Study on economic burden and its influencing factors of patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region

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Previous studies have indicated that cervical cancer is one of the common gynecological malignancies. This studied the economic burden of patients with cervical cancer and precancerous lesions within the Inner Mongolia Autonomous Region, providing a scientific basis for the development and implementation of cervical cancer prevention and control measures locally. Methods : This was a cross-sectional, population-based, and multi-center survey. We selected patients with precancerous lesions and cervical cancer in the initial stage, radiotherapy stage, recurrence stage and follow-up review stage by using multi-stage stratified sampling method to collected the basic information and overall cost data from patients in Inner Mongolia Autonomous Region from August 2020 to June2021. 151 patients with cervical cancer and cervical precancerous lesions aged 23-76 years old were invited to participate in investigation by questionnaires. SPSS 20.0 was used for statistical analysis. Results: The average age of 151 patients with cervical cancer and precancerous lesions was (50.7±11.6) years, and the direct medical costs of patients with cervical cancer and precancerous lesions at different treatment stages were statistically different (P<0.05). The direct medical costs gradually increased as the cervical cancer stages progressed (initial stage, radiotherapy stage, recurrence stage, and follow-up review stage). After the direct medical costs were reimbursed by urban workers' or residents' medical insurance, the economic burden on patients at the radiotherapy stage was the heaviest, reaching 0.5 and 0.49 times the total annual per capita income. The highest economic burden after being reimbursed by rural medical insurance on patients at the recurrence stage could reach 2.05 times the total annual per capita income. Multi-factor logistic regression analysis showed that different occupations, education levels, treatment stages, reimbursement amounts, and days of hospitalization all affected the direct economic burden of cervical cancer (P<0.05). Conclusions: The economic burden on patients with cervical cancer and precancerous lesions at different stages varied greatly. Marital status and reimbursement amount had a greater impact on the economic burden of patients in the Inner Mongolia Autonomous Region. Cervical cancer Precancerous cervical lesions Economic burden Influencing factors Background Cervical cancer is one of the common gynaecological malignancies. According to the latest data from GLOBOCAN, in the year 2022, the number of new cases and fatalities of cervical cancer are around 622 thousand and 348 thousand respectively [1]. The number of new cases and fatalities of cervical cancer in China in 2022 is 150 thousand and 55 thousand respectively, a growth of about 3.5% and 23.0% compared to 2018 [2,3]. Such data show that cervical cancer is extremely harmful to women's health, imposing a heavy psychological and economic burden on patients, as well as their families and society. In China, it is estimated that the pure cost of surgery treating an early-stage cervical cancer patient is about 30,000 RMB, and the cost of treatment with radiotherapy, chemotherapy, or targeted drug treatment for late-stage cervical cancer patients may reach hundreds of thousands of RMB[4]. Due to relatively slow economic development, poor medical conditions, and weak awareness of self-care among local women, Inner Mongolia has a high-risk area for cervical cancer in China. The Inner Mongolia Autonomous Region, located in the northern part of China, and characterized by high-altitude conditions averaging 3556 m above sea level, is characterized by the poor healthcare system and socioeconomic factors that influence its relatively underdeveloped status. The research has confirmed that the incidence of cervical cancer in Inner Mongolia was about 10 times the national average, and the incidence of cervical cancer among Mongolian people in Inner Mongolia is about 14 times the national average, with a high incidence age of 40-59 years old [5]. To our surprise, Inner Mongolia has taken a number of measures for cervical cancer prevention and control in order accelerate the elimination of this disease. As the first city in China to implement a policy of screening for cervical cancer in all women aged 35–64 years and to conduct HPV vaccine immunization for all girls aged 13–18 years, the WHO considered the Ordos of the city in China likely to be first eliminate cervical cancer [6], and the region has a high population of people with Mongol ethnicity, who have a higher incidence of cervical cancer. Among the 179,306 women enrolled in the baseline screening between 2016 and 2020, which was implemented by government-led cervical cancer screening program in Ordos City of Inner Mongolia, China [7]. The screening rate of the "two cancers" among women of appropriate age in Ordos City has reached 73%, and the vaccination rate of the cervical cancer vaccine has reached 88.9% [8]. Except the relatively good results in Ordos, the other areas of Inner Mongolia was improvement in cervical cancer prevention and control. As we known, the increasing disease burden of cervical cancer causes considerable economic losses to patients, families, and society [9]. Published articles reporting on the economic burden of patients with cervical cancer and precancerous lesions mostly focused on studies of the