OBJECTIVE: Human Papillomavirus infection is the principal cause of cervical cancer and most cervical neoplasia. Despite available screening and treatment, cervical cancer remains an important public health problem. HPV vaccination studies have shown high efficacy against HPV-induced cervical lesions. Prior to implementing a vaccination programme, data about cervical dysplasia and annual treatment costs are critical. This study assessed resource use and costs for Pap III, IIID and IV patients in Germany. METHODS: A one-year retrospective chart review of 138 patients, diagnosed with Pap III, IIID or IV between February - March 2004, was conducted to assess clinical and resource use. Resources included consultations, medications, procedures, diagnostics, adverse events and hospital stays. Unit costs from official sources were applied to calculate the average cost per patient. RESULTS: Most patients had Pap IIID (n=79) vs. Pap III (n=27) or Pap IV (n=32). Mean duration of treatment was 4.4, 5.5, and 4.9 months for Pap III, IIID and IV respectively. Pap IIID patients had on average 4.6 gynaecologist consultations vs. 4.2 and 5.6 for Pap III and IV respectively. Most common diagnostic tests were Pap-smears (99%) and colposcopy (in 89%, 73% and 75% of Pap III, IIID and IV). Typically, patients were treated by conisation (in 22%, 27% and 84% of Pap III, IIID and IV). More Pap IV patients had hysterectomies (22% vs. 4% for Pap III) and laser coagulation (12.5% vs. 4% for Pap IIID). 33% of the patients were hospitalised (mean 7.4 ± 8.3 days). The estimated average annual cost per patient was €1,070, €955 and €3,240 for Pap III, IIID and Pap IV, including 40% indirect costs. CONCLUSION: The cost of managing pre-cancerous cervical lesions in Germany is high. An HPV vaccine preventing many of these lesions could avert much of these costs.