METHODS

We used a national commercial claims database (Clinformatics) with individual-level demographic information and inpatient, outpatient, and pharmacy claims for plan members residing in all 50 US states (Appendix 1, available online at https://links. lww. com/AOG/C473). Women aged 21–65 years, enrolled in a single, employer-based health plan between 2006 and 2019 who underwent at least one colposcopy and were continuously enrolled for at least 6 months after the index colposcopy episode were included in the study. Colposcopy episodes were categorized into three groups: colposcopy alone, with biopsy, or with additional procedures (ie, loop electrode excisional procedure or conization). We included colposcopy episodes associated with excisional procedures that are both diagnostic and therapeutic, because all colposcopies are aimed at cancer prevention and shortening time to diagnosis and treatment of cancer. Out-of-pocket spending (ie, deductible, co-payments, and co-insurance) for colposcopy and related care, including biopsy, conization, and pathology services, incurred within 60 days of the colposcopy procedure was quantified. This study using de-identified data was deemed not regulated by the University of Michigan Institutional Review Board (HUM00164685).

RESULTS

We identified 374,169 women with 503,335 colposcopy episodes over the study period. A substantial percentage of colposcopy episodes were associated with biopsies (85.1%) or additional procedures (7.2%)(Fig. 1). Over the entire study period, at least 79% of colposcopy episodes had some cost sharing (Fig. 1). Out-of-pocket costs (Fig. 2) were nontrivial, increased throughout the study period, and were higher when a biopsy or additional procedure was performed (2019, colposcopy alone: median [interquartile range] $112 [$20–184]; with biopsy: $155 [$31–293]; with additional procedure: $702 [$220–1,499]; Appendix 1, https://links. lww. com/AOG/C473).