Ambulatory care visits for Pap tests, abnormal Pap test results, and cervical cancer procedures in the United States.
OBJECTIVE
To establish current estimates and project potential reductions in the volume and cost of annual Pap tests administered at visits to physician office and hospital outpatient departments in light of cervical cancer screening changes and HPV vaccination.


METHODS
Assessment of baseline national administrative data and future projection.


METHODS
We used data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to analyze physician office and hospital outpatient department visits made by female subjects 15 years and older from 2003 through 2005.


RESULTS
Pap tests were ordered annually at 30.2 million physician office and hospital outpatient department visits in the United States from 2003 through 2005. Among visits by young women aged 15 to 26 years, Pap tests were ordered at 5.8 million visits each year, representing 19.3% of all Pap tests ordered. Among visits made by women of childbearing age that included Pap tests, 76.0% occurred in obstetrics and gynecology offices or clinics. Using a simple projection model, we estimated an overall annual decrease of 1.2 million Pap tests for young women aged 15 to 26 years and a corresponding cost reduction of $77.6 million after routine HPV vaccination and HPV DNA testing. Among female subjects 15 years and older, the estimated potential decrease in Pap tests was 6.3 million, with an estimated $403.8 million in cost reduction.


CONCLUSIONS
The NAMCS and NHAMCS provide baseline data to estimate the effects of HPV vaccination and HPV DNA testing on cervical cancer screening policy. These future technologies may result in changes to cervical cancer screening policies and, when fully accepted and implemented, may reduce economic costs associated with cervical cancer in the United States.
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. msaraiya@cdc.gov
Mona
M
Saraiya
Linda F
LF
McCaig
Donatus U
DU
Ekwueme
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003363:Cost Control; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D006285:Health Planning; D006291:Health Policy; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D009936:Organizational Innovation; D053918:Papillomavirus Vaccines; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000706:statistics & numerical data*; D014626:Vaginal Smears / Q000706:statistics & numerical data*
D053918:Papillomavirus Vaccines