title: Cost-effectiveness analysis of 2 surveillance options for cervical intraepithelial neoplasia 1.
abstract: OBJECTIVE
  We aim to determine the difference in cost between 2 accepted surveillance strategies for women diagnosed with cervical intraepithelial neoplasia 1 (CIN 1): repeat cytology at 6 and 12 months versus human papillomavirus (HPV) DNA testing at 12 months.
  
  
  METHODS
  Extracting data from the literature regarding the natural history of HPV infection and CIN 1, we estimated regression, persistence, and progression rates during a 2-year interval. Costs were based on 2011 Medicaid reimbursements for cytology, biopsy interpretation, HPV testing, and the associated office visit or procedure fee. We constructed a decision tree model to estimate the potential cost benefits of using HPV testing, and sensitivity analyses were performed. Treatment costs for high-grade disease were not included because of equal occurrence in both groups.
  
  
  RESULTS
  In a hypothetical cohort of 100 women with CIN 1 (assumed compliant with 2 y of follow-up), the total cost for cytology-based follow-up was $89,969, whereas the total cost for HPV-based follow-up was $37,357. This indicates an average cost savings of $526 per patient in favor of HPV testing. If we then consider the 234,603 incident cases of CIN 1 in the United Sates per year, preferential use of HPV-based follow-up would save $123,429,305.
  
  
  CONCLUSIONS
  Although both cytology and HPV testing are sound methods for surveillance of CIN 1, it is more cost-effective to use HPV testing.
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Ashlyn H
authors.initials: AH
authors.lastname: Savage
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Marlow
authors.forename: Mallory H
authors.initials: MH
authors.lastname: Alkis
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
mesh_terms: D003362:Cost-Benefit Analysis; D003584:Cytological Techniques / Q000191:economics* / Q000379:methods*; D004279:DNA, Viral / Q000302:isolation & purification; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000191:economics / Q000379:methods; D027383:Papillomaviridae / Q000302:isolation & purification; D014773:Virology / Q000191:economics* / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D004279:DNA, Viral