direct economic burden of cervical cancer or analysis of the costs of treatment at both the initial treatment and follow-up stages of LSIL patients [10]. It was reported the economic burden of cervical cancer by considering direct costs, as well as indirect costs associated in United States [11], Canada [12]and India [13] associated with individuals who temporarily or permanently leave their employment due to illness. These costs were used to assessment the effectiveness of existing prevention and treatment programs and predict expenditures and potential economic impacts on new interventions. However, there are several studies related to the treatment costs of specific treatment stages of cervical cancer, it is challenging to evaluate the Inner Mongolia Autonomous Region. This study was conducted to understand the direct medical costs and indirect medical costs at different treatment stages of patients with cervical cancer and precancerous lesions within the Inner Mongolia Autonomous Region as well as their influencing factors, with the aim of providing basis for better prevention and treatment of cervical cancer, as well as providing a basis for the treatment of cervical cancer patients in the Inner Mongolia Autonomous Region. Material and methods 2.1 Study design A cross-sectional, hospital-based survey were used in China from August 2020 to June 2021. This study was derived from a multi-center study on the economic evaluation of patients with cervical cancer and precancerous lesions at the Cancer Hospital of the Chinese Academy of Medical Sciences [9]. This study uses stratified sampling to select patients from hospitals at the initial treatment stage, radiotherapy stage, recurrence stage, and follow-up review stage of precancerous cervical lesions (high-grade squamous intraepithelial lesions, low-grade squamous intraepithelial lesions of the uterine cervix) and cervical cancer (stage I, II, III, and IV). The basic information, overall costs of treatment, and economic burden on patients were collected by questionnaires. Ethics approval was obtained from the Cancer Hospital, Chinese Academy of Medical Sciences (No. 22/364-3566)). Written informed consent was obtained from all participants. Study population The inclusion criteria for our study were as follows: 1) patients diagnosed pathologically with LSIL, HSIL, and invasive cervical cancer stages IA, IB, IIA, IIB, III, and IV;2) outpatient and inpatient who had a complete diagnosis and treatment information from the surveyed hospitals during their disease course, and the follow-up had been lasted for ≥1 year(s) and ≤5 years; and 3) patients with common chronic diseases could be included in this survey as long as the treatment for these diseases did not have a significant impact on the overall treatment cost for SIL and cervical cancer. The exclusion criteria were as follows: 1) patients who had other primary neoplasms or serious complications like coronary heart disease and organ transplantation; or 2) patients who could not provide valid informed consent Sample Size According to the Kendall sample size estimation method, the sample size is 5 to 10 times the number of independent variables. The study was collected a total of 151 questionnaires, which meeting the sample size requirements. Data collection The main data in this study included basic characteristics (age, ethnicity, home address, occupation, education, marital status, etc.), clinical information (diagnosis and pathology classification, disease courses, treatment patterns, etc.), and costs (direct medical costs, direct non-medical costs, and indirect costs). ; direct economic costs, such as the cost of surgeries, medical and hospitalization fees for further treatment, cost of self-funded and reimbursed diagnosis, treatment, health care, and medicine; indirect economic costs, such as fees of transport, accommodation, meals, nutrition, care, and losses for absence from work. The questionnaire was based on the Norms for the diagnosis and treatment of cervical cancer [14], which demonstrated robust internal consistency, with Cronbach’s alpha coefficients of 0.85 and 0.89, confirming its reliability and validity. Statistical analysis The database was created through Excel, and SPSS 20.0 software was used to analyze the data. The data distribution showed that the data on cost were skewed. We use median and interquartile spacing to describe the concentration trend, dispersion trend, and the average economic burden of patient treatment. Through single factor analysis and multiple linear regression analysis in rank sum test, the economic burden and its influencing factors on patients with cervical cancer and precancerous lesions were analyzed, with a significance level of α=0.05. (1) Direct economic burden[15] Direct economic burden = direct medical costs + direct non-medical costs Direct medical costs = outpatient costs + hospitalization costs + out-of-hospital drug purchase costs Direct non-medical costs = transport costs + accommodation costs + meal costs + care fees + other costs. (2) Indirect economic burden Indirect economic burden = days of losses for absence from work of patients × (national per capita wage income + net operating income per capita) + days of losses for absence from work of family members who care for patients× (national per capita wage income + net operating income per capita) The national average wage equals the sum of national per capita wage income and net operating income per capita. According to the data on income and consumption expenditure of residents from the National Bureau