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Alternative management strategies that have been adopted in many high\u2010income settings are to offer immediate colposcopy referral or to utilise human papillomavirus (HPV) DNA testing as a triage for colposcopy referral, and to consider different strategies according to women's age. The objective of our study was to evaluate the lifetime cost effectiveness in terms of cost per years of life saved (YLS) of these alternative strategies for a middle income setting. A Markov model was developed using data from the Ludwig\u2010McGill cohort and calibrated to independent observational datasets and local cost estimates obtained. In the base\u2010case analysis, repeat cytology was the least costly strategy but also the least effective. Based on the WHO threshold for very cost\u2010effective interventions, HPV triage for women above 30 years\u2010old was the strategy with the highest probability of being cost effective. HPV triage including younger women with ASCUS results would also be a cost\u2010effective option. Whilst there was a slight further gain in effectiveness with immediate colposcopy referral, it was also more expensive and did not appear to be cost effective. Threshold analysis indicated that an HPV test would have to be more than twice as expensive as a cytology test for HPV triage to no longer be cost effective. In conclusion, our results indicate that in middle income settings HPV triage is likely to be the optimal strategy for managing women presenting with ASC\u2010US results.<\/jats:p>","DOI":"10.1002\/ijc.25708","type":"journal-article","created":{"date-parts":[[2010,9,30]],"date-time":"2010-09-30T17:55:06Z","timestamp":1285869306000},"page":"671-679","source":"Crossref","is-referenced-by-count":18,"title":["Economic evaluation of strategies for managing women with equivocal cytological results in Brazil"],"prefix":"10.1002","volume":"129","author":[{"given":"Tazio","family":"Vanni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Legood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo L.","family":"Franco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa L.","family":"Villa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula Mendes","family":"Luz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilberto","family":"Schwartsmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,11,12]]},"reference":[{"key":"e_1_2_6_2_2","volume-title":"GLOBOCAN 2000: cancer incidence, mortality and prevalence worldwide version 1.0","author":"Ferlay JBF","year":"2001"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.11719"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2008.05.026"},{"key":"e_1_2_6_5_2","volume-title":"Incidencia de Cancer no Brasil","author":"Estimativa 2010","year":"2009"},{"key":"e_1_2_6_6_2","volume-title":"Nomenclatura Brasileira para laudos cervicais e condutas preconizadas","year":"2006"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2008.05.040"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.18.2382"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38698.458866.7C"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21513"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00080-5"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm086"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021641"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1086\/587698"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1020-49891999000900001"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1086\/315086"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6600442"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1086\/425907"},{"key":"e_1_2_6_19_2","unstructured":"PecorelliS NH HackerNF.Staging classification and clinical practice guidelines for gynaecological cancers. 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