ObjectiveTo compare the cost‐effectiveness of different treatments for cervical intraepithelial neoplasia (CIN).DesignA cost‐effectiveness analysis based on data available in the literature and expert opinion.SettingEngland.PopulationWomen treated for CIN.MethodsWe developed a decision‐analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10‐year period. The costs calculated were those incurred by the National Health Service (NHS) of England.Main outcome measuresCost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted.ResultsFor young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost‐effective treatment overall at all willingness‐to‐pay thresholds. For postmenopausal women, LLETZ remained the most cost‐effective treatment up to a threshold of £31,500, but laser conisation became the most cost‐effective treatment above that threshold.ConclusionsLLETZ is the most cost‐effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence.

中文翻译：

---

英国宫颈上皮内瘤变的治疗方法：成本效益分析

目的比较宫颈上皮内瘤变 (CIN) 不同治疗方法的成本效益。根据文献中的数据和专家意见设计成本效益分析。背景英国。接受 CIN 治疗的女性人群。方法我们开发了一个决策分析模型来模拟1000 名接受 CIN 局部治疗的女性的临床病程，并在治疗后随访 10 年。在模型中，我们考虑了 10 年期间的手术并发症以及肿瘤和生殖结果。计算的费用是由英国国家医疗服务体系 (NHS) 产生的费用。 主要结果指标 每避免一次 CIN2+ 复发的成本（肿瘤学结果）；每一次避免早产的成本（生殖结果）；每避免一项不良肿瘤或生殖结果的总体成本。结果对于育龄的年轻女性，变性区大环切除术（LLETZ）是在所有支付意愿阈值下总体上最具成本效益的治疗方法。对于绝经后女性来说，在 31,500 英镑以下的阈值内，LLETZ 仍然是最具成本效益的治疗方法，但在该阈值以上，激光锥切术成为最具成本效益的治疗方法。 结论 对于年轻和老年女性来说，LLETZ 都是最具成本效益的治疗方法。然而，对于老年女性，如果 NHS 愿意花费超过 31,500 英镑来避免一次 CIN2+ 复发，也可以考虑采用激光锥切术进行更彻底的切除。