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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:

The authors did not receive funding for this study.

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