Economic burden associated with the management of cervical cancer, cervical dysplasia and genital warts in Belgium

Figures & data

Table 1.  ICD-9-CM codes for FIGO stage classification of cervical cancer patients.

FIGO classification	ICD-9-CM	ICD-9-CM description
Stage I	180	Malignant neoplasm of cervix uteri
	180.0	Malignant neoplasm of endocervix
	180.1	Malignant neoplasm of exocervix
	180.8	Malignant neoplasm of other specified sites of cervix
	180.9	Malignant neoplasm of cervix uteri, unspecified site
Stage II–IIIa	182	Malignant neoplasm of corpus uteri, except isthmus
	182.1	Malignant neoplasm of isthmus
	182.8	Malignant neoplasm of other specified sites of body of uterus
	198.82	Secondary malignant neoplasm of genital organs
Stage IIIb	197.6	Secondary malignant neoplasm of retroperitoneum and peritoneum
Stage IVa	198.1	Secondary malignant neoplasm of other urinary organs
Stage IVb	197	Secondary malignant neoplasm of respiratory and digestive systems
	197.0	Secondary malignant neoplasm of lung
	197.1	Secondary malignant neoplasm of mediastinum
	197.2	Secondary malignant neoplasm of pleura
	197.3	Secondary malignant neoplasm of other respiratory organs
	197.4	Secondary malignant neoplasm of small intestine includes duodenum
	197.5	Secondary malignant neoplasm of large intestine and rectum
	197.7	Malignant neoplasm of liver, secondary
	197.8	Secondary malignant neoplasm of other digestive organs and spleen
	198	Secondary malignant neoplasm of other specified sites
	198.0	Secondary malignant neoplasm of kidney
	198.2	Secondary malignant neoplasm of skin
	198.3	Secondary malignant neoplasm of brain and spinal cord
	198.4	Secondary malignant neoplasm of other parts of nervous system
	198.5	Secondary malignant neoplasm of bone and bone marrow
	198.6	Secondary malignant neoplasm of ovary
	198.7	Secondary malignant neoplasm of adrenal gland
	198.8	Secondary malignant neoplasm of other specified sites
	198.81	Secondary malignant neoplasm of breast

ICD-9-CM, 9th Revision of the International Classification of Diseases Clinical Modification; FIGO, International Federation of Gynecology and Obstetrics.

Table 2.  Unit costs (in Euros (€)).

Parameter	INAMI (HCPP)	INAMI + patient (SP)
Cost of GP visit*	16.99	20.79
Cost of gynaecologist visit*	13.55	20.79
Cost of dermatologist visit*	15.23	24.97
Cost of other consultation*	13.55	20.79
Cost of Pap smear*	20.25	24.34
Cost of colposcopy*	11.06	11.06
Cost of biopsy*	112.76	121.44
Cost of laser coagulation*	32.77	32.77
Cost of cryotherapy (cervix)*	5.30	5.30
Cost of conisation*	162.5	171.44
Cost of cervix amputation*	189.20	189.20
Cost of electrocoagulation*	32.77	32.77
Cost of surgical excision*	52.44	52.44
Cost of hysterectomy performed at hospital^†	2945.63	2945.63
Cost of conisation performed at hospital^†	685.29	685.29
Hotel cost of 1 hospitalisation day	305.98	346.28
Cost of 1 lost workday^†	—	132.69

INAMI, National Institute of Sickness and Disability Insurance; HCCP, healthcare payer perspective; SP, societal perspective; GP, general practitioner; IMS: Intercontinental Marketing Services.

* INAMI/RIZIV²⁶.

^† IMS Hospital Disease Database: based on 1,252 admissions for conisation and 7,585 for hysterectomies.

^† National Institute for Statistics²⁴.

Table 3.  Estimate of annual productivity-related costs of CC in the Belgian population.

Age group (years)	Annual number of CC cases	% of active women^25	Annual number of workdays lost*	Total annual cost (€)^†
15–24	4	32.7	114	15,161
25–29	20	82.5	1,295	171,883
30–34	53	82.1	3,365	446,522
35–39	77	79.7	4,796	636,367
40–44	82	76.4	4,867	645,800
45–49	76	71.3	4,231	561,431
50–54	64	56.2	2,793	370,539
55–59	56	32.4	1,414	187,660
≥60	234	9 (0% in the ≥65)	1,641	217,692
Total	667^4		24,516	3,253,055

CC, cervical cancer.

