HPV triage testing or repeat Pap smear for the management of atypical squamous cells (ASCUS) on Pap smear: is there evidence of process utility?
Version of Record online: 3 SEP 2007
Copyright © 2007 John Wiley & Sons, Ltd.
Volume 17, Issue 5, pages 593–605, May 2008
How to Cite
Howard, K., Salkeld, G., McCaffery, K. and Irwig, L. (2008), HPV triage testing or repeat Pap smear for the management of atypical squamous cells (ASCUS) on Pap smear: is there evidence of process utility?. Health Econ., 17: 593–605. doi: 10.1002/hec.1278
- Issue online: 17 APR 2008
- Version of Record online: 3 SEP 2007
- Manuscript Accepted: 5 JUL 2007
- Manuscript Revised: 14 JAN 2007
- Manuscript Received: 15 MAY 2006
- National Health and Medical Research Council. Grant Numbers: 211205, 402764
- utility measurement;
- process utility;
- patient preference;
- cervical screening;
A two-stage standard gamble was used to evaluate women's preferences for alternative managements of atypical squamous cells of undermined significance (ASCUS) on Pap smear (repeat Pap smear compared with immediate HPV test), and to test for the evidence of process utility.
Women's utilities for the health state scenarios were clustered towards the upper end of the 0–1 scale with considerable variability in women's preferences. There was evidence of process utility, with immediate human papillomavirus (HPV) testing strategies having lower valuations than repeat Pap smear, where the clinical outcome was the same. Mean (95% CI) utilities for HPV testing (negative test) followed by resolution were 0.9967 (0.9957–0.9978) compared with repeat Pap smear followed by resolution: 0.9972 (0.9964–0.9980). Mean (95% CI) utilities for immediate HPV testing (positive test), followed by colposcopy, biopsy and treatment were 0.9354 (0.8544–1.0) compared with repeat Pap smear followed by colposcopy, biopsy and treatment: 0.9656 (0.9081–1.0).
Our results add to the existing evidence that the impact of healthcare interventions on well-being is not limited to the effect of the intervention on the health outcomes expected from the intervention; process of care can have quality of life implications for the individual. A modelled application of trial-based data will allow characterisation of the true population costs, benefits, risks and harms of alternative triage strategies and subsequent policy implications thereof. Copyright © 2007 John Wiley & Sons, Ltd.