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

Ana I. Tergas, Laura J. Havrilesky, Amanda N. Fader, Saketh R. Guntupalli, Warner K. Huh, L. Stewart Massad, B. J. Rimel

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)421-425
Number of pages5
JournalGynecologic oncology
Volume130
Issue number3
DOIs
StatePublished - Sep 1 2013

Keywords

  • Cervical cancer
  • Colposcopy
  • Cost analysis
  • Surveillance

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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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. Gynecologic oncology, 130(3), 421-425. https://doi.org/10.1016/j.ygyno.2013.05.037