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Objective: To compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN)., Design: A cost-effectiveness analysis based on data available in the literature and expert opinion., Setting: England., Population: Women treated for CIN., Methods: We developed a decision-analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10-year period. The costs calculated were those incurred by the National Health Service (NHS) of England., Main Outcome Measures: Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted., Results: For young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost-effective treatment overall at all willingness-to-pay thresholds. For postmenopausal women, LLETZ remained the most cost-effective treatment up to a threshold of £31,500, but laser conisation became the most cost-effective treatment above that threshold., Conclusions: LLETZ is the most cost-effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence., (© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To estimate the impact of using the Aptima messenger RNA (mRNA) high-risk human papilloma virus (HR-HPV) assay versus a DNA HR-HPV assay in a primary HPV cervical screening programme., Design: One hypothetical cohort followed for 3 years through HPV primary cervical screening., Setting: England., Participants: A hypothetical cohort of women aged 25-65 years tested in the National Health Service (NHS) Cervical Screening Programme (CSP) for first call or routine recall testing., Methods: A decision tree parameterised with data from the CSP (2017/18) and the HORIZON study. Uncertainty analyses were conducted using data from the FOCAL and GAST studies, other DNA HPV tests in addition to one-way and probabilistic sensitivity and scenarios analyses, to test the robustness of results., Interventions: Aptima mRNA HR-HPV assay and a DNA HR-HPV assay (cobas 4800 HPV assay)., Main Outcome Measures: Primary: total colposcopies and total costs for the cohort. Secondary: total HPV and cytology tests, number lost to follow-up., Results: At baseline for a population of 2.25 million women, an estimated £15.4 million (95% credibility intervals (CI) £6.5 to 24.1 million) could be saved and 28 009 (95% CI 27 499 to 28 527) unnecessary colposcopies averted if Aptima mRNA assays are used instead of a DNA assay, with 90 605 fewer unnecessary HR-HPV and 253 477 cytology tests performed. These savings are due to a lower number of HPV positive samples in the mRNA arm. When data from other primary HPV screening trials were compared, results indicated that using the Aptima mRNA assay generated cost savings and reduced testing in every scenario., Conclusion: Using the Aptima mRNA assay versus a DNA assay would almost certainly yield cost savings and reduce unnecessary testing and procedures, benefiting the NHS and women in the CSP., Competing Interests: Competing interests: EJA, GW, MJH and CD report grants from Hologic to their Employer (Aquarius Population Health) during the conduct of the study, and grants on diagnostics from Cepheid, Enigma Diagnostics, Jupiter Diagnostics, Binx, Momentum Bioscience, St Georges University of London, BIVDA and Roche Diagnostics, outside the submitted work. TI reports grants from Hologic and from Becton Dickinson, outside the submitted work to his institution (University Hospital Tuebingen) and personal speaker honoraria from Hologic Inc during the conduct of the study. MK received grants from Welcome Trust, NIHR, Genesis Trust, Imperial BRC, Imperial Charity outside the submitted work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)