title: Overtreatment and Cost-Effectiveness of the See-and-Treat Strategy for Managing Cervical Precancer.
abstract: See-and-treat using loop electrosurgical excision procedure (LEEP) has been recommended as an alternative in managing high-grade cervical squamous intraepithelial lesions, but existing literature lacks evidence of the strategy's cost-effectiveness. We evaluated the overtreatment and cost-effectiveness of the see-and-treat strategy compared with usual care.
  
  
  
  We modeled a hypothetical cohort of 40-year-old females who had not been screened for cervical cancer and followed them through their lifetimes using a Markov model. From a U.S. health-system perspective, the analysis was conducted in 2012 dollars and measured effectiveness in quality-adjusted life-years (QALY). We estimated incremental cost-effectiveness ratios (ICER) using a willingness-to-pay threshold of $50,000/QALY. The robustness of the see-and-treat strategy's cost-effectiveness and its overtreatment rates were further examined in various sensitivity analyses.
  
  
  
  In the base-case, the see-and-treat strategy yielded an ICER of $70,774/QALY compared with usual care. For most scenarios in the deterministic sensitivity analysis, this strategy had ICERs larger than $50,000/QALY, and its cost-effectiveness was sensitive to the disutility of LEEP treatment and biopsy-directed treatment adherence under usual care. Probabilistic sensitivity analysis showed that the see-and-treat strategy had a 50.1% chance to be cost-effective. It had an average overtreatment rate of 7.1% and a 78.8% chance to have its overtreatment rate lower than the 10% threshold.
  
  
  
  The see-and-treat strategy induced an acceptable overtreatment rate. Its cost-effectiveness, compared with usual care, was indiscriminating at the chosen willingness-to-pay threshold but much improved when the threshold increased.
  
  
  
  The see-and-treat strategy was reasonable for particular settings, that is, those with low treatment adherence. Cancer Epidemiol Biomarkers Prev; 25(5); 807-14. ©2016 AACR.
authors.affiliation: Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, Texas. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Van T
authors.initials: VT
authors.lastname: Nghiem
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Kalatu R
authors.initials: KR
authors.lastname: Davies
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beck
authors.affiliation: Department of Obstetrics & Gynecology, Brookdale University Hospital & Medical Center, Brooklyn, New York.
authors.forename: Michele
authors.initials: M
authors.lastname: Follen
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas. sbcantor@mdanderson.org.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D000069342:Medical Overuse; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000473:pathology