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Title: Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study
Authors: Legood R; Smith MA; Lew JB; Walker R; Moss S; Kitchener H; Patnick J; Canfell K
Categories: Cancer Type - Cervical Cancer
Cancer Control, Survivorship, and Outcomes Research - Health Services, Economic and Health Policy Analyses
Keywords: analysis; Early Detection of Cancer; economics; Guidelines; Health Services; Health Services Research; Humans; Markov Chains; Mass Screening; cancer; Middle Aged; Models,Theoretical; Neoplasm Recurrence,Local; Papillomavirus Infections; Patient Compliance; screening; Sentinel Surveillance; therapy; Treatment Outcome; Uterine Cervical Neoplasms; virology; Cervical Intraepithelial Neoplasia; Cost-Benefit Analysis; diagnosis; drug therapy
Year: 2012
Journal Title: BMJ
Volume: 345
Page number start: e7086
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 pound358,222 (euro440,426; $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 pound9388 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
Programme: Epi Mod Screen
Division: Cancer Research Division
Funding Body: The study was funded by the NHS Cancer Screening Programme. KC was supported by a NHMRC Fellowship (GNT1007994)
DOI: 10.1136/bmj.e7086
Appears in Collections:Research Articles

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