• Rosa Legood, Megan Smith, Jie-Bin Lew, Robert Walker, Sue Moss, Henry Kitchener, Julietta Patnick, and Karen Canfell.
• Health Services Research and Policy Unit, London School of Hygiene and Tropical Medicine, London WC1 9HS, UK. rosa.legood@lshtm.ac.uk
• BMJ. 2012 Jan 1;345:e7086.

ObjectivesTo evaluate the cost effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia (CIN).DesignEconomic analysis using a Markov modelling approach to combine cost and epidemiological data from the NHS Sentinel Sites Study with data from previous studies of post-treatment recurrence rates.SettingEnglish NHS Cervical Cancer Screening Programme.InterventionsManagement guidelines after treatment of CIN involving annual cytology follow-up for 10 years, compared with alternative protocols using the human papillomavirus test to reduce the amount of post-treatment surveillance.Main Outcome MeasuresCases of underlying CIN3+ averted at 10 years and costs per 1000 women treated.ResultsModel predictions indicated that, at observed levels of compliance with post-treatment recommendations, management with only cytological follow-up would result in 29 residual cases of recurrent CIN3+ by 10 years and would cost £358,222 (€440,426; $574,910) (discounted) per 1000 women treated. Implementation of human papillomavirus test of cure in cytologically negative women according to the sentinel sites protocol would avert an additional 8.4 cases of CIN 3+ and reduce costs by £9388 per 1000 women treated.ConclusionsHuman papillomavirus test of cure would be more effective and would be cost saving compared with cytology only follow-up. The results of this evaluation support the full scale implementation of human papillomavirus test of cure after treatment of CIN within the NHS Cervical Screening Programme.

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