Economic analysis of human papillomavirus triage, repeat cytology, and immediate colposcopy in management of women with minor cytological abnormalities in Sweden.
Acta Obstet Gynecol Scand
; 89(10): 1316-25, 2010 Oct.
Article
in En
| MEDLINE
| ID: mdl-20846064
ABSTRACT
OBJECTIVE:
To assess the cost-effectiveness of using human papillomavirus testing (HPV triage) in the management of women with minor cytological abnormalities in Sweden.DESIGN:
An economic analysis based on a clinical trial, complemented with data from published meta-analyses on accuracy of HPV triage. The study takes perspective of the Swedish healthcare system.SETTING:
The Swedish population-based cervical cancer screening program.METHODS:
A decision analytic model was constructed to evaluate cost-effectiveness of HPV triage compared to repeat cytology and immediate colposcopy with biopsy, stratifying by index cytology (ASCUS = atypical squamous cells of undetermined significance, and LSIL = low-grade squamous intraepithelial lesion) and age (23-60 years, <30 years and ≥30 years). MAIN OUTCOMEMEASURES:
Costs, incremental cost, incremental effectiveness and incremental cost per additional high-grade lesion (CIN2+) detected.RESULTS:
For women with ASCUS ≥30 years, HPV triage is the least costly alternative, whereas immediate colposcopy with biopsy provides the most effective option at an incremental cost-effectiveness ratio (ICER) of SEK 2,056 per additional case of CIN2+ detected. For LSIL (all age groups) and ASCUS (23-60 years and <30 years), HPV triage is dominated by immediate colposcopy and biopsy. Model results were sensitive to HPV test cost changes.CONCLUSION:
With improved HPV testing techniques at lower costs, HPV triage can become a cost-effective alternative for follow-up of minor cytological abnormalities. Today, immediate colposcopy with biopsy is a cost-effective alternative compared to HPV triage and repeat cytology.
Full text:
1
Database:
MEDLINE
Main subject:
Vaginal Smears
/
Uterine Cervical Dysplasia
/
Uterine Cervical Neoplasms
/
Triage
/
Colposcopy
Type of study:
Diagnostic_studies
/
Health_economic_evaluation
/
Prognostic_studies
Limits:
Adult
/
Female
/
Humans
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Year:
2010
Type:
Article