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: http://dx.doi.org/10.1136/bmj.e7086 (Published 1 November 2012)
Cite this as: BMJ 2012;345:e7086

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As an afterthought of my previous response to the same article, I suggest once the woman has become HPV negative, she should be immunized with HPV vaccine to acquire lifelong immunity against oncogenic strains (6, 11, 16 & 18). There is a possibility of subsequent re-infection by HPV after cure if the patient is not vaccinated(1) as in the case of Diphtheria where the disease does not give lifelong immunity and one has to be given a full course of immunization.

1. http://www.parentingbanter.com/showthread.php?t=66758

Competing interests: None declared

Neeru Gupta, Scientist E

Indian Council of Medical Research, Ansari Nagar, New Delhi-11029

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The post-treatment follow-up will not be helped by HPV DNA’s detection only once at six-months (declaring as cure) and thereafter calling the patient as routine recalls just as for the population at risk1. Following facts should as well be considered:

1. Human Papilloma virus infection may recur and become as risky again in spite of a negative result at six month’s follow-up.
2. The previous cervical dysplasia has a recurrence of four-fold as stated in other, just published paper in BMJ2. It may be due to high risk behavior and reduced immunity.

Since it is clear that the cancer or its cause (HPV) may recur, so cost-effectiveness study is not commensurate with biological explanation. And the patient may need the three repeat cytology tests at six, 12, and 24 months and thereafter annual follow-ups as the usual practice till now.

References:

1. BMJ 2012;345:e7086

2. BMJ 2012;345:e6855

Competing interests: None declared

Neeru Gupta, Scientist E

Indian Council of Medical Reserch, Ansari Nagar, New Delhi-110029

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