Women's preferences regarding options for management of atypical, borderline or low-grade cervical cytological abnormalities: a review of the evidence.

OBJECTIVES: To review the evidence on women's preferences for and valuation of alternative management pathways following identification of low-grade cytological abnormalities as part of routine cervical cancer screening. The aim was to identify empirical studies evaluating women's preferences regarding alternative management pathways and to compare the impact of alternative elicitation methods on results. METHODS: A systematic review of the literature was conducted using the online bibliographic information service PubMed database. Empirical studies were identified that elicited general preferences, utilities or valuations based on willingness to pay (WTP) with respect to management of low-grade cytology results. Data were extracted on the methodology used and the empirical results. RESULTS: Where quality of life data were elicited directly from patients that were undergoing management of low-grade abnormalities utilizing direct elicitation techniques such as WTP, general preference questionnaires and the Euroqol, the studies tended towards a preference in favour of HPV testing (and colposcopy referral if HPV positive) rather than repeat cytology. In contrast, where studies included the general population and presented hypothetical scenarios of treatment pathways, and explicitly tried to incorporate assessment of process utility, the evidence indicated a slight tendency to favour repeat cytology. CONCLUSION: Consideration of patient preferences in the management of low-grade cytology is important for designing screening protocols. The reviewed studies indicate that potentially different conclusions may be drawn depending on the elicitation methodology and selection of participants in the research.