Reproductive Morbidity

Local treatment of cervical pre-invasive and early invasive disease: synthesis of the evidence and network meta-analysis on efficacy and treatment-related reproductive morbidity

Principal investigator: Huseyin Naci
Start date: 01 September 2018
End date: 31 August 2020
Region: Europe
Keywords: reproductive morbidity, cervical cancer, treatment, NHS, cost-effectiveness, risk


Treatment for cervical pre-invasive and early invasive disease with conisation removes or ablates a cone-shaped part of the uterine cervix containing the abnomal cells. Although the efficacy of conisation is high, there has been increasing evidence to suggest that the risk of preterm birth is increased and that this is higher for techniques that remove larger parts of the cervix. This has led to the use of less radical treatments, while concerns have been raised that this shift may adversely impact the rates of precancerous and cancerous recurrence.

This project aims to provide patients and their clinicians with the best, up-to-date evidence about the relative efficacy and safety of the various treatment techniques so as to enable them to take informed decision. It also aims to develop an economic evaluation model to compare the cost-effectiveness of these techniques. Our objectives are to:

  • Identify, evaluate and synthesize the results from studies comparing different treatments with respect to the rates of pre-invasive and invasive recurrence, complications and reproductive morbidity
  • Generate a clinically useful ranking of the alternative options for treatment according to their efficacy, morbidity and cost-effectiveness in order to make recommendations and contribute to NHS guidelines for decision makers
  • Empower the national health care service consumer by providing accessible and understandable summaries of the available evidence

We will search electronic databases to identify all randomised controlled trials (RCTs) and observational studies comparing the efficacy and complications including the risk of preterm birth amongst different treatment techniques as compared to untreated controls and perform a series of meta-analyses and network meta-analyses.

The proposed evidence synthesis will empower health care consumers and will contribute to NHS and international guidelines with data on the efficacy and risk of alternative options for treatment.

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