title: Cost and effectiveness comparison of immediate colposcopy versus human papillomavirus DNA testing in management of atypical squamous cells of undetermined significance in Turkish women.
abstract: BACKGROUND
  A small but significant proportion of cases with atypical squamous cells of undetermined significance (ASCUS) may harbour CIN 2-3, or even invasive carcinoma. Although immediate colposcopy, HPV-DNA testing or expectant management are three recommended options in ASCUS triage, a consensus does not currently exist on which one of these approaches is the most efficient. In this study, we aimed to compare the performance and cost of immediate colposcopy and colposcopy based on the human papillomavirus (HPV) testing for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN) in women with ASCUS.
  
  
  METHODS
  Records of 594 women with an index Papanicolaou smear showing ASCUS were retrospectively analyzed. Women in the immediate colposcopy arm were referred directly to colposcopy (immediate colposcopy group, n=255) and those in the HPV triage arm were proceeded to colposcopy if the high-risk HPV (hrHPV) test was positive (HPV triage group, n=339). High grade CIN (CIN2+) detection rate and treatment costs were compared between the groups.
  
  
  RESULTS
  The detected rate of CIN2+ was higher in the HPV triage group compared to immediate colposcopy group (8% vs. 1.6%, p=0.011). In the HPV triage group, the total cost, cost per patient, and the cost for detecting one case of high grade CIN were higher than the immediate colposcopy group (p<0.001).
  
  
  CONCLUSIONS
  In women with ASCUS cytology, HPV DNA testing followed by colposcopy is more costly than immediate colposcopy, but this approach is associated with a higher rate of CIN2+ detection. This findings suggest that HPV DNA testing combined with cervical cytology could reduce the referral rate to colposcopy.
authors.affiliation: Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Altindag, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kececioglu
authors.forename: Berna
authors.initials: B
authors.lastname: Seckin
authors.forename: Eralp
authors.initials: E
authors.lastname: Baser
authors.forename: Cihan
authors.initials: C
authors.lastname: Togrul
authors.forename: Tugban Seckin
authors.initials: TS
authors.lastname: Kececioglu
authors.forename: Mahmut Nedim
authors.initials: MN
authors.lastname: Cicek
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gungor
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D016009:Chi-Square Distribution; D003127:Colposcopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000191:economics / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014421:Turkey; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000473:pathology* / Q000821:virology
chemical_list: D004279:DNA, Viral