Original Article Cost-Effectiveness of Active versus Conservative Colposcopic Management of Mild Dyskaryosis
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. (IJCEP803002).
Key Words: Mild dyskaryosis, Active management, Conservative Management, Colposcopy, Cost-Effectiveness