Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa

• DOI: 10.1371/journal.pone.0203921
• Publication Date: 2018-10-11T17:34:59Z
• Authors: Naomi Lince-Deroche; Craig van Rensburg; Jaqueline Roseleur; Busola Sanusi; Jane Phiri; Pam Michelow; Jennifer S. Smith; Cindy Firnhaber
• Keywords: Cryotherapy

Cervical cancer incidence is significant in countries, such as South Africa, with high burdens of both HIV and human papillomavirus (HPV). largely preventable if dysplasia diagnosed treated early, but there debate regarding the best approaches for screening treatment, especially low-resource settings. Currently Africa provides Pap smears followed by colposcopic biopsy LEEP needed its public health facilities. We estimated costs cost-effectiveness two treating cervical intraepithelial neoplasia grade 2 or higher (CIN2+) among HIV-infected women, most whom were taking antiretroviral at a treatment facility Johannesburg, Africa.Method effectiveness was derived from an intention-to-treat analysis data gathered clinical trial completed previously study facility. In trial, women who CIN2+ eligible cryotherapy randomized to LEEP. If six months determined via smear biopsy, all women-regardless their original assignment-received "Cure" then defined absence disease 12 based on biopsy. Health service using micro-costing between June 2013 April 2014. Capital annualized discount rate 3%. Two different volume scenarios considered, results as-treated considered sensitivity analysis.In total, 166 enrolled (86 had LEEP; 80 cryotherapy). At months, cumulative loss follow-up 12.8% (11/86) group 13.8% (11/80) cryotherapy. Based unadjusted conducted this economic evaluation, no difference efficacy. 83.8% (95% CI 73.8-91.1) baseline free disease. contrast, 76.7% 66.4-85.2) assigned On average, initially less costly per patient US$ 118.00 (113.91-122.10), case "cured" 140.90 (136.01-145.79). Women cost 162.56 (157.90-167.22) 205.59 (199.70-211.49) cured. analysis, which data, more efficacious than cryotherapy; however, not significant. Cryotherapy remained cost-effective scenario analyses.For approach into consideration uncertainty outcomes, strategy involving plus dominant again retreatment. However, compared other studies comparing cryotherapy, efficacy low groups-possibly due HIV-positivity participants. Further research needed, present choosing "right" option may be important ensuring access providing careful monitoring outcomes.