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Int J Clin Exp Pathol 2(3),261-266;2009

Original Article
Cost-Effectiveness of Active versus Conservative Colposcopic Management of Mild

Mohsen M. El-Sayed, Wael I. Al-Daraji, Chris M. Finnegan, Wendy E. Dugmore, Barbel U. Vonau, Paul G. Carter and Michael H. Jones

Departments of Gynaecology, Department of Histopathology, Darent Valley Hospital, Dartford, Kent, UK

Received 11 March 2008; Accepted in revision 19 September 2008; Available online 2 October 2008

Abstract: Management of mild dyskaryosis remains controversial. In this study, we compared the cost-effectiveness of active versus
conservative colposcopic management of women presenting with mild dyskaryosis in two different hospital settings. All women presenting in
2001 with a mild dyskaryotic smear and requiring colposcopy were studied in two different clinical settings (70 women at Darent Valley Hospital
(DVH) and 327 at St George’s Hospital (SGH)). At DVH, treatment is offered should there be any evidence of cervical intraepithelial neoplasia
(CIN). On the other hand, a more conservative approach of cytological and colposcopical follow-up is offered to patients with evidence of low-
grade disease at SGH. The outcome of both groups of patients was determined in terms of the number of colposcopy visits per patient, the risk
of missing disease as a consequence of patients lost to follow-up and hospital costs as well as costs to patient over a four-year period. The
majority (70%) of DVH patients had 1-2 colposcopy visits whereas the majority (60%) of SGH patients had 3-7 visits. At SGH 44% of untreated
patients were lost to follow-up and an unknown number of those might have had high-grade disease. Active management is more cost-effective
compared with conservative management (£323 and £589 as cost per patient effectively treated in the two hospitals respectively). In conclusion,
active management of low-grade disease is associated with lower hospital and patient costs compared with the conservative strategy.

Key Words: Mild dyskaryosis, Active management, Conservative Management, Colposcopy, Cost-Effectiveness

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Address all correspondence to: Wael Al-Daraji, M.D., Histopathology Department, Darent Valley Hospital, Darenth Wood Road, Dartford
Kent, DA2 8DA, Tel: 01322 428 131, Fax 01322 428 259 (Attention Dr Wael Al-Daraji), E-mail: