{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:10:40Z","timestamp":1780337440983,"version":"3.54.1"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Persistent challenges in cervical cancer (CC) control highlight the need for stage-specific cost estimates to refine prevention strategies. Structural integration of National Health Insurance (NHI) administrative claims, the Taiwan Cancer Registry (TCR), and the National Cause of Death Registry (NCDR) provided the empirical basis for this population-based research. The final analytical sample encompassed 6055 women with cervical intraepithelial neoplasia (CIN) identified in 2016 as well as 9318 patients diagnosed with stage I to IV invasive CC during the 2008 to 2015 period. Reimbursed direct medical costs were estimated for CIN within 6 months after diagnosis and for CC over 5 years after diagnosis. Across CIN grades, no consistent cost gradient was observed, although inpatient utilization was highest in CIN3. Among women with CC, healthcare utilization and expenditures were concentrated in the first year after diagnosis, accounting for 52\u201365% of the total 5-year costs. After age adjustment, the mean first-year costs increased from NT$256,095 (US$8413) in stage I to NT$474,724 (US$15,595) in stage IV, while 5-year survival declined from 85.3% to 19.5%. These findings show that cervical disease imposes substantial direct medical costs on Taiwan\u2019s healthcare system and provide updated evidence to inform human papillomavirus (HPV) vaccination and CC screening policy.<\/jats:p>","DOI":"10.3390\/curroncol33060329","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:11:01Z","timestamp":1780333861000},"page":"329","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stage-Specific Healthcare Costs in Cervical Cancer and Cervical Intraepithelial Neoplasia: A Population-Based Analysis Informing Value-Based Oncology and Equitable Prevention"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9280-0643","authenticated-orcid":false,"given":"Tian-Shyug","family":"Lee","sequence":"first","affiliation":[{"name":"Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242062, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0975-5178","authenticated-orcid":false,"given":"Yu-Chiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu 300102, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F","article-title":"Human papillomavirus is a necessary cause of invasive cervical cancer worldwide","volume":"189","author":"Walboomers","year":"1999","journal-title":"J. Pathol."},{"key":"ref_2","unstructured":"World Health Organization (2025, December 20). Cervical Cancer. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer."},{"key":"ref_3","unstructured":"World Health Organization (2020). Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, World Health Organization."},{"key":"ref_4","unstructured":"World Health Organization (2021). WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention, World Health Organization. [2nd ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/S1470-2045(22)00294-7","article-title":"Accuracy and effectiveness of HPV mRNA testing in cervical cancer screening: A systematic review and meta-analysis","volume":"23","author":"Arbyn","year":"2022","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1056\/NEJMp1011024","article-title":"What is value in health care?","volume":"363","author":"Porter","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e017133","DOI":"10.1136\/bmjgh-2024-017133","article-title":"The financial toxicity of cancer: Unveiling global burden and risk factors\u2014A systematic review and meta-analysis","volume":"10","author":"Kitaw","year":"2025","journal-title":"BMJ Glob. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"oyaf140","DOI":"10.1093\/oncolo\/oyaf140","article-title":"Association of financial hardship and survival in working-age patients following cancer diagnosis in Taiwan","volume":"30","author":"Ciou","year":"2025","journal-title":"Oncologist"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1177\/0969141306013001S11","article-title":"Efficacy and cost-effectiveness of nationwide cervical cancer screening in Taiwan","volume":"13","author":"Koong","year":"2006","journal-title":"J. Med. Screen."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1038\/sj.bjc.6605974","article-title":"Cost-effectiveness analysis of human papillomavirus DNA testing and Pap smear for cervical cancer screening in a publicly financed health-care system","volume":"103","author":"Chow","year":"2010","journal-title":"Br. J. Cancer"},{"key":"ref_11","unstructured":"Health Promotion Administration, Ministry of Health and Welfare, Taiwan (2025, December 20). Cervical Cancer Prevention, Available online: https:\/\/www.hpa.gov.tw\/Pages\/Detail.aspx?kv=ocd09&nodeid=614&pid=1125."},{"key":"ref_12","unstructured":"Health Promotion Administration, Ministry of Health and Welfare, Taiwan (2025, December 20). Boys and Girls Get Vaccinated Together to Stay Away from HPV: Expansion of Publicly Funded Human Papillomavirus (HPV) Vaccination, Available online: https:\/\/www.mohw.gov.tw\/cp-7175-83470-1.html."},{"key":"ref_13","unstructured":"National Health Insurance Administration, Ministry of Health and Welfare, Taiwan (2025, December 20). Patients with Catastrophic Illnesses or Rare Diseases, Available online: https:\/\/www.nhi.gov.tw\/en\/cp-90-d4e0a-18-2.html."