A cost‐effectiveness analysis of four management strategies in the determination and follow‐up of atypical squamous cells of undetermined significance

Abstract

Atypical squamous cells of undetermined significance (ASC-US) are the most common abnormal cytological result on Papanicolaou (Pap) smear. We analyzed four management strategies in a hypothetical cohort of women divided by age group: (1) immediate colposcopy, (2) repeat cytology after an ASC-US Pap smear result, (3) conventional Pap with reflex human papillomavirus (HPV) testing, and (4) liquid-based cytology with reflex HPV testing. Parameter variables were collected from previously published data. Strategies that included reflex HPV testing had the lowest overall costs for all age groups combined. Repeat Pap smears had the highest number of true positive results throughout all stages but also had the uppermost number of missed cancers and highest costs. Immediate colposcopy had the second highest overall costs and detected fewer true positive results than liquid-based cytology. Younger women (aged 18-24 yr) consistently had higher total costs for all strategies investigated. Using the incremental cost-effectiveness (CE) ratio, the immediate colposcopy strategy was more costly and less effective than liquid-based cytology and, therefore, was dominated. The incremental CE ratio was lowest for liquid-based cytology compared with conventional cytology and liquid-based cytology with reflex HPV testing was the most cost-effective strategy.

An economic analysis of human papillomavirus triage for the management of women with atypical and abnormal Pap smear results in Germany

“…In a second study using this model to examine the cost effectiveness of HPV triage in the UK, The Netherlands, France, and Italy, Kim et al found that HPV triage was more effective than each country's status quo screening policy, and each HPV triage scenario examined had an incremental cost-effectiveness ratio below $13,000 per year of life saved [21]. Similar studies in the USA looking at management alternatives for ASCUS and atypical glandular cells of undetermined significance (AGCUS) also found HPV testing to be the most costeffective option [22,23]. Guyot et al conducted a cost [25].…”

ASCUS : état des lieux

“…1 Ces trois options ont été validées par de nombreux travaux parus dans la littérature nord-américaine [14][15][16][17].…”

“…Elle a l'inconvénient de retarder le diagnostic s'il s'agit d'un cancer invasif mais comme nous l'avons vu, cette éventualité est exceptionnelle. C'est l'option la moins sensible [17].…”

O diagnóstico de células escamosas atípicas em citologia oncológica cervical

“…As alternativas mais estudadas são: a repetição da citologia em 4 a 6 meses e encaminhamento para investigação se houver persistência do achado ou modificação para pior, o encaminhamento imediato e a investigação da presença de infecção por papilomavírus. Os resultados de várias investigações dão suporte para cada uma destas condutas [18][19][20][21] independente da classificação empregada para emissão do laudo citológico.…”