Cost and Effectiveness Comparison of Immediate Colposcopy Versus Human Papillomavirus DNA Testing in Management of Atypical Squamous Cells of Undetermined Significance in Turkish Women

Abstract

<b>Background:</b> A small but significant proportion of cases with atypical squamous cells of undeterminedsignificance (ASCUS) may harbour CIN 2-3, or even invasive carcinoma. Although immediate colposcopy,HPV-DNA testing or expectant management are three recommended options in ASCUS triage, a consensus doesnot currently exist on which one of these approaches is the most efficient. In this study, we aimed to comparethe performance and cost of immediate colposcopy and colposcopy based on the human papillomavirus (HPV)testing for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN) in women withASCUS. Materials and <br/><b>Methods</b>: Records of 594 women with an index Papanicolaou smear showing ASCUSwere retrospectively analyzed. Women in the immediate colposcopy arm were referred directly to colposcopy(immediate colposcopy group, n=255) and those in the HPV triage arm were proceeded to colposcopy if thehigh-risk HPV (hrHPV) test was positive (HPV triage group, n=339). High grade CIN (CIN2+) detection rateand treatment costs were compared between the groups. <br/><b>Results</b>: The detected rate of CIN2+ was higher inthe HPV triage group compared to immediate colposcopy group (8% vs. 1.6%, p=0.011). In the HPV triagegroup, the total cost, cost per patient, and the cost for detecting one case of high grade CIN were higher thanthe immediate colposcopy group (p<0.001). <br/><b>Conclusions</b>: In women with ASCUS cytology, HPV DNA testingfollowed by colposcopy is more costly than immediate colposcopy, but this approach is associated with a higherrate of CIN2+ detection. This findings suggest that HPV DNA testing combined with cervical cytology couldreduce the referral rate to colposcopy