Costs of colposcopy services and their impact on the incidence and mortality rate of cervical cancer in Canada.
OBJECTIVE
Organized cervical cancer screening services consisting of conventional Papanicolaou cervical smears, colposcopy, and related treatment modalities are readily available in all provinces. The purpose of this report was to study the impact of colposcopy usage and costs on cervical cancer incidence and mortality rates in several Canadian provinces. Knowledge of such information is essential before newer technology such as liquid-based cytology and human papillomavirus testing is introduced or replaces the traditional systems used.


METHODS
The Ministries of Health of five provinces were contacted and asked to furnish information on the number of colposcopic services and fee-for-service costs for these and for cryosurgery, carbon dioxide laser vaporization, loop electrosurgical excisions, and cold-knife conizations for the year 2000. Canadian Cancer Society estimates of incidence and mortality rates for cervical cancer were also obtained.


RESULTS
All provinces had similar incidence and mortality rates for cervical cancer; however, the number of colposcopic services on a per-capita basis varied substantially, with Manitoba and Ontario having rates that were approximately two or three times higher. Fee-for-service payments for colposcopy were similar in the Provinces studied but unit costs for surgical treatment services were highest in Ontario and British Columbia.


CONCLUSIONS
Although both the incidence and mortality rates for cervical cancer in Canada fell dramatically after the Walton Report in 1976, these rates have plateaued over the past decade despite widespread availability of colposcopy and related ambulatory treatment services. Higher rates of colposcopy usage do not seem to result in lower incidence rates for this disease. Unit costs for colposcopy are similar among the provinces reviewed, but substantial difference exists for certain treatment services. Additional studies are recommended before the widespread introduction or replacement of existing methods with newer, more costly techniques.
Benedet
John L
JL
Division of Gynecologic Oncology, Department of Obstertics and Gynecology, University of British Columbia, 805 W. 12th Avenue, Vancouver, B.C., V5Z 1M4 Canada. lbenedet@interchange.ubc.ca
Bertrand
Monique A
MA
Matisic
Jasenka M
JM
Garner
David
D
D002170:Canada / Q000453:epidemiology; D002584:Cervix Uteri / Q000601:surgery*; D003127:Colposcopy / Q000191:economics* / Q000706:statistics & numerical data*; D019092:Conization / Q000191:economics; D003452:Cryosurgery / Q000191:economics; D004598:Electrosurgery / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D053685:Laser Therapy / Q000191:economics; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality