title: Economic burden of vulvar and vaginal intraepithelial neoplasia: retrospective cost study at a German dysplasia centre.
abstract: BACKGROUND
  Human papillomavirus is responsible for a variety of diseases including grade 2 and 3 vulvar and vaginal intraepithelial neoplasia. The aim of this study was to assess parts of the burden of the last diseases including treatment costs. The direct medical resource use and cost of surgery associated with neoplasia and related diagnostic procedures (statutory health insurance perspective) were estimated, as were the indirect costs (productivity losses) associated with surgical treatment and related gynaecology visits for diagnostic purposes.
  
  
  METHODS
  Data from 1991-2008 were retrospectively collected from patient records of the outpatient unit of the Gynaecological Dysplasia Clinic, Heinrich Heine University, Dusseldorf, Germany. Two subgroups of patients were analysed descriptively: women undergoing one surgical procedure related to a diagnosis of vulvar and/or vaginal intraepithelial neoplasia, and women undergoing two or more surgical procedures. Target measures were per-capita medical resource consumption, direct medical cost and indirect cost.
  
  
  RESULTS
  Of the 94 women analysed, 52 underwent one surgical intervention and 42 two or more interventions (mean of 3.0 interventions during the total period of analysis). Patients undergoing one surgical intervention accrued €881 in direct costs and €682 in indirect costs; patients undergoing more than one intervention accrued €2,605 in direct costs and €2,432 in indirect costs.
  
  
  CONCLUSIONS
  The economic burden on German statutory health insurance funds and society induced by surgical interventions and related diagnostic procedures for grade 2/3 vulvar and vaginal neoplasia should not be underrated. The cost burden is one part of the overall burden attributable to human papillomavirus infections.
authors.affiliation: Universitätsfrauenklinik Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Hampl
authors.forename: Eduard
authors.initials: E
authors.lastname: Huppertz
authors.forename: Olaf
authors.initials: O
authors.lastname: Schulz-Holstege
authors.forename: Patrick
authors.initials: P
authors.lastname: Kok
authors.forename: Sarah
authors.initials: S
authors.lastname: Schmitter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D014625:Vaginal Neoplasms / Q000191:economics* / Q000628:therapy / Q000821:virology; D014846:Vulvar Neoplasms / Q000191:economics* / Q000628:therapy / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000628:therapy / Q000821:virology