Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study.

Legood, R; Smith, M; Lew, JB; Walker, R; Moss, S; Kitchener, H; Patnick, J; Canfell, K; (2012) Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study. BMJ (Clinical research ed), 345. e7086. ISSN 0959-8138 DOI: 10.1136/bmj.e7086

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Abstract

OBJECTIVES: To evaluate the cost effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia (CIN). DESIGN: Economic analysis using a Markov modelling approach to combine cost and epidemiological data from the NHS Sentinel Sites Study with data from previous studies of post-treatment recurrence rates. SETTING: English NHS Cervical Cancer Screening Programme. INTERVENTIONS: Management guidelines after treatment of CIN involving annual cytology follow-up for 10 years, compared with alternative protocols using the human papillomavirus test to reduce the amount of post-treatment surveillance. MAIN OUTCOME MEASURES: Cases of underlying CIN3+ averted at 10 years and costs per 1000 women treated. RESULTS: Model predictions indicated that, at observed levels of compliance with post-treatment recommendations, management with only cytological follow-up would result in 29 residual cases of recurrent CIN3+ by 10 years and would cost £358?222 (€440?426; $574?910) (discounted) per 1000 women treated. Implementation of human papillomavirus test of cure in cytologically negative women according to the sentinel sites protocol would avert an additional 8.4 cases of CIN 3+ and reduce costs by £9388 per 1000 women treated. CONCLUSIONS: Human papillomavirus test of cure would be more effective and would be cost saving compared with cytology only follow-up. The results of this evaluation support the full scale implementation of human papillomavirus test of cure after treatment of CIN within the NHS Cervical Screening Programme.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 23117060
Web of Science ID: 310779000004
URI: http://researchonline.lshtm.ac.uk/id/eprint/396609

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