Determining Costs of Health Care Services for Cost-Effectiveness Analyses: The Case of Cervical Cancer Prevention and Treatment

• Published in: Medical care 1999-07, Vol.37 (7), p.652-661
• Main Authors: Helms, L. Jay, Melnikow, Joy
• Format: Article
• Language: English
• Subjects: California; Case-Control Studies; Cervical cancer; Colposcopy; Cost analysis; Cost control; Cost estimates; Cost-Benefit Analysis; Data Interpretation, Statistical; Dollar averaging; Economic costs; Estimation methods; Family Planning Services - economics; Fees and Charges - statistics & numerical data; Female; Health care costs; Health Care Costs - statistics & numerical data; Health Maintenance Organizations - economics; Health Resources - economics; Health Resources - statistics & numerical data; Health Services Research; Humans; Prospective Studies; Reimbursement; Reimbursement Mechanisms - economics; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - therapy; Washington
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-199907000-00005

Objectives. To estimate costs for the prevention and treatment of cervical cancer based on resource utilization and to compare those costs to published estimates and to local charges and reimbursements. Design. Cost estimates for cervical cancer prevention services were based on clinic staff time, use of specialized equipment and supplies, laboratory costs, and clinic overhead. Cost estimates for cervical cancer treatment were based on HMO expenditures for cervical cancer patients and control patients. These costs were adjusted for stage distribution and survival rates. Published cost estimates were obtained from a systematic review of the medical literature between 1990 and 1996. Setting. Three family planning clinics (for prevention costs) and a staff-model HMO (for treatment costs). Patients. For treatment costs: 98 cervical cancer patients and 133,058 female control patients, matched by age and chronic disease score. Main Outcome Measures. Estimated costs for prevention and treatment of cervical cancer. Cost-to-charge and cost-to-reimbursement ratios. Results. Costs of cervical cancer prevention and treatment services have been determined using a variety of methods. We found substantial variation in these estimates, even for studies with similar methodologies. Detailed resource-based estimation suggests that prevention costs are generally lower than those previously published in the literature, whereas the costs of cervical cancer treatment are generally higher. Conclusions. It is practical and desirable to employ resource use-based estimates of medical costs in cost-effectiveness analyses. Failure to do so for cervical cancer may affect policy recommendations by understating the relative benefits of prevention programs.