Management of Precancerous Cervical Lesions in Iran: A Cost Minimizing Study


Background: Cervical cancer is a common, preventable and manageable disease in women worldwide.
Objectives: This study was conducted to determine the cost of follow-up for suspicious precancerous cervicallesions within a screening program using Pap smear or HPV DNA test through the decision tree. Materialsand
Methods: Patient follow-up processes were determined using standard guidelines and consultation withspecialists to design a decision tree model. Costs of treatment in both public and private sectors were identifiedaccording to the national tariffs in 2010 and determined based on decision tree and provided services (visitsto specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number ofpatients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV wereobtained from literature to estimate the cost of treatment for each woman in the population.
Results: Follow-upcosts were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total costof 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 theexisting screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that wemanage precancerous cervical lesions with this latter test.