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

ObjectiveTo compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN).DesignA cost-effectiveness analysis based on data available in the literature and expert opinion.SettingEngland.PopulationWomen treated for CIN.MethodsWe 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 measuresCost 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.ResultsFor 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 pound, but laser conisation became the most cost-effective treatment above that threshold.ConclusionsLLETZ 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 pound to avert one CIN2+ recurrence.