Clinical management of abnormal cytology test results and costs associated with the prevention of cervical cancer in Spain.
OBJECTIVE
To evaluate the clinical management of women with abnormal cervical cytology results, the associated health care resource allocation, and costs in Spain.


METHODS
A retrospective, observational, multicenter study of 849 women with abnormal cervical cytology results: 162 cases of atypical squamous cells of undetermined significance (ASCUS; 19.1%), 272 cases of low-grade squamous intraepithelial lesions (LSILs; 32.0%), 369 cases of high-grade squamous intraepithelial lesions (HSILs; 43.5%), and 46 cases of cancer (5.4%). Health care resources allocated to the diagnosis and treatment of lesions for a minimum of 2 years from the first abnormal cervical cytology result were assessed from patients' charts.


RESULTS
Histologic diagnosis confirmed 159 cases of cervical intraepithelial neoplasia grade 1 (CIN 1; 18.7%), 120 cases of CIN 2 (14.1%), 295 cases of CIN 3 (34.8%), and 79 cases of cancer (9.3%). Median waiting time to first intervention after an abnormal cytology result was 47 days (diagnostic range = 31-60). The most common diagnostic procedures were colposcopy and additional cytology testing. The principal therapeutic procedure was loop electrosurgical excision. The costs generated according to cytology result were (euro)1,196.80 (ASCUS), (euro)912.43 (LSIL), (euro)1,333.00 (HSIL), and (euro)6,261.30 (cancer). The costs generated according to histology results were (euro)790.10 (CIN 1), (euro)1,131.20 (CIN 2), (euro)1,181.30 (CIN 3), and (euro)7,041.70 (cancer).


CONCLUSIONS
Waiting time to the first intervention may be longer than clinically desirable. Direct costs associated with the management patterns of women with abnormal cervical cytology result are high and have important economic consequences to the Spanish National Health System. These results will allow to improve the effectiveness and efficiency of future intervention strategies.
Blade
Aureli
A
Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona, Spain. aureli@comb.es
Cararach
Montserrat
M
Castro
María
M
Catalá-López
Ferrán
F
Pérez-Escolano
Isabel
I
de Sanjosé
Silvia
S
D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D014626:Vaginal Smears / Q000191:economics*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy