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Published on: June 14, 2019
Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia
V M H Coupé1, J Berkhof, R H M Verheijen
1Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands. v.coupe@vumc.nl
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 Euro 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.