Wie hoch sind die Kosten der Konisation unter Berücksichtigung schwangerschaftsassoziierter Komplikationen?

Abstract

INTRODUCTION: Conisation, the standard therapy for high-grade cervical dysplasia, is highly effective and one of the most common procedures performed in women of fertile age in Germany. However, the risk of complications such as cervical insuffiency with premature rupture of the membranes, premature delivery and low birth weight is elevated in subsequent pregnancies, and this may lead to life-long fetal disability. These costs have to be duly considered when assessing conisation procedures. METHOD: We analysed the costs of the whole treatment pathway after diagnosis of a cervical dysplasia requiring surgery. Using data from former studies and from quality assurance programs, the total costs were analysed, with particular attention paid to the costs of maternofetal morbidity. RESULTS: Total costs per conisation were 2178 €. The main cost factor turned out to be costs associated with the inability to work (1011 €). Maternofetal morbidity accounted for 705 €. The smallest cost factor was the conisation procedure which amounted to 462 € including follow-up costs. A total of 71, 144 and 545 children were born prematurely at 28, 32, and 37 weeks of gestation in Germany due to previous conisation. Of these, 18, 24, and 65 children will statistically suffer from severe, moderate or mild disability, respectively. CONCLUSION: The costs of the therapy of maternofetal morbidity represent 1/3 of the total costs of conisation. To prospectively reduce the number of conisations, the HPV vaccination rate and indications for surgery should be improved. Furthermore, conisations should be done by laser or electric loop under colposcopy.