Résumé :
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[BDSP. Notice produite par INIST-CNRS d2hR0xUE. Diffusion soumise à autorisation]. Context Every year approximately 2 million US women are diagnosed as having a cervical cytological result of atypical squamous cells of undetermined significance (ASC-US). Objective To determine the most efficient and cost-effective management strategy for women in the United States diagnosed as having ASC-US. Design and Setting Cost-effectiveness analysis of data from clinical trials, prospective studies, and other published literature. A computer-based model was used to compare 4 management strategies for a cytological result of ASC-US : immediate colposcopy ; human papillomavirus (HPV) triage, which includes colposcopy if high-risk HPV types are detected ; repeat cytology, which includes follow-up cytology at 6 and 12 months and referral for colposcopy if a repeat abnormal result occurs ; and reclassifying ASC-US as normal in which a cytological result of ASC-US is ignored. Reflex HPV DNA testing uses either residual liquid-based cytological specimens or samples co-collected at the time of the initial screening for conventional cytology. Another method, referred to as the 2-visit HPV DNA triage, requires a woman with an ASC-US result to return within 1 month to provide another speciman sample. Main Outcome Measures Years of life saved (YLS), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Results The least costly strategy for biennial screening was to reclassify ASC-US as normal, resulting in a reduction in total cancer incidence of 75% for conventional cytology and 84% for liquid-based cytology compared with no screening. The next least costly strategy was HPV DNA testing resulting in a reduction in total cancer incidence of 86% for conventional cytology and 90% for liquid-based cytology, followed by immediate colposcopy with a reduction of 87% and 91%, respectively. (...)
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