Economic burden of guideline-discordant cervical cancer screening among commercially insured women age 15 to 20 years.

Abstract

50 Background: Clinical guidelines recommend against cervical cancer screening in average-risk women younger than 21 years. Nonetheless, prior studies suggest that 13.8% of women aged 15 to 20 years still receive potentially unnecessary cervical cancer screening. We sought to estimate the costs of guideline-discordant care in this age group. Methods: We conducted a retrospective cohort study using the 2020–2023 Merative MarketScan Commercial Database. Using ICD-10, CPT, and HCPCS codes, we identified average-risk women (excluding those with high-risk conditions or immunosuppressive medication use warranting non-routine screening) aged 15 to 20 years who underwent cervical cancer screening, compared with an unscreened group. The index date was the first screening date for screened women and a randomly selected claim date for unscreened women. We balanced the baseline characteristics collected before or on the index date using stabilized inverse probability of treatment weighting. We used a difference-in-differences design to estimate one-year cascade costs attributable to guideline-discordant screening, including subsequent testing and diagnostic procedures, adjusted for available demographic and clinical characteristics. Results: Among 284,618 average-risk women aged 15 to 20 years during January 2021 to December 2022, 42,144 (14.8%) received cervical cancer screening. Screened women (vs. unscreened) were more likely to have received sexually transmitted disease (STD) testing (57.5% vs. 14.3%), use birth control (39.2% vs. 9.2%), and be pregnant (8.2% vs. 3.3%) in the 12 months before and on the index date. Logistic regression showed that STD testing and birth control were also the strongest predictors of screening with odds ratios of 5.27 [95% CI: 5.14–5.40] and 3.72 [3.62–3.83], respectively. After screening, most cascade costs were incurred within 1 month. The average total annual cascading cost was $201.8 [198.9–204.6] per person, of which 95.0% was paid by insurance ($191.6 [189.2–194.1]), amounting to approximately $8.1 million in total costs across the screened sample. Over the 1-year follow-up, excisional procedures were uncommon in both groups but more frequent among screened women (14.2 vs. 3.3 per 100,000). Cervical cancer diagnosis was also rare in this population: among the unscreened women, 4 cases were identified after they reached age 21 and entered the recommended screening window during follow-up. Conclusions: Approximately 1 in 7 women under 21 with private health insurance received a guideline-discordant cervical cancer screening, leading to over $8 million in costs that were largely covered by insurance. De-implementing guideline-discordant screening through payer reforms and targeted interventions in young women could reduce potentially unnecessary spending and physical and psychological harms of low-value care.