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Cost-effectiveness Analysis of 2 Surveillance Options for Cervical Intraepithelial Neoplasia 1

Savage, Ashlyn H. MD, MSCR; Marlow, Nicole M. MSPH; Alkis, Mallory H. MD; Simpson, Kit N. PhD

Journal of Lower Genital Tract Disease: April 2014 - Volume 18 - Issue 2 - p 136–141
doi: 10.1097/LGT.0b013e31829eaf31
Original Articles

Objective: We aim to determine the difference in cost between 2 accepted surveillance strategies for women diagnosed with cervical intraepithelial neoplasia 1 (CIN 1): repeat cytology at 6 and 12 months versus human papillomavirus (HPV) DNA testing at 12 months.

Materials and Methods: Extracting data from the literature regarding the natural history of HPV infection and CIN 1, we estimated regression, persistence, and progression rates during a 2-year interval. Costs were based on 2011 Medicaid reimbursements for cytology, biopsy interpretation, HPV testing, and the associated office visit or procedure fee. We constructed a decision tree model to estimate the potential cost benefits of using HPV testing, and sensitivity analyses were performed. Treatment costs for high-grade disease were not included because of equal occurrence in both groups.

Results: In a hypothetical cohort of 100 women with CIN 1 (assumed compliant with 2 y of follow-up), the total cost for cytology-based follow-up was $89,969, whereas the total cost for HPV-based follow-up was $37,357. This indicates an average cost savings of $526 per patient in favor of HPV testing. If we then consider the 234,603 incident cases of CIN 1 in the United Sates per year, preferential use of HPV-based follow-up would save $123,429,305.

Conclusions: Although both cytology and HPV testing are sound methods for surveillance of CIN 1, it is more cost-effective to use HPV testing.

HPV testing at 12-month intervals is more cost-effective than cytology at 6-month intervals for surveillance of cervical intraepithelial neoplasia 1.

Medical University of South Carolina, Charleston, SC

The authors have declared they have no conflicts of interest.

Reprint requests to: Ashlyn H. Savage, MD, MSCR, Medical University of South Carolina, 96 Jonathan Lucas, CSB Suite 634, Charleston, SC 29425. E-mail: savagea@musc.edu

The authors did not receive funding for this study.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology