Cost-effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia

Objective: To compare current cytological follow up of women treated for high-grade cervical intraepithelial neoplasia (CIN) with follow up by high-risk human papillomavirus (HPV) testing together with cytology. Design: A cost-effectiveness modelling study. Setting: Gynaecology clinics in the Netherlands. Population: Women treated for high-grade CIN. Methods: A Markov model was developed to compare six follow-up strategies with HPV testing with current cytological follow up at 6, 12, and 24 months. Model parameter estimation was based on three Dutch follow-up studies and a Dutch population-based screening cohort. Main outcome measures: The number of CIN2/3 cases missed after 5 years follow up, the number of diagnostic procedures, and costs involved. Results: Strategies with adjunct HPV testing were more effective than current follow up (reduction in missed CIN2/3 cases 32-77%, corresponding to a number needed to treat of 192-455) and less inconvenient (reduction in repeat smears 28-65%). A particularly attractive strategy was HPV testing alone at 6 months and both HPV and cytological testing at 24 months after treatment. This strategy yielded a high detection rate of post-treatment CIN, did not lead to an increase in colposcopy rate, and was €49 per woman cheaper than the current strategy. Conclusions: Our model supports the use of high-risk HPV testing for monitoring women treated for high-grade CIN.