Cost-effectiveness analysis based on the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion Triage Study (ALTS).
Select Content Type
Clinical Guidelines
Authored By
Kulasingam SL, Kim JJ, Lawrence WF, Mandelblatt JS, Myers ER, Schiffman M, Solomon D, Goldie SJ
Authored On
Interests
Obstetrics & Gynecology
Oncology
Speciality
Obstetrics & Gynecology
Oncology
Book Detail
volume
98
ISSN
1460-2105
No. of pages
9
Publication Date
Actions
Download in App
Event Data
{"article_title":"Cost-effectiveness analysis based on the atypical squamous cells of undetermined significance\/low-grade squamous intraepithelial lesion Triage Study (ALTS).","author":"\"Kulasingam, Shalini L , Kim, Jane J , Lawrence, William F , Mandelblatt, Jeanne S , Myers, Evan R , Schiffman, Mark , Solomon, Diane , Goldie, Sue J , ALTS Group\"","journal_title":"Journal of the National Cancer Institute","issn":"1460-2105 ; Electronic","isbn":"","publication_date":"20060118","volume":"98","issue":"2","first_page":"92","page_count":"9","accession_number":"16418511","doi":"10.1093\/jnci\/djj009","publisher":"Oxford University Press","doctype":"Journal Article; Research Support","subjects":"Oncoloy ","interest_area":["Obstetrics & Gynecology"," Oncology"],"abstract":"The ALTS (atypical squamous cells of undetermined significance [ASCUS] and low-grade squamous intraepithelial lesion [LSIL] Triage Study) suggests that, for women diagnosed with ASCUS, human papillomavirus (HPV) DNA testing followed by referral to colposcopy of only those women with oncogenic HPV (i.e., HPV DNA testing) is as effective at detecting cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN3+) as referring all women with ASCUS for immediate colposcopy. We conducted a cost-effectiveness analysis of the ALTS trial to determine whether HPV DNA testing is a cost-effective alternative to immediate colposcopy or conservative management with up to three cytology examinations.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=16418511&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Kulasingam SL, Kim JJ, Lawrence WF, Mandelblatt JS, Myers ER, Schiffman M, Solomon D, Goldie SJ","Corporate_Authors":"ALTS Group","Journal_Info":"Publisher: Oxford University Press Country of Publication: United States NLM ID: 7503089 Publication Model: Print Cited Medium: Internet ISSN: 1460-2105 (Electronic) Linking ISSN: 00278874 NLM ISO Abbreviation: J Natl Cancer Inst Subsets: MEDLINE","Publication_Type":"Journal Article; Research Support, N.I.H., Extramural","Published_Date":"2006-01-18","Source":"Journal of the National Cancer Institute [J Natl Cancer Inst] 2006 Jan 18; Vol. 98 (2), pp. 92-100.","Languages":"English","Electronic_ISSN":"1460-2105","MeSH_Terms":"Carcinoma, Squamous Cell\/*economics , Colposcopy\/*economics , DNA Probes, HPV\/*economics , Mass Screening\/*economics , Papillomaviridae\/*isolation & purification , Uterine Cervical Neoplasms\/*economics, Adult ; Aged ; Carcinoma, Squamous Cell\/diagnosis ; Carcinoma, Squamous Cell\/virology ; Cost-Benefit Analysis ; DNA, Viral\/isolation & purification ; Decision Trees ; Direct Service Costs ; Female ; Humans ; Mass Screening\/methods ; Middle Aged ; Multicenter Studies as Topic ; Papillomaviridae\/genetics ; Randomized Controlled Trials as Topic ; Sensitivity and Specificity ; Triage\/economics ; United States ; Uterine Cervical Neoplasms\/diagnosis ; Uterine Cervical Neoplasms\/virology ; Uterine Cervical Dysplasia\/diagnosis ; Uterine Cervical Dysplasia\/economics","Subjects":"Adult, Aged, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell virology, Cost-Benefit Analysis, DNA, Viral isolation & purification, Decision Trees, Direct Service Costs, Female, Humans, Mass Screening methods, Middle Aged, Multicenter Studies as Topic, Papillomaviridae genetics, Randomized Controlled Trials as Topic, Sensitivity and Specificity, Triage economics, United States, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms virology, Uterine Cervical Dysplasia diagnosis, Uterine Cervical Dysplasia economics, Carcinoma, Squamous Cell economics, Colposcopy economics, DNA Probes, HPV economics, Mass Screening economics, Papillomaviridae isolation & purification, Uterine Cervical Neoplasms economics","Title_Abbreviations":"Journal of the National Cancer Institute","Volume":"98"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"16418511","RelevancyScore":"759","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"758.640686035156"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=16418511&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=16418511&authtype=shib&custid=ns346513&group=main&profile=eds"}
