Analysis Of Direct Medical Cost And Efficacy Of Patients With Cervical Squamous Intraepithelial Lesions Treated By Different Means

Objective(s):1.The purpose of this study is to compare the outcomes between low-grade squamous intraepithelial lesion with drugs treatment or without treatment,which provides reference for clinical selection of appropriate treatment;2.The aim of this study is to evaluate the outcomes of two different ways(LEEP and CKC)to treat high-grade squamous intraepithelial lesion(such as negative HPV,marginal status,specimen volume,etc.),and to find effective and smaller cervical volume surgical methods.3.The purpose of this study is to analyze the economic burden of patients with cervical intraepithelial lesions,treating by different methods,and to provide the basis for the standardized,rational,economical and effective treatment of cervical intraepithelial lesions in clinical practice.Methods:We selected 763 patients diagnosed as SIL,who met inclusion criteria,from January 2019 to December 2020.There are 376 patients with LSIL(207 patients in the medication group and 169 patients in the observation group)and 387 patients with HSIL(191 cases in LEEP group and 196 cases in CKC group).The relevant clinical data of patients,including age,gestational time,menopausal status,nationality,asymptomatic,TCT/HPV were analyzed to compare the HPV outcome in LSIL treating or not,as well as the economic burden caused by the use of drugs.More over,the purpose is to compare the efficacy and direct medical costs of HSIL treated by LEEP and CKC.Using nonparametric statistical method with SPASS 26.0,such as inspection,χ~2test methods.p<0.05 was considered statistically significant.Results:1.The minimum age of patients with SIL was 19 years old,the maximum age was 72 years old,and the median age was 41(34,48)years old,mainly ranging from30 to 49 years old.The age distribution of patients with LSIL ranged from 19 to 68years old,and the median age was 42(34,49)years old.Patients in the HSIL group ranged in age from 21 to 72 years,with a median age of 40(34,47)years.There were no statistically significant differences in age group,age,gestational time and birth time between HSIL and LSIL groups(p>0.05),but there were statistically significant differences in nationality,menopause and symptoms,contraceptive methods(p<0.05).2.In the LSIL group,123 cases were≥ASCUS(67 cases of ASCUS,43 cases of LSIL,11 cases of ASC-H,and 2 cases of HSIL),and in the HSIL group,There were241 patients with≥ASCUS(67 patients with ASCUS,54 patients with LSIL,38patients with ASC-H,81 patients with HSIL,and 1 patient with SCC),and there was statistical difference between the two groups(p<0.05).3.The common subtypes of HPV in SIL patients were 16,52 and 58,and there were no significant differences in HPV positive and single/compound infection between LSIL and HSIL groups(p>0.05).4.The overall negative conversion rate of HPV in LSIL group without treatment was slightly higher than medication group,and there was no statistically significant difference(p>0.05).The negative conversion rate of HPV in LSIL group treated with one drug was higher than that treated with more than one drug,and there was no statistically significant difference(p>0.05).5.The overall negative conversion rate of HPV in 6 months and 12 months after LEEP treatment was higher than that of HSIL after CKC treatment,but there was no statistically significant difference between the two groups(p>0.05),and there was no statistically significant difference in HPV negative conversion in different transformation areas and different age groups of HSIL after LEEP and CKC treatment(p>0.05).6.The cervical specimen volume of patients HSIL with type II or III transformation area after LEEP treatment was smaller than that of CKC group,with a statistically significant difference(p<0.05);7.The average cost of LSIL group was higher than that of HSIL via LEEP,and the difference was statistically significant(p<0.05);The direct medical cost and surgical cost of HSIL treated by CKC were significantly higher than those treated by LEEP,with significant statistical difference(p<0.05).Conclusion(s):1.All SIL patients were mainly aged from 30 to 49 years old.In this study,HPV was mainly monotypic infection,and the most common subtypes were HPV16,58and 52,among which LSIL was mainly infected with type 52,and HSIL was mainly infected with type 16.2.There was no significant difference in HPV negative conversion rate between the LSIL treatment group and the observation group.3.The HPV negative conversion rate and positive rate of incisal margin after LEEP and CKC treatment were similar in HSIL,but the coning volume of LEEP was smaller than that of CKC group;4.The disease burden of LSIL treatment was heavy,and its economic burden was higher than that of HSIL treatment via LEEP;The direct medical cost of HSIL after treatment with CKC is significantly higher than that of HSIL after treatment with LEEP.The medical diagnosis cost and drugs cost account for the largest proportion in CKC.The economic burden of patients can be reduced by reducing unnecessary examinations and drugs.LEEP in the treatment of HSIL can maximize the protection of the patient’s fertility,facilitate later follow-up and review,significantly reduce the patient’s economic burden and save medical and health resources.