title: Management of precancerous cervical lesions in iran: a cost minimizing study.
abstract: BACKGROUND
  Cervical cancer is a common, preventable and manageable disease in women worldwide.
  
  
  OBJECTIVE
  This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree.
  
  
  METHODS
  Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population.
  
  
  RESULTS
  Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174 $ respectively.
  
  
  CONCLUSIONS
  The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.
authors.affiliation: Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran E-mail : baratimarnani@gmail.com.
authors.forename: Azin
authors.initials: A
authors.lastname: Nahvijou
authors.forename: Ali Akbari
authors.initials: AA
authors.lastname: Sari
authors.forename: Kazem
authors.initials: K
authors.lastname: Zendehdel
authors.forename: Ahmad Barati
authors.initials: AB
authors.lastname: Marnani
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000628:therapy / Q000821:virology; D003127:Colposcopy; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000235:genetics; D003663:Decision Trees; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D007492:Iran; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000191:economics* / Q000628:therapy / Q000821:virology; D011230:Precancerous Conditions / Q000191:economics* / Q000628:therapy / Q000821:virology; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000628:therapy / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000628:therapy / Q000821:virology
chemical_list: D004279:DNA, Viral