OBJECTIVES: Our aim was to determine the cost-effectiveness of three strategies for detecting cervical intraepithelial neoplasia 2 and 3 after a determination of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion on screening Papanicolaou (Pap) smear.
METHODS: Single repeat Pap smear. Hybrid Capture testing for human papillomavirus, and immediate colposcopy were compared. A theoretical decision analysis model was constructed with 10,000 women in each group. Costs and outcomes are those of diagnosis and treatment of cervical intraepithelial neoplasia (CIN) 2 or 3. Outcome probabilities and utilization data were obtained from a literature review and expert opinion.
RESULTS: Repeat smear detected 1,125 cases, Hybrid Capture, 1,350 cases, and colposcopy, 1,482 cases of CIN2 or CIN3, costing $1,490,000, $1,980,000, and $2,420,000, respectively. Incremental cost per high-grade dysplasia was $2,178 for Hybrid Capture and $3,333 for colposcopy. Sensitivity analyses that test management efficiencies are reported.
CONCLUSIONS: More effective strategies are more costly. However, if costs saved by preventing invasive cancers are included, all three strategies may be cost-saving.