Treatment methods for cervical intraepithelial neoplasia in England: a cost‐effectiveness analysis

Tinelli, Michela ORCID: 0000-0002-8816-4389, Athanasiou, Antonios, Veroniki, Areti angeliki, Efthimiou, Orestis, Kalliala, Ilkka, Bowden, Sarah, Paraskevaidi, Maria, Lyons, Deirdre, Martin‐hirsch, Pierre, Bennett, Phillip, Paraskevaidis, Evangelos, Salanti, Georgia, Kyrgiou, Maria and Naci, Huseyin ORCID: 0000-0002-7192-5751 (2024) Treatment methods for cervical intraepithelial neoplasia in England: a cost‐effectiveness analysis. BJOG: An International Journal of Obstetrics and Gynaecology, 131 (10). 1411 - 1419. ISSN 1470-0328

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Abstract

Objective To compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN). Design A cost-effectiveness analysis based on data available in the literature and expert opinion. Setting England. Population Women treated for CIN. Methods We developed a decision-analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10-year period. The costs calculated were those incurred by the National Health Service (NHS) of England. Main outcome measures Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted. Results For young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost-effective treatment overall at all willingness-to-pay thresholds. For postmenopausal women, LLETZ remained the most cost-effective treatment up to a threshold of £31,500, but laser conisation became the most cost-effective treatment above that threshold. Conclusions LLETZ is the most cost-effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence.

Item Type:	Article
Official URL:	https://obgyn.onlinelibrary.wiley.com/journal/1471...
Additional Information:	© 2024 The Author(s)
Divisions:	Care Policy and Evaluation Centre Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	26 Apr 2024 09:45
Last Modified:	29 Nov 2024 07:42
URI:	http://eprints.lse.ac.uk/id/eprint/122807

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