OBJECTIVES : Cervical conization is a common surgical procedure for diagnosis and treatment of high-grade cervical intraepithelial neoplasia (CIN) caused by human papillomavirus (HPV). The objective of this study was to assess healthcare-related costs in women 18-45 years-old who underwent a conization in Germany.

METHODS : We conducted a retrospective cross-sectional claims data analysis using the “Institute for Applied Health Research Berlin” (InGef) Research Database, which covers approximately 4 million individuals. All women aged 18-45 who underwent cervical conization (OPS code 5-671.0*) in the InGef research database between July 1st, 2013 and December 31st, 2016 were identified. Inclusion criterion was no former conization procedure record 6 months prior to conization (index conization), and minimum follow-up post-index conization of 24 months. All-cause healthcare costs (excluding costs pre-conization) were reported by inpatient, outpatient, pharmaceutical, and sick leave costs and as sum, as well as conization-specific costs during 24 months follow-up after index conization. Missing data on sick leave costs were imputed using mean.

RESULTS : Overall, 4,415 women who underwent a conization and were continuously observable for at least 24 months after the conization were identified. After 24 months follow-up, total all-cause healthcare costs were €4,873 (SD:€13,924) for women undergoing conization. All-cause costs were driven by inpatient care (€2,018 (SD:€3,882)) followed by outpatient care (€1,690 (SD:€1,454)). The total conization specific costs were €1,369 (SD:€1,861), which were mainly driven by conization related hospitalizations (€866 (SD:€1,850)). The conization specific costs accounted for about 28% of the all-cause healthcare costs during follow-up.

CONCLUSIONS : Women aged 18-45-year-old in Germany undergoing conization showed considerable all-cause health economic burden. Further analyses to assess the health economic burden of women with CIN undergoing a conization including costs pre-treatment compared to women without CIN are planned. Attempts should be made to reduce the burden of CIN as a main cause for subsequent conization.