Clinical and economic benefit of HPV-load testing in follow-up and management of women postcone biopsy for CIN2–3

This study aimed to evaluate the clinical and economic implications of integrating human papilloma virus (HPV) load testing into the follow-up and management protocol of women postconisation for high-grade cervical intraepithelial neoplasia (CIN2–3). We evaluated 130 suitable women: 63 were screened biannually by Pap smears (‘conventional approach’) and 67 also had HPV-load testing (‘HPV approach’). More stringent criteria for undergoing colposcopy or reconisation were observed by the former group compared to the latter. Both approaches were analysed for cost effectiveness. There were 33 out of 67 (49.2%) colposcopic referrals and 24 out of 67 (35.8%) reconisation/hysterectomies with the ‘conventional approach’ compared to 9 out of 63 (14.2%) and 7 out of 63 (11.1%) with the ‘HPV approach’. Cervical intraepithelial neoplasia 2–3 residual disease was detected in 7 out of 67 (10.5%) and 7 out of 63 (11.1%) women. The ‘conventional approach’ had more negative colposcopic biopsies and more negative reconisation/hysterectomy histologies than the ‘HPV approach’. The respective cost per detection of one case of residual disease was US$3573 and US$3485. The ‘HPV approach’ required fewer colposcopic and reconisation procedures to detect one case of residual CIN2–3. Its higher positive predictive value than that of cytology provided a significant decrease in false positive rates and a reduction of US$88 per detected case.