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Surveillance after treatment for cervical intraepithelial neoplasia: outcomes, costs, and cost-effectiveness.
- Source :
-
Obstetrics and gynecology [Obstet Gynecol] 2010 Nov; Vol. 116 (5), pp. 1158-70. - Publication Year :
- 2010
-
Abstract
- Objective: To estimate outcomes and costs of surveillance strategies after treatment for high-grade cervical intraepithelial neoplasia (CIN).<br />Methods: A hypothetical cohort of women was evaluated after treatment for CIN 2 or 3 using a Markov model incorporating data from a large study of women treated for CIN, systematic reviews of test accuracy, and individual preferences. Surveillance strategies included initial conventional or liquid-based cytology, human papillomavirus testing, or colposcopy 6 months after treatment, followed by annual or triennial cytology. Estimated outcomes included CIN, cervical cancer, cervical cancer deaths, life expectancy, costs, cost per life-year, and cost per quality-adjusted life-year.<br />Results: Conventional cytology at 6 and 12 months, followed by triennial cytology, was least costly. Compared with triennial cytology, annual cytology follow-up reduced expected cervical cancer deaths by 73% to 77% and had an average incremental cost per life-year gained of $69,000 to $81,000. For colposcopy followed by annual cytology, the incremental cost per life-year gained ranged from $70,000 to more than $1 million, depending on risk. Between-strategy differences in mean additional life expectancy per woman were less than 4 days; differences in mean incremental costs per woman were as high as $822. In the cost-utility analysis, colposcopy at 6 months followed by annual cytology had an incremental cost per quality-adjusted life-year of less than $5,500. Human papillomavirus testing or liquid-based cytology added little to no improvement to life-expectancy with higher costs.<br />Conclusion: Annual conventional cytology surveillance reduced cervical cancers and cancer deaths compared with triennial cytology. For high risk of recurrence, a strategy of colposcopy at 6 months increased life expectancy and quality-adjusted life expectancy. Human papillomavirus testing and liquid-based cytology increased costs, but not effectiveness, compared with traditional approaches.
- Subjects :
- Adult
Colposcopy economics
Conization
Cost-Benefit Analysis
Cryosurgery
Cytodiagnosis economics
False Positive Reactions
Female
Follow-Up Studies
Humans
Markov Chains
Papillomaviridae isolation & purification
Papillomavirus Infections complications
Papillomavirus Infections diagnosis
Papillomavirus Infections economics
Uterine Cervical Neoplasms diagnosis
Uterine Cervical Neoplasms economics
Uterine Cervical Neoplasms virology
Uterine Cervical Dysplasia diagnosis
Uterine Cervical Dysplasia economics
Uterine Cervical Dysplasia virology
Uterine Cervical Neoplasms surgery
Uterine Cervical Dysplasia surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1873-233X
- Volume :
- 116
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Obstetrics and gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 20966702
- Full Text :
- https://doi.org/10.1097/AOG.0b013e3181f88e72