Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia
Article first published online: 9 MAR 2007
RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 114, Issue 4, pages 416–424, April 2007
How to Cite
Coupé, V., Berkhof, J., Verheijen, R. and Meijer, C. (2007), Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 416–424. doi: 10.1111/j.1471-0528.2007.01265.x
- Issue published online: 9 MAR 2007
- Article first published online: 9 MAR 2007
- Accepted 31 October 2006.
- Cervical intraepithelial neoplasia;
- human papillomavirus;
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.