Trial reportBMJ (Clinical research ed.)2009
Options for managing low grade cervical abnormalities detected at screening: cost effectiveness study.
Trial report in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 39 citations in OpenAlex.
- The overtreatment rate, medical cost and psychological affection of see-and-treat versus three-step approaches in the treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis.BMC women's health · 2025Pooled it
- Pooled it
- Immediate referral to colposcopy versus cytological surveillance for minor cervical cytological abnormalities in the absence of HPV test.The Cochrane database of systematic reviews · 2017Pooled it
- Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions.The Cochrane database of systematic reviews · 2013Pooled it
- Long-term psychosocial impact of alternative management policies in women with low-grade abnormal cervical cytology referred for colposcopy: a randomised controlled trial.British journal of cancer · 2011Trial
- Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial.BMJ (Clinical research ed.) · 2010Trial
- Biopsy and selective recall compared with immediate large loop excision in management of women with low grade abnormal cervical cytology referred for colposcopy: multicentre randomised controlled trial.BMJ (Clinical research ed.) · 2009Trial
- Cytological surveillance compared with immediate referral for colposcopy in management of women with low grade cervical abnormalities: multicentre randomised controlled trial.BMJ (Clinical research ed.) · 2009Trial
- Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program.Geburtshilfe und Frauenheilkunde · 2023Article
- Handling Missing Data in Within-Trial Cost-Effectiveness Analysis: A Review with Future Recommendations.PharmacoEconomics - open · 2017Review
- Relevance of HPV Screening for Triaging Equivocal Cytology Findings in the Pap II-p, Pap III and Pap IIID Groups - Results of Two Long-Term Studies.Geburtshilfe und Frauenheilkunde · 2015Article
- Does the correspondence between EQ-5D health state description and VAS score vary by medical condition?Health and quality of life outcomes · 2013Article
- Article
- HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the Sentinel Sites study.British journal of cancer · 2011Article
Corrections and comments
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Authors and funding
1 author at 1 institution in 1 country.
Funding
Abstract
objectiveTo estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening. Design Cost analysis within multicentre individually randomised controlled trial.
settingGrampian, Tayside, and Nottingham.
participants4201 women with low grade abnormalities.
interventionsCytological surveillance or referral to colposcopy for biopsy and recall if necessary or referral to colposcopy with immediate treatment based on colposcopic appearance.
main outcome measuresData on resource use collected from participants throughout the duration of the trial (36 months), enabling the estimation of both the direct (health care) and indirect (time and travel) costs of management. Quality of life assessed at recruitment and at 12, 18, 24, and 30 months, using the EQ-5D instrument. Economic outcomes expressed as costs per case of cervical intraepithelial neoplasia (grade II or worse) detected, by trial arm, as confirmed at exit, and cost utility ratios (cost per quality adjusted life year (QALY) gained) for the three pairwise comparisons of trial arms.
resultsThe mean three year discounted costs of surveillance, immediate treatment, and biopsy and recall were pound150.20 (euro177, $249), pound240.30 (euro283, $415), and pound241.10 (euro284, $4000), respectively, viewed from the health service perspective. From the social perspective, mean discounted costs were pound204.40 (euro241, $339), pound339.90 (euro440, $563), and pound327.50 (euro386, $543), respectively. Estimated at the means, the incremental cost effectiveness ratios indicated that immediate treatment was dominated by the other two management methods, although it did offer the lowest cost per case of cervical intraepithelial neoplasia detected and treated. The pronounced skews in the distributions indicated that probabilistic uncertainty analysis would offer more meaningful estimates of cost effectiveness. The observed differences in the cost effectiveness ratios between trial arms were not significant.
conclusionJudged within the time frame of the TOMBOLA evaluation, there is no compelling economic reason to favour any one follow-up method over either of the others.
trial registrationISRCTN 34841617.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.