The health care costs of cervical human papillomavirus–related disease

Abstract

Objective The purpose of this study was to examine the health care costs of cervical human papillomavirus–related disease in a US health care setting. Study design We conducted an observational cohort study using 1997 through 2002 administrative and laboratory records from 103,476 female enrollees of the Kaiser Permanente Northwest health plan (Portland, Ore). We examined the cost per case and annual cost per 1000 enrollees for cervical human papillomavirus–related events. Results A cervical examination with a normal routine papanicolaou smear incurred costs of $57 (95% CI, 57-57). Costs that were associated with abnormal routine screening diagnoses ranged from $299 for atypical squamous cells (95% CI, 245-352) to $2349 for high-grade squamous intraepithelial lesion (95% CI, 1,047-3,650). The costs of histologically confirmed cervical intraepithelial neoplasia ranged from $1026 for cervical intraepithelial neoplasia 1 (95% CI, 862-1191) to $3235 for cervical intraepithelial neoplasia 3 (95% CI, 2051-4419); a cost of $376 (95% CI, 315-436) was associated with false-positive test results. At the level of the health plan, overall annual cervical cancer prevention and treatment costs were $26,415 per 1000 female enrollees, with routine cervical cancer screening accounting for expenditures of $16,746 per 1000 female enrollees, cervical intraepithelial neoplasia accounting for expenditures of $4535 per 1000 female enrollees, cervical cancer accounting for expenditures of $2629 per 1000 female enrollees, and false-positive test results accounting for expenditures of $2394 per 1000 female enrollees. Conclusion These are the first direct estimates of both individual and population level costs of cervical human papillomavirus–related disease in a general US health care setting. Routine cervical cancer screening comprises nearly two thirds of total annual cervical human papillomavirus–related health care costs, with 10% of expenditures dedicated to the treatment of invasive cervical cancer, 17% to the management of cervical precancers, and 9% to dealing with false-positive Papanicolaou test results.