Annual Cytology Best Screening Strategy After CIN

Cytology annually better than triennially after high-grade cervical intraepithelial neoplasia

THURSDAY, Dec. 2 (HealthDay News) -- Using a model to compare various follow-up strategies after treatment for high-grade cervical intraepithelial neoplasia (CIN), annual cytology screening appears to be the most cost-effective, and human papillomavirus screening adds little value, according to research published in the November issue of Obstetrics & Gynecology.

To evaluate a hypothetical cohort of women after treatment for CIN 2 or 3, Joy Melnikow, M.D., of the University of California at Davis, and colleagues used a Markov model incorporating data from a large study of women treated for CIN, systematic reviews of test accuracy, and individual preferences. Surveillance strategies considered included initial conventional or liquid-based cytology, human papillomavirus testing, or colposcopy six months after treatment, followed by cytology either annually or every three years.

The researchers found that the least expensive follow-up method was conventional cytology at six and 12 months, followed by triennial cytology. Annual cytology reduced expected cervical cancer deaths by 73 to 77 percent more than triennial cytology, with an average incremental cost per life-year gained of $69,000 to $81,000. A strategy of colposcopy followed by annual cytology raised the incremental cost per life-year gained to between $70,000 and more than $1 million, depending on risk. Human papillomavirus testing or liquid-based cytology did not improve life expectancy and added higher costs.

"[Our findings] suggest that newer technologies have increased the cost of surveillance after treatment without providing any meaningful increase in life expectancy or reductions in cancer, compared with traditional approaches to surveillance. Increasing use of conventional cytology and initial colposcopy for surveillance of women at high risk would reduce the costs of posttreatment surveillance and provide health care resources that could be used more productively to broaden access to cervical cancer screening, treatment, and surveillance," the authors conclude.

One author disclosed financial relationships with the pharmaceutical and medical device industries.

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