Cost‐effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia

Coupé, Veerle M.H.; Berkhof, Johannes; Verheijen, René H.M.; Meijer, Chris J.L.M.

doi:10.1111/j.1471-0528.2007.01265.x

Cited by 34 publications

(23 citation statements)

References 40 publications

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“…The decision for a second treatment in our study relied upon cytology and colposcopy protocol, mainly (81.2%) during the first year of follow-up. Histology reports were mostly negative in those reoperated 6 months after conization, which confirms findings of some other authors that this protocol is more often falsepositive in the early follow-up period [10].…”

Section: Discussionsupporting

confidence: 87%

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

Banović

Mahovlić

Salopek

et al. 2014

Pathol. Oncol. Res.

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There is still debate on what is the optimal follow-up protocol after a treatment for preinvasive cervical disease. We performed this study in order to improve diagnostic accuracy of the follow-up protocol and at the same time reducing the number of overtreated patients. One hundred and fourteen patients were followed up after conization for CIN3 and/or AIS at 3-6 month, 9-12 month and 18-24 month intervals, then yearly. The follow-up consisted of cytology, colposcopy with biopsy if needed and HPV testing. The end-point of the study was a secondary treatment due to a high suspicion of resdidual/recurrent disease or disease free period of at least 24 months. The median follow-up time was 41 months (5-72 months). In predicting residual/recurrent disease cytology had a specificity of 88.9%, sensitivity of 100%, PPV of 33.3% and a NPV of 100% whereas HPV had a specificity of 76.9%, sensitivity of 100%, PPV of 21.4% and a NPV of 100%. According to our results both tests can be used as a primary follow-up tool after conization. The choice should depend on a socio-economic aspect. In our setting the HPV test should be done only in those patients with a positive smear any time during follow-up as the point of decision for a second treatment. With this approach we could considerably decrease the number of reoperated patients and co-morbidities.

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Section: Discussionsupporting

confidence: 87%

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

Banović

Mahovlić

Salopek

et al. 2014

Pathol. Oncol. Res.

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“…Although Coup e et al previously recommended the latter strategy on basis of a simulation prediction model, we could not confirm the advantage in our study. 26 An explanation might be the difference in follow-up time for residual/recurrence, which was 5 years in the prediction model in contrast with 2 years follow-up in this randomised clinical trial. Conversely, our proposed modification (B1) of combined testing at 6 and 24 months for low-risk women and combined testing at 6,12 and 24 months for high-risk women was not evaluated in the prediction model.…”

Section: Discussionmentioning

confidence: 85%

“…This is in agreement with previous observational studies where hrHPV testing has been proposed as a screening tool for follow-up after treatment for high-grade CIN. 13,[18][19][20]22,26 Although improvement of specificity to detect residual/recurrent CIN was obtained using combined testing, no significant change in sensitivity was observed. Because of the small numbers of residual/recurrent CIN, this finding remains uncertain based on the confidence interval (Table III).…”

Section: Discussionmentioning

confidence: 98%

“…HPV testing was performed with the consensus GP51/GP61 PCR enzyme immunoassay (EIA) using a cocktail probe covering all (probably) hrHPV types (i.e., HPV 16,18,26,31,33,35,39,45,51,52,53,56,58,59,66,68,73 and 82) and a yet unclassified HPV type (i.e., HPV 67) of which an oncogenic potential cannot be excluded, as previously described. 23 This test is clinically validated.…”

Section: Hpv Testingmentioning

confidence: 99%

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Post‐treatment CIN: Randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease

