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

Background: A small but significant proportion of cases with atypical squamous cells of undetermined significance (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 does not currently exist on which one of these approaches is the most efficient. In this study, we aimed to compare the 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 with ASCUS. Materials and Methods: Records of 594 women with an index Papanicolaou smear showing ASCUS were 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 the high-risk HPV (hrHPV) test was positive (HPV triage group, n=339). High grade CIN (CIN2+) detection rate and treatment costs were compared between the groups. Results: The detected rate of CIN2+ was higher in the HPV triage group compared to immediate colposcopy group (8% vs. 1.6%, p=0.011). In the HPV triage group, the total cost, cost per patient, and the cost for detecting one case of high grade CIN were higher than the immediate colposcopy group (p<0.001). Conclusions: In women with ASCUS cytology, HPV DNA testing followed by colposcopy is more costly than immediate colposcopy, but this approach is associated with a higher rate of CIN2+ detection. This findings suggest that HPV DNA testing combined with cervical cytology could reduce the referral rate to colposcopy

Clinical Significance of Atypical Squamous Cells of Undetermined Significance in Detecting Preinvasive Cervical Lesions in Post-Menopausal Turkish Women

“…In our post-menopausal group women HPV DNA positivity and preinvasive lesions were lower than the premenopausal age women. Kececioglu et al (2013) reported that HPV DNA testing results in more cases with high grade preinvasive lesions than immediate colposcopy in women who had ASCUS on first PAP test. But, while this approach reduces the referral rate to colposcopy, it could increase the cost of management.…”

Clinical management of the first ASCUS report in Chile. Prospective single-cohort study

“…1,2 The clinical significance of ASCUS is considered to be indeterminate, which means that there is controversy or debate regarding its clinical management, given that there is no single choice for optimal treatment. 3,4 In Chile, the Ministry of Health (Minsal) has developed clinical guidelines that contain two clinical decision diagrams called the "algorithm for conveying the first atypical Pap test according to Bethesda 2001 classification, to a specialist or cervical pathology unit (CPU)" and the "algorithm for diagnostic confirmation". 5,6 These diagrams contain the steps for diagnostic confirmation and treatment of cervical atypia and are based on the first consensus guidelines for management of these cervical atypia, published by Wright et al, 7 which were based on the multicenter study titled Atypical Squamous Cells of Undetermined…”

Prevalence of High-Grade Intraepithelial Neoplasia in Patients with Cytology Presenting Atypical Squamous Cells of Undetermined Significance

“…In Turkey, Kececioglu et al [8] evaluated 594 women with ASCUS cytology and concluded that HPV DNA testing followed by colposcopy in positive cases is more costly than an immediate colposcopy. However, this first approach is associated with a higher rate of CIN 2+ detection [8]. …”

“…Some countries recommend the use of HPV-DNA testing which, if positive, is the indicative criterion for colposcopy [8]. However, owing to the high cost of the test in the Brazilian market, this strategy is not implemented in Brazil, where the majority of public health services do not have this technology available, and so repetition of the cytopathological exam is used to screen those women who truly need a colposcopy.…”