Academic journal article Central European Journal of Public Health

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland - a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health

Academic journal article Central European Journal of Public Health

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland - a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health

Article excerpt


Cemcal cancer (CC) is a major public health problem worldwide as the fourth most common malignant neoplasm in women with approximately 528,000 new cases and 266,000 deaths estimated for 2012 (1). It has been proven that infection with human papillomavirus (HPV) is a necessary cause of CC and a great maj ority of its precursors termed CIN (cervical intraepithelial neoplasia graded 1, 2 and 3) (2). Prophylactic vaccines against HPVs are currently registered and available worldwide. They are reimbursed in about 40 countries, including around 20 in Europe (3). They have been proven to be safe, immunogenic and highly effective in clinical trials (4). The fact that HPV is an aetiological factor of CC and CIN has been also utilized in elaborating HPV assays applied as sensitive screening tests to detect CIN and CC (5) and HPV tests are currently in clinical use in many parts of the world.

Population of Poland is 38.5 million inhabitants and CC agestandardised mortality rate of 7.4/100,000 is twice as high as the average 3.7/100,000 in European Union (6) and is decreasing slowly (7) despite initiation of organised screening in 2006/2007. Although recommended for use in immunization programme by the Ministry of Health (8), HPV vaccines are not reimbursed from public fimds for general population of adolescent girls. HPV tests are currently used in pilot studies in organised screening programme in two regions of Poland but are not reimbursed for screening in the country.

Country-specific data on the burden and costs of management of HPV-related cervical neoplasia are important for public health decision-makers and may be used to plan public health interventions or for health technology assessment analyses of new technologies in screening and vaccination. Phannacoeconomic modelling proved various degrees of HPV vaccination costeffectiveness for many countries (9-12) and it was used to make decisions on their reimbursement. Also, HPV testing has proven to be cost-effective in many countries (13) but such analyses for Poland have not been performed yet.

The National Cancer Registry in Poland produces data on incidence of and mortality from invasive cancers, but the burden of precancerous lesions and comprehensive costs of management of cervical neoplasia in Poland, to oui' knowledge, have not been analysed and published yet. Therefore, the objective of our study was to estimate the burden of cervical neoplasia and costs of its detection and management in Poland from the perspective of the National Health Fund (NHF) - the only public healthcare insurance institution. These data may turn out to be important for further analysis of cost-effectiveness of HPV-based screening and HPV vaccination in the prevention of CIN and CC.


Burden and Costs of Medical Procedures in Organised and Opportunistic CC Screening

The costs of medical procedures in organised and opportunistic screening are covered by the NHF. Approximately 95% of the Polish population are insured in the NHF and this analysis tends to present data from the national health-payer's perspective. All data on the numbers of medical procedures and related costs of organised CC screening in Poland in 2012 were drawn from cervical screening registry called the Information System for Monitoring of Prophylaxis (ISMP). Data on the reimbursed opportunistic screening were drawn from other NHF electronic databases by drawing the numbers and related costs of reimbursement of services coded with the International Classification of Diseases version 10 (ICD10) code Z12.4 (special screening examination for neoplasm of the cervix). To produce a more comprehensive picture of the burden of reimbursed Pap tests, the data on Pap tests performed within NHF-reimbursed services were also drawn by the number of sendees reported with the International Classification System for Surgical, Diagnostic and Therapeutic Procedures (ICD-9-CM) code: 91. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.