Gynaecology Research Today is a free monthly online journal that collates and summarizes the latest research about Gynaecology, including details on pap smears, laparoscopy, ultrasound, hysteroscopy. | ||||||||
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Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia.Coupé VM, Berkhof J, Verheijen RH, Meijer CJ Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands. v.coupe@vumc.nl 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. DESIGN: A cost-effectiveness modelling study. SETTING: Gynaecology clinics in the Netherlands. POPULATION: 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. MAIN OUTCOME MEASURES: 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. Published 23 March 2007 in BJOG, 114(4): 416-24.
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