Determining costs of health care services for cost-effectiveness analyses - The case of cervical cancer prevention and treatment

OBJECTIVES. To estimate costs for the prevention and treatment of cervical cancer based on resource utilization and to compare those costs to publishe d estimates and to local charges and reimbursements. DESIGN. Cost estimates for cervical cancer prevention services were based o n clinic staff time, use of specialized equipment and supplies, laboratory costs, and clinic overhead. Cost estimates for cervical cancer treatment we re based on HMO expenditures for cervical cancer patients and control patie nts. These costs were adjusted for stage distribution and survival rates. P ublished cast estimates were obtained from a systematic review of the medic al literature between 1990 and 1996. SETTING, Three family planning clinics (for prevention costs) and a staff-m odel HMO (for treatment costs), PATIENTS. For treatment tests: 98 cervical cancer patients and 133,058 fema le control patients, matched by age and chronic disease score. MAIN OUTCOME MEASURES. Estimated costs for prevention and treatment of cerv ical cancer. Cost-to-charge and cost-to-reimbursement ratios. RESULTS. Costs Of cervical cancer prevention and treatment services have be en determined using a variety of methods. We found substantial variation in these estimates, even for studies with similar methodologies. Detailed res ource-based estimation suggests that prevention costs are generally lower t han those previously published in the literature, whereas the costs of cerv ical cancer treatment are generally higher. CONCLUSIONS. It is practical and desirable to employ resource use-based est imates of medical costs in cost-effectiveness analyses, Failure to do so fo r cervical cancer may affect policy recommendations by understating the rel ative benefits of prevention programs.