Immediate colposcopy or cytological surveillance for women with mild dyskaryosis: a cost effectiveness analysis

G. Flannelly, M. K. Campbell, P. Meldrum, D. J. Torgerson, A. Templeton, H. C. Kitchener
1997 Journal of public health  
The aim of the study was to compare the cost effectiveness of immediate diagnosis and treatment of mild dyskaryosis compared with the usual policy of cytological surveillance. Methods A cost effectiveness analysis was carried out alongside a randomized clinical trial. Results Immediate diagnosis and treatment increased total costs by 50 per cent from £54.42 per treated woman [95 per cent confidence interval (CD £48.85-£59.98] in the surveillance group to £82.02 per woman in the immediate
more » ... he immediate diagnosis and treatment group with an incremental cost of £27.60 (95 per cent Cl £22.04-£33.17). However, the number of cases of CIN III detected increased by 69 per cent for the policy of immediate diagnosis and treatment. This led to an average cost effectiveness ratio of £180.18 for the immediate diagnosis and treatment group and £199.94 per case of CIN III detected for the surveillance group, with a marginal cost effectiveness ratio of £148.22 (95 per cent Cl £94.01-£309.33) for the immediate diagnosis and treatment group. Conclusion Immediate diagnosis and treatment increases the total cost of managing mildly dyskaryotic smears but this increased cost is offset by a sharp increase in the number of cases of CIN III detected. The patients and methods of the Aberdeen Birthright study of mild and moderate dyskaryosis have been described previously. 3 In brief, from August 1989, all women with mild or moderate dyskaryosis on a first abnormal cervical smear (the index smear) were seen at a dedicated colposcopy clinic and invited to participate in the study. Informed consent was obtained and all eligible women were randomized to one of four groups: an immediate diagnosis and treatment group and three surveillance groups with six-monthly cytological and colposcopic surveillance for six, 12 and 24 months, respectively; however, in this paper, only cytological results are considered
doi:10.1093/oxfordjournals.pubmed.a024671 pmid:9467148 fatcat:kwnp2dfd4zbtxpewdiepft4efy