Management of Precancerous Cervical Lesions in Iran: A Cost Minimizing Study

  • Nahvijou, Azin (Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences) ;
  • Sari, Ali Akbari (Department of Health Economics and Management, School of Public Health, and Knowledge Utilization Research Center (KURC)) ;
  • Zendehdel, Kazem (Cancer Research Center of Cancer Institute of Iran, Tehran University of Medical Sciences) ;
  • Marnani, Ahmad Barati (Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences)
  • Published : 2014.10.23


Background: Cervical cancer is a common, preventable and manageable disease in women worldwide. Objectives: This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. Materials and Methods: Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. Results: Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174$ respectively. Conclusions: The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.


Cost minimization;Pap smear;HPV DNA testing;decision tree;Iran


Supported by : Iran University of Medical Sciences


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