Purpose: A substantial number of women with equivocal cervical cytology results are likely to harbor high-grade lesions. Recent clinical trial data have shown that only 64-67% of lesions will be identified with colposcopy, a procedure used to visualize the cervix for abnormalities and guide the location of a biopsy. We assess the potential cost-effectiveness (CE) of a new optical detection system technology (ODS) designed to improve the performance of colposcopy.

Methods: We modified a cervical cancer model to reflect recent data on false positive and false negative colposcopy errors at the level of (1) initial visualization of the cervix, (2) accuracy of biopsy location, and (3) misclassification of lesions during pathologic interpretation. We incorporated trial data on ODS technology showing a 26% improvement in detection of high-grade lesions among women with equivocal cytology results. Strategies included cytology at different frequencies using either conventional ($196) or ODS-enhanced colposcopy (colpo-ODS) ($246). We assumed that cytology results indicating high-grade lesions, even if colpo-ODS was negative, triggered excisional treatment. To explore the implications of practice change we repeated the analysis assuming women negative on colpo-ODS, regardless of initial cytology result, would be followed closely but not treated. Outcomes included life expectancy (LE), lifetime costs (LC) and incremental CE ratios.

Results: Per-woman lifetime costs (LE) increased from $210 (28.70) without screening to $2,810 (28.80) with annual screening using colpo-ODS. Assuming a threshold CE ratio of $50,000 per YLS, the optimal strategy was every 4 year cytology screening with colpo-ODS. With a CE threshold of $100,000 per YLS, the optimal strategy was every 2 year cytology screening with conventional colposcopy. In comparison, every 2 year cytology with colpo-ODS was $170,200 per YLS. In our exploratory analysis that assumed clinical protocols would be altered with improved colposcopy, every 2 year cytology with colpo-ODS was more attractive, costing $100,000 per YLS. Results were most sensitive to underlying cytology sensitivity, false negative rate of colposcopy, and the incremental cost of ODS.

Conclusions: A cervical cancer screening strategy that relies on every two or three-year cytology and colposcopy enhanced with ODS has the potential to be cost-effective, although results are dependent on clinicians being willing to “trust” a negative colposcopy result and withhold definitive treatment while closely monitoring the woman.