of Statistics of China, in 2020 the national per capita wage income was 17,917 yuan and the net operating income per capita was 5,307 yuan[16]. Results Basic characteristics The survey results showed that among a total of 151 patients with cervical cancer and cervical precancerous lesions in hospitals in the Inner Mongolia Autonomous Region, the average age was (50.7 ± 11.6) years old. The number of hospitalization days M (P25, P75) was 8.0 (4.0, 36.0) d. Patients at the initial treatment stage accounted for 37.09%, the proportion of medical insurance or business insurance accounted for 54.30%, and the proportion of married women was 92.05%. For family financial status: the per capita annual family income was 45,894 yuan in Table 1. The economic burden on patients with cervical cancer and precancerous lesions at different treatment stages The direct medical costs of patients with cervical cancer and precancerous lesions at different treatment stages were statistically different (P < 0.05); and which was increased as the condition of patients exacerbates. The indirect medical costs of patients with cervical cancer and precancerous lesions at the recurrence stage and radiotherapy stage were statistically different (P < 0.05), while there was no significant difference at the initial stage and follow-up review stage. At any stage, both direct and indirect medical costs of patients with cervical cancer were higher than those of patients with precancerous lesions, and there was a statistical difference (P < 0.05) in Table 2. Economic burden after reimbursement on patients with cervical cancer and precancerous lesions at different treatment stages After direct economic costs were partially reimbursed by urban workers' medical insurance and urban residents' medical insurance, the economic burden borne by patients at the radiotherapy stage was the highest at RMB 17,500.0 (10,000.0, 25,000) and RMB 15,902.5 (8,055.3, 23750.0) respectively, which were 0.5 and 0.49 times the total annual per capita income. The lowest burden after reimbursement was the initial treatment stage, with a total of RMB 2623.8 (1380.8, 3866.8) and 6164.5 (1329.0, 11000.0) respectively. After the direct economic costs were partially reimbursed by the new rural cooperative medical insurance, the economic burden of medical treatment in rural areas was still heavy, with the heaviest for patients at the relapse stage, which was 2.05 times the total annual per capita income, following 1.94 and 1.32 times for patients at the initial stage and radiotherapy stage, respectively, showing that the economic burden after reimbursed by the new rural cooperative medical insurance was still heavy. The results are shown in Table 3. Influencing factors of the direct and indirect medical costs of patients with cervical cancer and precancerous lesions The results of single factor analysis showed that age, marital status, medical payment method, stage of treatment, and days of hospitalization were statistically different (P < 0.05) in the direct medical costs of patients with cervical cancer and precancerous lesions. Age, occupation, educational level, average annual income per capita, stage of treatment, and days of hospitalization were statistically different (P < 0.05) in the indirect medical costs of patients with cervical precancerous lesions, while age, medical payment method, stage of treatment, and days of hospitalization were statistically different (P < 0.05) in the indirect medical costs of patients with cervical cancer. Both direct and indirect medical costs of patients with cervical cancer were higher than those of patients with precancerous lesions under either influencing factor and were statistically different (P < 0.05) in Table 4. Multiple linear regression model analysis on influencing factors of economic burden on patients with cervical cancer and precancerous lesions The results showed that different occupations, educational levels, treatment stages, the amount of reimbursement, and hospitalization days were related to the direct economic cost of patients with cervical cancer and precancerous lesions. Patients at the radiotherapy stage were generally in the middle and late stages of the disease, therefore the more severe the disease was, the greater the economic burden; the more reimbursed by medical insurance, the greater the severity of the disease; the more days of hospitalization, the higher the cost of treating the disease for patients, and the greater the economic burden. The results are shown in Table 5. Discussion Cervical cancer is one of the most common tumours among women [ 17 ]. The incidence rate of cervical cancer is high in China, especially in the west less developed areas. Inner Mongolia Autonomous Region is one of the regions with a high incidence of cervical cancer in China[ 18 ]. It has face challenges including vast territory area, scattered population in ethnic minority areas, weak availability of medical resources and clinicians’ professional capabilities vary greatly among regions at different levels of development in Inner Mongolia Autonomous Region.Therefore, it is crucial to strengthen skills training for healthcare providers and increase the assistance of medical resources to enable clinicians to choose optimized individualized treatment strategies according to local medical resources and standard treatment guidelines. However, there is no report on the economic burden of patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region. Nationally, the economic burden of cervical cancer patients is limited to direct