THE COST-EFFECTIVENESS OF TREATING WOMEN WITH A CERVICAL VAGINAL SMEAR DIAGNOSIS OF ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE

OBJECTIVE: The purpose was to determine the optimal treatment protocol for women with a cervical vaginal diagnosis of atypical squamous cell s of undetermined significance. STUDY DESIGN: By means of decision ana lysis, 8 strategies were compared in terms of cost, life expectancy, c ost-effectiveness, and the number of cancers and complications from tr eatment. Data were obtained from the medical literature and the Univer sity of Iowa Hospitals and Clinics. RESULTS: Compared with more aggres sive strategies, such as those that use immediate colposcopy, strategi es featuring repeated smears were less expensive and carried fewer com plications but had lower life expectancies per patient and more cancer s. The strategy of repeating a smear annually had a lower cost per pat ient than did the other strategies, ranging from $112 to $989, and had a similar discounted life expectancy to that of the strategy with the longest discounted life expectancy. CONCLUSIONS: In most clinical sce narios strategies that used repeated smears were the most cost-effecti ve.