SEARCH

SEARCH BY CITATION

Keywords:

  • Cervical intraepithelial neoplasia;
  • cost-effectiveness;
  • human papillomavirus;
  • models;
  • post-treatment

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 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.