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

Publication ,  Journal Article
Tergas, AI; Havrilesky, LJ; Fader, AN; Guntupalli, SR; Huh, WK; Massad, LS; Rimel, BJ
Published in: Gynecol Oncol
September 2013

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.

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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

September 2013

Volume

130

Issue

3

Start / End Page

421 / 425

Location

United States

Related Subject Headings

  • Vaginal Smears
  • Uterine Cervical Neoplasms
  • Papanicolaou Test
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neoplasm Grading
  • Humans
  • Female
  • Decision Support Techniques
  • Cost-Benefit Analysis
 

Citation

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Tergas, A. I., Havrilesky, L. J., Fader, A. N., Guntupalli, S. R., Huh, W. K., Massad, L. S., & Rimel, B. J. (2013). Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer. Gynecol Oncol, 130(3), 421–425. https://doi.org/10.1016/j.ygyno.2013.05.037
Tergas, Ana I., Laura J. Havrilesky, Amanda N. Fader, Saketh R. Guntupalli, Warner K. Huh, L Stewart Massad, and B. J. Rimel. “Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer.Gynecol Oncol 130, no. 3 (September 2013): 421–25. https://doi.org/10.1016/j.ygyno.2013.05.037.
Tergas AI, Havrilesky LJ, Fader AN, Guntupalli SR, Huh WK, Massad LS, et al. Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer. Gynecol Oncol. 2013 Sep;130(3):421–5.
Tergas, Ana I., et al. “Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer.Gynecol Oncol, vol. 130, no. 3, Sept. 2013, pp. 421–25. Pubmed, doi:10.1016/j.ygyno.2013.05.037.
Tergas AI, Havrilesky LJ, Fader AN, Guntupalli SR, Huh WK, Massad LS, Rimel BJ. Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer. Gynecol Oncol. 2013 Sep;130(3):421–425.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

September 2013

Volume

130

Issue

3

Start / End Page

421 / 425

Location

United States

Related Subject Headings

  • Vaginal Smears
  • Uterine Cervical Neoplasms
  • Papanicolaou Test
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neoplasm Grading
  • Humans
  • Female
  • Decision Support Techniques
  • Cost-Benefit Analysis