Surveillance after treatment for cervical intraepithelial neoplasia: Outcomes, costs, and cost-effectiveness

Joy Melnikow, Shalini Kulasingam, Christina Slee, L. Jay Helms, Miriam Kuppermann, Stephen Birch, Colleen E. McGahan, Andrew Coldman, Benjamin K S Chan, George F. Sawaya

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objective: To estimate outcomes and costs of surveillance strategies after treatment for high-grade cervical intraepithelial neoplasia (CIN). Methods: A hypothetical cohort of women was evaluated after treatment for CIN 2 or 3 using a Markov model incorporating data from a large study of women treated for CIN, systematic reviews of test accuracy, and individual preferences. Surveillance strategies included initial conventional or liquid-based cytology, human papillomavirus testing, or colposcopy 6 months after treatment, followed by annual or triennial cytology. Estimated outcomes included CIN, cervical cancer, cervical cancer deaths, life expectancy, costs, cost per life-year, and cost per quality-adjusted life-year. Results: Conventional cytology at 6 and 12 months, followed by triennial cytology, was least costly. Compared with triennial cytology, annual cytology follow-up reduced expected cervical cancer deaths by 73% to 77% and had an average incremental cost per life-year gained of $69,000 to $81,000. For colposcopy followed by annual cytology, the incremental cost per life-year gained ranged from $70,000 to more than $1 million, depending on risk. Between-strategy differences in mean additional life expectancy per woman were less than 4 days; differences in mean incremental costs per woman were as high as $822. In the cost-utility analysis, colposcopy at 6 months followed by annual cytology had an incremental cost per quality-adjusted life-year of less than $5,500. Human papillomavirus testing or liquid-based cytology added little to no improvement to life-expectancy with higher costs. Conclusion: Annual conventional cytology surveillance reduced cervical cancers and cancer deaths compared with triennial cytology. For high risk of recurrence, a strategy of colposcopy at 6 months increased life expectancy and quality-adjusted life expectancy. Human papillomavirus testing and liquid-based cytology increased costs, but not effectiveness, compared with traditional approaches.

Original languageEnglish (US)
Pages (from-to)1158-1170
Number of pages13
JournalObstetrics and Gynecology
Volume116
Issue number5
DOIs
StatePublished - 2010

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

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    Melnikow, J., Kulasingam, S., Slee, C., Helms, L. J., Kuppermann, M., Birch, S., McGahan, C. E., Coldman, A., Chan, B. K. S., & Sawaya, G. F. (2010). Surveillance after treatment for cervical intraepithelial neoplasia: Outcomes, costs, and cost-effectiveness. Obstetrics and Gynecology, 116(5), 1158-1170. https://doi.org/10.1097/AOG.0b013e3181f88e72