title: Epidemiology and costs of screening and management of precancerous lesions of the cervix in Spain.
abstract: OBJECTIVE
  Oncogenic human papillomaviruses (HPVs) are essential causes of cervical cancer. Screening prevents cancer by detecting precancerous lesions (cervical intraepithelial neoplasia, CIN). Our aim was to assess the annual number of Pap smears and CIN diagnoses in Spain and to estimate associated management costs.
  
  
  METHODS
  A 1-year retrospective cross-sectional study was conducted among 65 gynecologists from public primary health care centers in 6 autonomous regions in Spain. We documented the total number of Pap smears performed and the management of women with CIN. Data on health care resource use related to CIN management for 2 years after diagnosis were collected and combined with unit costs to assess the mean cost per patient. We extrapolated to the general female Spanish population to estimate the total cost of screening and CIN management from the third-party payer's perspective.
  
  
  RESULTS
  In our study sample, 3.5% of routine Pap smears were abnormal. We estimated that 7.6 million Pap smears are performed annually in Spain, at a cost of 622 million euro (US$987). Furthermore, 40,530 women are annually diagnosed with CIN 1, 26,243 with CIN 2, and 28,423 with CIN 3. The mean cost of CIN management per patient was 1,115 euro for CIN 1, 1,626 euro for CIN 2, and 2,090 euro for CIN 3. The total cost of CIN management was estimated at 147 million euro (US$233).
  
  
  CONCLUSIONS
  This study shows that the costs of screening and management of CIN represent a heavy burden to the public health system in Spain.
authors.affiliation: Cancer Epidemiology Research Program, Institut Català d'Oncologia, IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsagué
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rémy
authors.forename: Luis M
authors.initials: LM
authors.lastname: Puig-Tintoré
authors.forename: Ricardo Sainz
authors.initials: RS
authors.lastname: de la Cuesta
authors.forename: Nuria
authors.initials: N
authors.lastname: Gonzalez-Rojas
authors.forename: Catherine
authors.initials: C
authors.lastname: Cohet
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D011230:Precancerous Conditions / Q000191:economics* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology