHS Cervical Cancer Screening Programme.
  
  
  METHODS
  Management guidelines after treatment of CIN involving annual cytology follow-up for 10 years, compared with alternative protocols using the human papillomavirus test to reduce the amount of post-treatment surveillance.
  
  
  METHODS
  Cases of underlying CIN3+ averted at 10 years and costs per 1000 women treated.
  
  
  RESULTS
  Model predictions indicated that, at observed levels of compliance with post-treatment recommendations, management with only cytological follow-up would result in 29 residual cases of recurrent CIN3+ by 10 years and would cost £358,222 (€440,426; $574,910) (discounted) per 1000 women treated. Implementation of human papillomavirus test of cure in cytologically negative women according to the sentinel sites protocol would avert an additional 8.4 cases of CIN 3+ and reduce costs by £9388 per 1000 women treated.
  
  
  CONCLUSIONS
  Human papillomavirus test of cure would be more effective and would be cost saving compared with cytology only follow-up. The results of this evaluation support the full scale implementation of human papillomavirus test of cure after treatment of CIN within the NHS Cervical Screening Programme.
authors.affiliation: Health Services Research and Policy Unit, London School of Hygiene and Tropical Medicine, London WC1 9HS, UK. rosa.legood@lshtm.ac.uk
authors.forename: Rosa
authors.initials: R
authors.lastname: Legood
authors.forename: Megan
authors.initials: M
authors.lastname: Smith
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.forename: Robert
authors.initials: R
authors.lastname: Walker
authors.forename: Sue
authors.initials: S
authors.lastname: Moss
authors.forename: Henry
authors.initials: H
authors.lastname: Kitchener
authors.forename: Julietta
authors.initials: J
authors.lastname: Patnick
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D008962:Models, Theoretical; D009364:Neoplasm Recurrence, Local; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D010349:Patient Compliance; D018571:Sentinel Surveillance; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000628:therapy*; D014773:Virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000628:therapy*