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A cost-effectiveness analysis of screening strategies for cervical intraepithelial neoplasia
J Michael Straughn1, T Michael Numnum, Rodney P Rocconi
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. jmstraughn@yahoo.com
Objective:
To assess the costs and usefulness of colposcopy using three screening strategies for cervical intraepithelial neoplasia (CIN).
Materials And Methods:
A decision model compared three screening strategies for CIN: (1) patients were screened annually with a conventional Pap smear, (2) patients were screened annually with a liquid-based cytologic method and reflex human papillomavirus testing for atypical squamous cells of undetermined significance results, and (3) patients were screened biennially with a liquid-based cytologic method and reflex human papillomavirus testing for atypical squamous cells of undetermined significance results.
Results:
Biennial liquid-based screening was the least expensive strategy with a cost of $9.5 million per 100,000 patients. Annual liquid-based screening was the most expensive strategy at $13.7 million. Annual conventional screening had an intermediate cost of $11.6 million. Biennial liquid-based screening referred the fewest patients to colposcopy (11.8%), followed by annual conventional screening and annual liquid-based screening (15.2% and 15.6%, respectively).
Conclusions:
Each of these treatment strategies is reasonable; however, biennial liquid-based screening would reduce medical costs significantly.