["Kulasingam SL, Kim JJ, Lawrence WF, Mandelblatt JS, Myers ER, Schiffman M, Solomon D, Goldie SJ","ALTS Group","Publisher: Oxford University Press Country of Publication: United States NLM ID: 7503089 Publication Model: Print Cited Medium: Internet ISSN: 1460-2105 (Electronic) Linking ISSN: 00278874 NLM ISO Abbreviation: J Natl Cancer Inst Subsets: MEDLINE","Journal Article; Research Support, N.I.H., Extramural","2006-01-18","Journal of the National Cancer Institute [J Natl Cancer Inst] 2006 Jan 18; Vol. 98 (2), pp. 92-100.","English","1460-2105","Carcinoma, Squamous Cell\/*economics , Colposcopy\/*economics , DNA Probes, HPV\/*economics , Mass Screening\/*economics , Papillomaviridae\/*isolation & purification , Uterine Cervical Neoplasms\/*economics, Adult ; Aged ; Carcinoma, Squamous Cell\/diagnosis ; Carcinoma, Squamous Cell\/virology ; Cost-Benefit Analysis ; DNA, Viral\/isolation & purification ; Decision Trees ; Direct Service Costs ; Female ; Humans ; Mass Screening\/methods ; Middle Aged ; Multicenter Studies as Topic ; Papillomaviridae\/genetics ; Randomized Controlled Trials as Topic ; Sensitivity and Specificity ; Triage\/economics ; United States ; Uterine Cervical Neoplasms\/diagnosis ; Uterine Cervical Neoplasms\/virology ; Uterine Cervical Dysplasia\/diagnosis ; Uterine Cervical Dysplasia\/economics","Adult, Aged, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell virology, Cost-Benefit Analysis, DNA, Viral isolation & purification, Decision Trees, Direct Service Costs, Female, Humans, Mass Screening methods, Middle Aged, Multicenter Studies as Topic, Papillomaviridae genetics, Randomized Controlled Trials as Topic, Sensitivity and Specificity, Triage economics, United States, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms virology, Uterine Cervical Dysplasia diagnosis, Uterine Cervical Dysplasia economics, Carcinoma, Squamous Cell economics, Colposcopy economics, DNA Probes, HPV economics, Mass Screening economics, Papillomaviridae isolation & purification, Uterine Cervical Neoplasms economics","Journal of the National Cancer Institute","98"]
Description
Background: The ALTS (atypical squamous cells of undetermined significance [ASCUS] and low-grade squamous intraepithelial lesion [LSIL] Triage Study) suggests that, for women diagnosed with ASCUS, human papillomavirus (HPV) DNA testing followed by referral to colposcopy of only those women with oncogenic HPV (i.e., HPV DNA testing) is as effective at detecting cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN3+) as referring all women with ASCUS for immediate colposcopy. We conducted a cost-effectiveness analysis of the ALTS trial to determine whether HPV DNA testing is a cost-effective alternative to immediate colposcopy or conservative management with up to three cytology examinations.<br />Methods: Data from the ALTS trial were used in conjunction with medical care costs in a short-term decision model. The model compared the incremental costs per case of CIN3+ detected as measured by the incremental cost-effectiveness ratio (ICER) for the following management strategies for women with ASCUS: immediate colposcopy, HPV DNA testing, and conservative management with up to three cytology examinations.<br />Results: The least costly and least sensitive strategy was conservative management with one repeat cytology examination using a threshold of high-grade squamous intraepithelial lesion (HSIL) for referral to colposcopy. Compared with this strategy, triage to colposcopy based on a positive HPV DNA test result had an ICER of 3517 dollars per case of CIN3+ detected. Immediate colposcopy and conservative management with up to three repeat cytology visits detected fewer cases of CIN3+ and were more costly than HPV DNA testing. Immediate colposcopy became cost-effective at 20,370 dollars compared with HPV DNA testing only if colposcopy and biopsy were assumed to be 100% sensitive.<br />Conclusions: HPV DNA testing is an economically viable strategy for triage of ASCUS cytology. The less than perfect sensitivity of colposcopy and biopsy needs to be accounted for in future clinical guidelines and policy analyses.
