title: Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer.
abstract: OBJECTIVE
  The aim of this study was to estimate cost and outcomes associated with colposcopy following abnormal Pap for women with a history of cervical cancer.
  
  
  METHODS
  Decision models compared the costs and number of isolated local recurrences (ILR) detected using two strategies, colposcopy and no colposcopy, for women with a history of cervical cancer and low grade or high grade Pap. Clinical data for input were derived from a cohort of women with a history of cervical cancer undergoing surveillance Paps at 2 institutions. Costs were obtained using national reimbursement data.
  
  
  RESULTS
  Five hundred fifty-six patients underwent 2900 surveillance Paps. Twenty-seven of 50 women with a low grade Pap underwent colposcopy. One of 3 recurrences in the colposcopy group was an ILR diagnosed colposcopically. Colposcopy following low grade Pap costs $354 more and resulted in a lower rate of diagnosis of ILR compared to no colposcopy (3.7% vs 8.6%). Sixty of 78 women with a high grade Pap underwent colposcopy. Three of 15 recurrences in the colposcopy group were ILR diagnosed colposcopically. Colposcopy following high grade Pap costs $623 more than no colposcopy but resulted in a higher rate of diagnosis of ILR (5% vs 0%; $7481 per additional ILR).
  
  
  CONCLUSIONS
  Colposcopy following low or high grade surveillance Pap smear adds substantial cost to the management of women with cervical cancer. Only colposcopy following a high grade Pap is associated with a higher probability that cervical cancer recurrence will be detected when salvageable. These findings support withholding colposcopy for abnormal surveillance Pap tests less than high grade.
authors.affiliation: Division of Gynecologic Oncology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. atergas1@jhmi.edu
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Fader
authors.forename: Saketh R
authors.initials: SR
authors.lastname: Guntupalli
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: B J
authors.initials: BJ
authors.lastname: Rimel
mesh_terms: D003127:Colposcopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics*; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000473:pathology* / Q000628:therapy; D014626:Vaginal Smears / Q000191:economics
keywords: Cervical cancer; Colposcopy; Cost analysis; Surveillance