title: Reimbursed Costs of Management of Uterine Cervical Lesions in Poland--a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health.
abstract: BACKGROUND
  Despite implementation of organised screening programme in 2006/2007, cervical cancer (CC) incidence and mortality in Poland are still higher than the average in the European Union. CC and preceding cervical intraepithelial neoplasia (CIN) caused by human papillomaviruses (HPVs) can be prevented by vaccines which are reimbursed in around 20 European countries but not in Poland. CC and CIN can be also detected with the use of HPV tests which are not included in the Polish screening programme. Reimbursement for HPV vaccines and HPV testing requires cost-effectiveness analyses which include country-specific data on the burden and costs of management of cervical neoplasia. Therefore, we investigated the burden of cervical neoplasia and direct costs associated with its detection and management in Poland in 2012 reimbursed by the National Health Fund (NHF) - the only public healthcare insurance institution. We also report administrative costs of the organised screening programme covered by the Ministry of Health.
  
  
  METHODS
  Data on the burden and reimbursed costs of organised and opportunistic screening as well as management of cervical neoplasia were drawn from the NHF databases. Numbers of women reported with CIN and CC were ascertained.
  
  
  RESULTS
  In 2012, there were 765,266 and 1,288,358 reimbursed Pap smears collected within and outside the organised screening programme, respectively. Expenditures on medical and administrative procedures in organised screening reached PLN (Polish Zloty) 41,470,664 and 12,150,398 respectively. The number of women with particular diagnosis and reimbursement for the management of these lesions were as follows: glandular ectropion 208,033 and PLN 37,349,515; CIN1 10,521 and PLN 6,616,375; CIN2 5,812 and PLN 5,071,155; CIN3 6,487 and PLN 7,611,062; unspecified grade CIN 36,575 and PLN 12,352,034; and CC 33,482 and PLN 52,377,006, respectively. In women with ectropion and CIN the total number of local excision/ablative therapeutic procedures on the cervix reached 47,658 and the total number of hysterectomies was 1,321.
  
  
  CONCLUSIONS
  In 2012, management of approximately 93 thousand women with HPV-related cervical lesions reimbursed in Poland amounted to PLN 84,027,632 which makes it a considerable public health problem. The number of women managed for glandular ectropion is considerable and related costs are high. Total reimbursement for detection, treatment and follow-up of all cervical lesions reaches at least PLN 137 million annually.
authors.affiliation: Second Department Oncologic Gynaecology, Saint John of Dukla Regional Cancer Centre, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Nowakowski
authors.affiliation: Central Office, National Health Fund, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Śliwczyński
authors.affiliation: ASSECO S.A. Poland, Warsaw, Poland.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Seroczyński
authors.affiliation: Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Cybulski
authors.affiliation: Central Office, National Health Fund, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Teter
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics*; D065006:Papanicolaou Test / Q000191:economics*; D030361:Papillomavirus Infections / Q000453:epidemiology; D011044:Poland / Q000453:epidemiology; D012051:Reimbursement Mechanisms; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000453:epidemiology / Q000628:therapy* / Q000821:virology
keywords: Poland; cervical cancer; cervical intraepithelial neoplasia; costs; reimbursement; screening