* Calculation based on an average of 120 days lost²³ per active women with CC who stops working multiplied by the proportion of women working full time or part time³⁰.

^† Based on a mean cost of €132.69 per work day lost²⁴.

Table 4.  Treatment pathway for CIN.

	CIN 1		CIN 2		CIN 3
	Mean	sd	Mean	sd	Mean	sd
Follow-up
Mean number of physician visits after CIN diagnosis	2.5	0.5	3.6	1.3	3.7	1.3
Number of Pap smears over a 12-month period	1.7	1.1	2.0	1.3	1.1	1.6
Procedures performed (%)
Laser therapy (ambulatory)	30.3	42.9	17.2	35.1	1.0	1.9
Laser therapy (hospital)	11.4	26.5	0.1	0.2	0.4	0.1
Cryotherapy (ambulatory)	5.6	16.7	0.6	1.8	0.2	0.7
Conisation (ambulatory)	49.8	41.0	75.5	32.4	88.2	6.4
Conisation (hospital)	3.0	4.9	4.8	5.5	5.5	5.4
Cervix amputation (hospital)	0	0.0	0.6	1.7	1.2	2.3
Vaginal hysterectomy (hospital)	0	0	1.2	3.7	3.8	3.6

CIN, cervical intraepithelial neoplasia; sd, standard deviation.

Table 5.  Mean annual cost of CIN treatment by categories.

			Mean cost (€)
	CIN 1		CIN 2		CIN 3
	HCPP	SP	HCPP	SP	HCPP	SP
Total cost	217.9	267.2	290.1	481.5	374.3	609.4
Ambulatory cost	158.7	188.1	218.0	259.2	217.2	256.9
Hospital cost	59.1	63.7	72.0	72.3	157.1	157.6
Productivity loss cost	0.0	15.3	0	150.0	0	194.9

CIN, cervical intraepithelial neoplasia; HCPP, healthcare payer perspective; SP, societal perspective.

Table 6.  Medical resource use for genital warts (mean frequencies).

	First-line treatment	Second-line treatment	Third-line treatment
% of patients treated Consultations (mean number per patient per year)	94.4	25.4	12.5
Visits to the GP	1.2	0.6	0.3
Visits to the dermatologist	1.1	1.0	1.5
Visits to the gynaecologist	2.1	2.4	3.3
Other (mixed visits)	0.3	0.4	0.0
Examinations (%)
No examination	3.0	15.0	16.0
Pap smear	70.7	16.7	13.3
Biopsy	5.2	51.7	50.7
Other (colposcopy)	15.6	20.0	20.0
Treatments (%)
Pharmacological treatment	71.5	33.3	13.7
Imiquimod	91.6	76.5	53.3
Podophyllotoxin	8.4	23.5	3.3
Electrocoagulation	14.6	0.0	33.3
Laser therapy	11.4	24.2	27.2
Cryotherapy	2.6	45.4	39.2
Surgical excision	0.0	3.6	0.8

GP, general practitioner.

Table 7.  Mean ambulatory cost (in Euros (€)) of genital wart treatment.

	Females			Males
	% of patients	HCPP cost (€)	SP cost (€)	% of patients	HCPP cost (€)	SP cost (€)
Mean ambulatory cost	89.1	236.3	295.4	90.8	236.3	295.4
Mean hospital cost	10.9	996	996	9.2	1,083	1,083
Mean total cost	100	319.05	371.7	100	314.2	367.9

HCPP, healthcare payer perspective; SP, societal perspective.

Table 8.  Economic burden associated with management of CC,CIN and GWs in Belgium.

	Annual number of cases	Annual cost (HCPP) (in million €)	Annual cost (SP) (in million €)
CC	667	6.48	9.73
CIN	10,495	1.97	3.17
GWs, females	4,079	1.30	1.51
GWs, males	3,909	1.23	1.44
Total	–	10.98	15.85

CC, cervical cancer; CIN, cervical intraepithelial neoplasia; GW, genital wart; HCPP, healthcare payer perspective; SP, societal perspective.