title: Treatment of high grade cervical intraepithelial neoplasia by photodynamic therapy using hexylaminolevulinate may be costeffective compared to conisation procedures due to decreased pregnancy-related morbidity.
abstract: OBJECTIVE
  Standard treatments of high-grade Cervical intraepithelial neoplasia (CIN) are conisation procedures. Theses methods have proven effectiveness but are associated with an increased risk of subsequent pregnancy complications. Recently, photodynamic therapy (PDT) of CIN using hexylaminolevulinate (HAL) may represent an alternative treatment without the risk of cervical insufficiency or scaring. This study aims to evaluate the economical aspect of CIN treatment including associated pregnancy complications by comparing both methods.
  
  
  METHODS
  We developed model treatment pathways for both conisation procedures and PDT using HAL. Thereafter, we calculated total costs for both treatment pathways including necessary re-treatments or alternative treatments. The estimated impact of conisation-related cervical insufficiency, prematurity, perinatal morbidity and life-long disability were determined. The total additional costs per conisation due to perinatal morbidity were calculated.
  
  
  RESULTS
  The total cost of treatment for CIN with a conisation procedure alone was 1,473 €, whereas the PDT procedure alone accounted for 1,386 €, based of assumptions of a 50% re-PDT rate, a 70% response rate and costs of 500 € for the PDT intervention itself. We computed 71, 144 and 545 newborns born prematurely due to conisation procedures <28, between 28 and <32 and between 32 and <37 weeks of gestation, leading to 18, 24 and 65 cases of severe, moderate and mild life-long disability. The attributable additional amount of maternofetal morbidity discounted by 3% for 7 years was 573 € per conisation. The total costs for a conisation therefore added up to 2,046 €, the total costs per treatment with PDT given the above-mentioned assumptions were 1,558 €.
  
  
  CONCLUSIONS
  For Germany, PDT has the potential to be a cost-effective treatment for high-grade CIN compared to conisation procedure. Most important, the increased perinatal morbidity, perinatal mortality and associated costs after conisation procedures are significant and may be reduced by the implementation of PDT in CIN treatment.
authors: University Women's Hospital, Hannover Medical School, Hannover, Germany. soergel.philipp@mh-hannover.de
authors: Philipp
authors: P
authors: Soergel
authors: Lars
authors: L
authors: Makowski
authors: Efthimia
authors: E
authors: Makowski
authors: Cordula
authors: C
authors: Schippert
authors: Hermann
authors: H
authors: Hertel
authors: Peter
authors: P
authors: Hillemanns
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D002584:Cervix Uteri / Q000601:surgery*; D019092:Conization / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D008954:Models, Biological; D018803:Models, Economic; D010778:Photochemotherapy / Q000191:economics*; D017319:Photosensitizing Agents / Q000191:economics / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000601:surgery
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester