Treatment methods for cervical intraepithelial neoplasia in England: A cost-effectiveness analysis.

Autor: Tinelli M; Department of Health Policy, The London School of Economics and Political Science, London, UK.; Care Policy Evaluation Centre, The London School of Economics and Political Science, London, UK., Athanasiou A; Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK., Veroniki AA; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada., Efthimiou O; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland., Kalliala I; Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK.; Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Bowden S; Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK., Paraskevaidi M; Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK., Lyons D; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK., Martin-Hirsch P; Department of Gynaecologic Oncology, Lancashire Teaching Hospitals, Preston, UK., Bennett P; Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK., Paraskevaidis E; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK.; Department of Obstetrics and Gynaecology, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece., Salanti G; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland., Kyrgiou M; Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK., Naci H; Department of Health Policy, The London School of Economics and Political Science, London, UK.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2024 Sep; Vol. 131 (10), pp. 1411-1419. Date of Electronic Publication: 2024 Apr 24.
DOI: 10.1111/1471-0528.17829
Abstrakt: 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.
(© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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