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2147\/CLEP.S196293","article-title":"Taiwan\u2019s National Health Insurance Research Database: Past and future","volume":"11","author":"Hsieh","year":"2019","journal-title":"Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s11192-010-0289-2","article-title":"Taiwan\u2019s National Health Insurance Research Database: Administrative health care database as study object in bibliometrics","volume":"86","author":"Chen","year":"2011","journal-title":"Scientometrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1093\/jjco\/hyu211","article-title":"Quality assessment and improvement of nationwide cancer registration system in Taiwan: A review","volume":"45","author":"Chiang","year":"2015","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1016\/j.jfma.2021.04.022","article-title":"Accuracy of long-form data in the Taiwan Cancer Registry","volume":"120","author":"Kao","year":"2021","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1093\/ije\/29.2.336","article-title":"Accuracy of cause-of-death coding in Taiwan: Types of miscoding and effects on mortality statistics","volume":"29","author":"Lu","year":"2000","journal-title":"Int. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s00404-009-1218-6","article-title":"Costs of cervical cancer and precancerous lesions treatment in a publicly financed health care system","volume":"281","author":"Tang","year":"2010","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s10198-021-01405-x","article-title":"Resource utilization and disaggregated cost analysis of bariatric surgery in the Australian public healthcare system","volume":"23","author":"Xia","year":"2022","journal-title":"Eur. J. Health Econ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"402","DOI":"10.6004\/jnccn.2017.7065","article-title":"Medical care costs associated with cancer in integrated delivery systems","volume":"16","author":"Banegas","year":"2018","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_22","first-page":"962","article-title":"Economic burden of metastatic ovarian cancer in a commercially insured population: A retrospective cohort analysis","volume":"26","author":"Chin","year":"2020","journal-title":"J. Manag. Care Spec. Pharm."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hung, M.C., Liu, M.T., Cheng, Y.M., and Wang, J.D. (2014). Estimation of savings of life-years and cost from early detection of cervical cancer: A follow-up study using nationwide databases for the period 2002\u20132009. BMC Cancer, 14.","DOI":"10.1186\/1471-2407-14-505"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2307\/2533947","article-title":"Estimating medical costs from incomplete follow-up data","volume":"53","author":"Lin","year":"1997","journal-title":"Biometrics"},{"key":"ref_25","unstructured":"Health Promotion Administration, Ministry of Health and Welfare, Taiwan (2026, April 01). 2019 Annual Report of the Health Promotion Administration, Available online: https:\/\/www.hpa.gov.tw\/Pages\/ashx\/GetFile.ashx?lang=c&type=1&sid=c8a3ee591699469492670b0a658a1033."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1158\/1055-9965.EPI-11-0650","article-title":"Economic burden of cancer in the United States: Estimates, projections, and future research","volume":"20","author":"Yabroff","year":"2011","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1093\/jnci\/87.6.417","article-title":"Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care","volume":"87","author":"Taplin","year":"1995","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1093\/jnci\/djq495","article-title":"Projections of the cost of cancer care in the United States: 2010\u20132020","volume":"103","author":"Mariotto","year":"2011","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_29","unstructured":"Health Promotion Administration, Ministry of Health and Welfare, Taiwan (2026, April 01). The First Global Cervical Cancer Elimination Day: Taiwan Fulfills Women\u2019s Health Commitment with Action, Available online: https:\/\/www.hpa.gov.tw\/Pages\/Detail.aspx?nodeid=4878&pid=19590."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"615.e1","DOI":"10.1016\/j.ajog.2015.11.021","article-title":"Phase-specific healthcare costs of cervical cancer: Estimates from a population-based study","volume":"214","author":"Liu","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.ygyno.2017.02.011","article-title":"Mean direct medical care costs associated with cervical cancer for commercially insured patients in Texas","volume":"145","author":"Lairson","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.31557\/APJCP.2019.20.5.1547","article-title":"Medical cost to treat cervical cancer patients at a social security third level oncology hospital in Mexico City","volume":"20","author":"Flores","year":"2019","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"de Rycke, Y., Tubach, F., Lafourcade, A., Guillo, S., Dalichampt, M., Dahlab, A., Bresse, X., Uhart, M., Bergeron, C., and Borne, H. (2020). Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228660"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kim, J., Lee, D., Son, K.-B., and Bae, S. (2020). The burden of cervical cancer in Korea: A population-based study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17176308"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/6\/329\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:43:00Z","timestamp":1780335780000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/6\/329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["curroncol33060329"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33060329","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}