Our aim was to determine the cost-effectiveness of three strategies for detecting cervical intraepithelial neoplasia 2 and 3 after a determination of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion on screening Papanicolaou (Pap) smear.Methods.
Single repeat Pap smear. Hybrid Capture testing for human papillomavirus, and immediate colposcopy were compared. A theoretical decision analysis model was constructed with 10,000 women in each group. Costs and outcomes are those of diagnosis and treatment of cervical intraepithelial neoplasia (CIN) 2 or 3. Outcome probabilities and utilization data were obtained from a literature review and expert opinion.Results.
Repeat smear detected 1,125 cases, Hybrid Capture, 1,350 cases, and colposcopy, 1,482 cases of CIN2 or CIN3, costing $1,490,000, $1,980,000, and $2,420,000, respectively. Incremental cost per high-grade dysplasia was $2,178 for Hybrid Capture and $3,333 for colposcopy. Sensitivity analyses that test management efficiencies are reported.Conclusions.
More effective strategies are more costly. However, if costs saved by preventing invasive cancers are included, all three strategies may be cost-saving.