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Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study

BMJ 2012; 345 doi: (Published 01 November 2012) Cite this as: BMJ 2012;345:e7086
  1. Rosa Legood, lecturer in decision modelling1,
  2. Megan Smith, program manager, cancer modelling2,
  3. Jie-Bin Lew, senior research programmer2,
  4. Robert Walker, senior research programmer2,
  5. Sue Moss, professor of cancer epidemiology3,
  6. Henry Kitchener, chair of gynaecological oncology4,
  7. Julietta Patnick, director at NHS cancer screening programmes5,
  8. Karen Canfell, associate professor and cancer modelling program leader26
  1. 1Health Services Research and Policy Unit, London School of Hygiene and Tropical Medicine, London WC1 9HS, UK
  2. 2Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011, Australia
  3. 3Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London EC1M 6BQ
  4. 4School of Cancer and Enabling Sciences, University of Manchester, St Mary’s Hospital, Manchester M13 9WL, UK
  5. 5NHS Cancer Screening Programme, Sheffield S10 3TH, UK
  6. 6School of Public Health, University of Sydney, Australia
  1. Correspondence to: R Legood rosa.legood{at}
  • Accepted 6 October 2012


Objectives To evaluate the cost effectiveness of human papillomavirus testing after treatment for cervical intraepithelial neoplasia (CIN).

Design Economic 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.

Setting English NHS Cervical Cancer Screening Programme.

Interventions Management 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 measures Cases of underlying CIN3+ averted at 10 years and costs per 1000 women treated.

Results Model 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.

Conclusions Human 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.


  • Contributors: RL, KC, and MS designed the study. MS, RW, J-BL, and KC implemented the model in TreeAge. RL and SM provided epidemiological support and data analysis. RL, KC, MS, and J-BL drafted the initial manuscript. All authors were responsible for redrafting the final manuscript.

  • Funding: The study was funded by the NHS Cancer Screening Programme. The analyses and decision to publish were independent of the funders.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: RL, SM, MS, RW, J-BL, and KC were funded by the NHS Cancer Screening Programme to do this work. KC is involved in configuring a new trial of cervical screening in Australia which will involve support from several manufacturers.

  • Ethical approval: Not needed.

  • Data sharing: Further details are available in the web technical appendix.

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