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Cost-Effectiveness in ALTS

Findings from the atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) triage study (ALTS) suggest that for women diagnosed with ASCUS, human papillomavirus (HPV) DNA testing, which refers about half of women to colposcopy, is as effective at detecting cervical intraepithelial neoplasia (CIN) 3 or cervical cancer as immediate colposcopy for all women. To investigate whether HPV DNA testing is a cost-effective alternative to immediate colposcopy or conservative management with up to three Pap smears, Kulasingam et al. (p. 92 ) analyzed data from the ALTS in conjunction with medical cancer costs. The least costly and least effective strategy was conservative management with one Pap test. However, immediate colposcopy and conservative management with up to three Pap tests detected fewer cases of CIN3+ and were either more costly or not as cost-effective as HPV DNA testing. The authors conclude that HPV DNA testing is an economically viable strategy for triage of ASCUS cytology.