Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer.

Published

Journal Article

OBJECTIVE: The aim of this study was to estimate cost and outcomes associated with colposcopy following abnormal Pap for women with a history of cervical cancer. METHODS: Decision models compared the costs and number of isolated local recurrences (ILR) detected using two strategies, colposcopy and no colposcopy, for women with a history of cervical cancer and low grade or high grade Pap. Clinical data for input were derived from a cohort of women with a history of cervical cancer undergoing surveillance Paps at 2 institutions. Costs were obtained using national reimbursement data. RESULTS: Five hundred fifty-six patients underwent 2900 surveillance Paps. Twenty-seven of 50 women with a low grade Pap underwent colposcopy. One of 3 recurrences in the colposcopy group was an ILR diagnosed colposcopically. Colposcopy following low grade Pap costs $354 more and resulted in a lower rate of diagnosis of ILR compared to no colposcopy (3.7% vs 8.6%). Sixty of 78 women with a high grade Pap underwent colposcopy. Three of 15 recurrences in the colposcopy group were ILR diagnosed colposcopically. Colposcopy following high grade Pap costs $623 more than no colposcopy but resulted in a higher rate of diagnosis of ILR (5% vs 0%; $7481 per additional ILR). CONCLUSIONS: Colposcopy following low or high grade surveillance Pap smear adds substantial cost to the management of women with cervical cancer. Only colposcopy following a high grade Pap is associated with a higher probability that cervical cancer recurrence will be detected when salvageable. These findings support withholding colposcopy for abnormal surveillance Pap tests less than high grade.

Full Text

Duke Authors

Cited Authors

  • Tergas, AI; Havrilesky, LJ; Fader, AN; Guntupalli, SR; Huh, WK; Massad, LS; Rimel, BJ

Published Date

  • September 2013

Published In

Volume / Issue

  • 130 / 3

Start / End Page

  • 421 - 425

PubMed ID

  • 23747836

Pubmed Central ID

  • 23747836

Electronic International Standard Serial Number (EISSN)

  • 1095-6859

Digital Object Identifier (DOI)

  • 10.1016/j.ygyno.2013.05.037

Language

  • eng

Conference Location

  • United States