Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China: A nationwide multicenter cross-sectional study

Objective: Cervical squamous intraepithelial lesion (SIL) and cervical cancer are major threats to females’ health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment. Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses ("diagnosis", "initial treatment", "chemoradiotherapy", "follow-up" and "recurrence/progression/metastasis") to estimate the total costs. The median and interquartile range (IQR) of total costs (including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated. Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL (LSIL) (n=549), high-grade SIL (HSIL) (n=803), cervical cancer stage IA (n=226), IB (n=610), IIA (n=487), IIB (n=282), III (n=452) and IV (n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7 (IQR: $956.4−$2,669.2) and $2,467.1 (IQR: $1,579.1−$3,762.3), while in rural areas the costs were $459.0 (IQR: $167.7−$1,330.3) and $1,230.5 (IQR: $560.6−$2,104.5), respectively. For patients with cervical cancer stage IA, IB, IIA, IIB, and III−IV, the total costs were $15,034.9 (IQR: $11,083.4−$21,632.4), $19,438.6 (IQR: $14,060.0−$26,505.9), $22,968.8 (IQR: $16,068.8−$34,615.9), $26,936.0 (IQR: $18,176.6−$41,386.0) and $27,332.6 (IQR: $17,538.7−$44,897.0), respectively. Medical insurance covered 43%−55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%−43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage. Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.