Management of women with abnormal cervical cytology: treatment patterns and associated costs in England and Wales

Objective To evaluate the time from abnormal Papanicolaou smear detected during routine screening to the initiation of investigation and treatment of subjects and to evaluate its related costs. Design Retrospective study of clinical records from women with abnormal cervical smears. Setting Six specialist gynaecology/colposcopy clinics in England and Wales. Sample Six hundred subsequent women (100 per clinic) with first abnormal cervical smear result at the specialist gynaecology/colposcopy clinic. Methods Details of all clinic visits, tests and procedures during 24 months starting from the first abnormal cervical smear were collected from the year 2002. Main outcome measures Patterns of management after initial abnormal smear, time to start the investigation and/or treatment expressed in days/months and treatment costs by cytology and histology grades. Results Significant age differences were observed between women with early grades of precancer lesions (32 years) and cancer (49 years) (P < 0.05). Subgroup analysis of women younger than 26 years indicates a representation of this age group in all the histology grades including cancer. Median time to initiate the investigation and/or treatment was 50 days. In contrast, for 5% of women, delay in management lasted for > 1 year. Colposcopy and repeated cervical smears were the most frequent systematic investigations performed, while the large loop excision of the transformation zone procedure was the principal therapeutic procedure. Analysis of average treatment costs by referral cytology showed small differences between the three grades of cytological diagnoses (mild dyskaryosis, 408.96; pound moderate dyskaryosis, 442.55 pound and severe dyskaryosis, 493.74) pound. Analysis by histology grade showed that the cost for women with a negative result (263.34) pound differed markedly from that for women with cervical intraepithelial neoplasia (CIN) (CIN1, 419.39; pound CIN2, 572.29; pound and CIN3, 584.92) pound. Conclusion Time to investigation could be improved for a subgroup of women. Costs associated with investigation and treatment of women with abnormal cervical smears differ significantly between analyses by cytology and histology grade. This needs to be borne in mind when designing cost-effectiveness studies of cervical screening.