Excess Cost of Cervical Cancer Screening beyond Recommended Screening Ages or after Hysterectomy in a Single Institution

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective The aim of the study was to estimate the excess cost of guideline nonadherent cervical cancer screening in women beyond the recommended screening ages or posthysterectomy in a single healthcare system. Materials and Methods All Pap tests performed between September 1, 2012, and August 31, 2014, in women younger than 21 years, older than 65 years, or after hysterectomy, were coded as guideline adherent or nonadherent per the 2012 America Society of Colposcopy and Clinical Pathology guidelines. We assumed management of abnormal results per the 2013 America Society of Colposcopy and Clinical Pathology management guidelines. Costs were obtained from a literature review and Center for Medicare and Medicaid Services data and applied to nonadherent screening and subsequent diagnostic tests. Results During this period, 1,398 guideline nonadherent Pap tests were performed (257 in women <21 years, 536 in women >65 years, and 605 after hysterectomy), with 88 abnormal results: 35 (13.5%) in women younger than 21 years, 14 (2.6%) in women older than 65 years, and 39 (6.5%) in women after hysterectomy. The excess cost for initial screening, diagnostic tests, and follow-up was US $35,337 for 2 years in women younger than 21 years, US $54,378 for 5 years in women older than 65 years, and US $77,340 for 5 years in women after hysterectomy, resulting in a total excess cost of US $166,100 for 5 years. Of the 1,398 women who underwent guideline nonadherent screening, there were only 2 (0.1%) diagnoses of high-grade dysplasia (VaIN3). Conclusions Guideline nonadherent cervical cancer screening in women beyond the recommended screening ages and posthysterectomy resulted in costs exceeding US $160,000 for screening, diagnostic tests, and follow-up with minimal improvement in detection of high-grade dysplasia.

Original languageEnglish (US)
Pages (from-to)184-188
Number of pages5
JournalJournal of lower genital tract disease
Volume22
Issue number3
DOIs
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
Objective: The aim of the study was to estimate the excess cost of guideline nonadherent cervical cancer screening in women beyond the recommended screening ages or posthysterectomy in a single healthcare system. Materials and Methods: All Pap tests performed between September 1, 2012, and August 31, 2014, in women younger than 21 years, older than 65 years, or after hysterectomy, were coded as guideline adherent or nonadherent per the 2012 America Society of Colposcopy and Clinical Pathology guidelines. We assumed management of abnormal results per the 2013 America Society of Colposcopy and Clinical Pathology management guidelines. Costs were obtained from a literature review and Center for Medicare and Medicaid Services data and applied to nonadherent screening and subsequent diagnostic tests. Results: During this period, 1,398 guideline nonadherent Pap tests were performed (257 in women <21 years, 536 in women >65 years, and 605 after hysterectomy), with 88 abnormal results: 35 (13.5%) in women younger than 21 years, 14 (2.6%) in women older than 65 years, and 39 (6.5%) in women after hysterectomy. The excess cost for initial screening, diagnostic tests, and follow-up was US $35,337 for 2 years in women younger than 21 years, US $54,378 for 5 years in women older than 65 years, and US $77,340 for 5 years in women after hysterectomy, resulting in a total excess cost of US $166,100 for 5 years. Of the 1,398 women who underwent 1Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN; 2Institute for Health Informatics, University of Minnesota, Minneapolis, MN; 3Medical School, University of Minnesota, Minneapolis, MN; 4Biostatistics & Bioinformatics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN; 5School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, MN; 6Department of Surgery, Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN; and 7Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN Reprint requests to: Deanna Teoh, MD, Mayo Mail Code 395 420 Delaware St. SE Minneapolis, MN 55455. E-mail: dkteoh@umn.edu The authors have declared they have no conflicts of interest. Portions of this research were presented as an oral abstract at the 2017 International Federation of Cervical Pathology & Colposcopy World Congress, Orlando, FL, April 6, 2017. This study has been approved by the University of Minnesota IRB (Study # 1410M54723). The Masonic Cancer Center Women's Health Scholar is sponsored by the University of Minnesota Masonic Cancer Center, a comprehensive cancer center designated by the National Cancer Institute, and administrated by the University of Minnesota Deborah E. Powell Center for Women's Health. Research is supported by the Building Interdisciplinary Research Careers in Women's Health Grant (# K12HD055887) and administered by the University of Minnesota Deborah E. Powell Center for Women's Health. This award is co-funded by the Eunice Kennedy Shriver National Institutes of Child Health (NICHD) and the Office of Research on Women's Health (ORWH). This award is also funded by the Office of the Director, National Institutes of Health (OD), National Institute of Mental Health (NIMH), and the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the office views of the co-funders. NIH grant P30 CA77598 using the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota. National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. © 2018, ASCCP DOI: 10.1097/LGT.0000000000000400 guideline nonadherent screening, there were only 2 (0.1%) diagnoses of high-grade dysplasia (VaIN3). Conclusions: Guideline nonadherent cervical cancer screening in women beyond the recommended screening ages and posthysterectomy resulted in costs exceeding US $160,000 for screening, diagnostic tests, and follow-up with minimal improvement in detection of high-grade dysplasia.

Funding Information:
The Masonic Cancer Center Women's Health Scholar is sponsored by the University of Minnesota Masonic Cancer Center, a comprehensive cancer center designated by the National Cancer Institute, and administrated by the University of Minnesota Deborah E. Powell Center for Women's Health. Research is supported by the Building Interdisciplinary Research Careers in Women's Health Grant (# K12HD055887) and administered by the University of Minnesota Deborah E. Powell Center for Women's Health. This award is co-funded by the Eunice Kennedy Shriver National Institutes of Child Health (NICHD) and the Office of Research on Women's Health (ORWH)

Funding Information:
Two of the authors are supported by career development awards (DT: NIH Building Interdisciplinary Research Careers in Women's Health; RIV: institutional Masonic Cancer Center Women's Health Scholarship). The content of the article is solely the responsibility of the authors and does not represent the views of the funders. The study design, data collection, analysis, research findings, and interpretation of results were not influenced in any way by the funding sources. The corresponding author (DT) had final responsibility for the decision to submit for this article for publication.

Publisher Copyright:
© 2018, ASCCP.

Keywords

  • cervical cancer screening
  • cost
  • guideline adherence
  • posthysterectomy

Fingerprint

Dive into the research topics of 'Excess Cost of Cervical Cancer Screening beyond Recommended Screening Ages or after Hysterectomy in a Single Institution'. Together they form a unique fingerprint.

Cite this