Bais

Eijkemans

Snijders

et al. 2008

Intl Journal of Cancer

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We investigated in a randomised clinical trial whether addition of hrHPV testing (high-risk human papillomavirus) to cytological follow-up after treatment for high-grade CIN (cervical intraepithelial neoplasia 2/3) can lead to a better selection of women at risk for residual/recurrent CIN. We included 210 women with high-grade CIN undergoing treatment in outpatient clinics in The Netherlands. Follow-up was based on cytology alone and cytology combined with hrHPV detection. Our primary outcome measurement was improving specificity for residual/recurrent CIN after treatment. Secondary, we compared health-care costs and impact of individual hrHPV type on the risk of residual/recurrent CIN. Follow-up by abnormal cytology alone (6, 12 and 24 months after treatment according to the Dutch protocol) showed a lower specificity for detection of residual/recurrent CIN than follow-up by abnormal cytology and presence of hrHPV (80 vs. 91%, relative risk 0.87 (95% CI 0.77-0.99)). Both methods showed no significant difference in sensitivity ((86 vs. 100%) RR 0.86 (95% CI 0.63-1.16)). Comparing different post hoc modifications in the strategy of combined testing showed similar test characteristics when lowrisk women (normal cytology and hrHPV negative at 6 months) omitted the 12 months visit (specificity 91%, p 5 1.00 z 5 0.00). Prediction of residual/recurrent CIN by typing of hrHPV could not be confirmed. Total health-care costs using cytology and hrHPV testing during follow-up decreased when low-risk women omit the 12 months visit. Follow-up after treatment for high-grade CIN can be improved by combining cytology with hrHPV testing. We advise combined cytology and hrHPV testing at 6, 12 and 24 months after treatment. Low-risk women may omit the 12 months visit, resulting in cost reduction. ' 2008 Wiley-Liss, Inc.Key words: cervical intraepithelial neoplasia; human papillomavirus; residual/recurrent CIN; RCT According to current Dutch standards, follow-up after treatment for high-grade CIN (cervical intraepithelial neoplasia 2/3) consists of cervical cytological monitoring at 6, 12 and 24 months, to identify residual/recurrent CIN lesions (CIN 2/3).1 Colposcopic examination is performed where there is abnormal cervical cytology. In case of normal cytology after 24 months, follow-up will be performed within the national screening program. One of the drawbacks of cervical cytological follow-up after treatment is the high number of false-positive findings. Approximately 20% of the women have abnormal cervical cytology within the first 2 years of follow-up. However, in more than half of these women no underlying residual/recurrent CIN will be found, resulting in unnecessary diagnostic and therapeutic procedures.2-6 The reported residual/recurrent high-grade CIN rates vary between 5 and 35%. 2,3,[7][8][9] A persistent infection with high-risk human papillomavirus (hrHPV) is necessary for the development, maintenance and progression of primary CIN lesions. [10][11][12] It is assumed that effective treatment for CIN lesions results...

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“…1) : un premier contrôle entre trois et six mois associant frottis et test HPV (à trois mois on augmentera la compliance à la surveillance mais on s'exposera à un plus fort taux de faux positifs) : la très forte sensibilité des deux tests couplés permet de ne pas méconnaître une lésion grave persistante et la valeur prédictive négative très élevée des deux tests négatifs autorise un contrôle à 18 mois après la conisation et en cas de négativité maintenue des deux tests une surveillance comparable à celle de la population générale qui sera prolongée cependant plus de 25 ans ; en cas de positivité d'un des deux tests ou des deux tests, une colposcopie est nécessaire (et dans cette population sélectionnée, la colposcopie sera rentable pour peu qu'elle soit interprétable) : normale, elle conduira à un contrôle à six mois cytologique et virologique, pathologique à une prise en charge adaptée ; si la colposcopie n'est pas interprétable et que seul le test virologique est positif (donc avec une cytologie normale), il [73,74]. Par ailleurs, les premières études coût-efficacité sont en faveur de l'introduction de ce test dans la surveillance [75].…”

Section: Vers Un Nouveau Protocole De Surveillance Après Conisationunclassified

Quel suivi après traitement chirurgical d’une lésion de haut grade du col utérin ?

Mergui¹,

Lévèque

2008

Gynécologie Obstétrique & Fertilité

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Cost‐effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia

Abstract: Our model supports the use of high-risk HPV testing for monitoring women treated for high-grade CIN.

Cited by 34 publications

References 40 publications

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

Post‐treatment CIN: Randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease

Quel suivi après traitement chirurgical d’une lésion de haut grade du col utérin ?

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