medical costs, and there are few reports on indirect medical costs. This study is the first report that analyses the direct medical costs and indirect medical costs of patients at different treatment stages of cervical cancer and precancerous lesions as well as their influencing factors in Inner Mongolia, which can provide a basis for the prevention and treatment of cervical cancer in the Inner Mongolia Autonomous Region. This study found out that the direct medical costs of patients with cervical cancer and precancerous lesions at the initial stage, radiotherapy stage, follow-up review stage, and recurrence stage were gradually increased as the severity of the disease increased, which may be related to the fact that the more severe the cervical cancer disease is, the more drugs are used for treatment, which is consistent with the reason of the World Health Organization taking measures to eliminate cervical cancer. This study also found that at either stage, the direct medical costs of patients with precancerous lesions were always lower than those of patients with cervical cancer. Through early screening for cervical cancer, the incidence of cervical cancer can be effectively reduced, thus reducing the cost of treatment. Compared to patients with precancerous lesions, patients with cervical cancer in the middle and late stages have to pay a huge treatment cost for radiotherapy[ 19 ]. Patients with precancerous lesions at the recurrence stage and follow-up review stage should pay more attention to cervical cancer screening, as timely follow-up and review can prevent precancerous lesions from converting to cervical cancer to a greater extent, thus saving more treatment costs. Comparing the direct medical costs of patients with cervical cancer at different stages of treatment, we found that patients at the radiotherapy stage bore the highest costs, consistent with the national research results[ 9 ],which can be explained by the fact that patients at the radiotherapy stage were mostly at the middle and late stages of cervical cancer, i.e., the higher the stage of cervical cancer cases, the more severe the disease, which incurred higher surgical and medical costs and heavier economic burden. Notably, this study found that the direct medical costs of cervical cancer treatment at any stage accounted for more than 90% of the total costs, which is higher than the result reported by Righolt in Canada[ 20 ] and is also in line with many studies[ 21 , 22 ], indicating that direct medical costs impose a heavier economic burden on cervical cancer patients. In our study, direct medical costs accounted for the majority of the total costs, and were the dominant treatment-related expenditures for patients. To reduce unnecessary treatment costs fundamentally, it is essential to standardize and transparentize charges items, avoid bundled and repeated fee-for-service, and adjust the charges standards for medical services appropriately. Therefore, it is important to improve the cervical cancer screening rate and promote early diagnosis and treatment so that the incidence of cervical cancer can be effectively reduced, thus reducing the economic burden on patients with cervical cancer. WHO pointed out that annual per capita medical expenditure accounting for more than 40% of annual per capita gross income can be considered as excess expenditure, indicating that the medical expenditure has seriously affected residents’ normal quality of life[ 23 ]. This study found that in urban areas, patients with cervical cancer or precancerous lesions at the radiotherapy stage were still overspending, although their costs were partially reimbursed through urban employees' medical insurance or urban residents' medical insurance. The costs for other patients at other stages were within the normal expenditure range. However, in rural areas, the annual per capita medical expenses at the initial treatment stage, radiotherapy stage, and recurrence stage were 1.94 times, 1.32 times, and 2.05 times the annual total income per capita, although such costs were partially reimbursed by the new rural cooperative medical insurance, indicating that such costs for patients with cervical cancer in rural areas were overspending, thus the medical insurance reimbursement system in rural areas needs to be improved subsequently. Based on our study, it still needs further increase in government funding and universal health insurance coverage and investment in medicare for rural residents, especially in critical diseases, are significant measures to prevent catastrophic medical expenditure and ensure health equity. Tao Siyuan et al.[ 24 ] analysed the direct economic burden of patients with cervical cancer and precancerous lesions in 23 hospitals in 14 provinces or municipalities, and their results showed that the annual per capita medical expenditure spent by patients in the middle and late stages after using rural cooperative medical reimbursement was 4.12 times their annual per capita income, which was higher than the results of this study. Such difference may be caused by the variation in time as well as different reimbursed percentages in each region. However, even if the medical expenses can be partially reimbursed, the costs of treatment still increase with the severity of the disease. Therefore, it is necessary to improve the cervical cancer screening rate, establish a sound health insurance system, and increase the reimbursement rate of rural cooperative medical care. We suggest reducing outpatient bills, increasing the reimbursement rate of hospitalization in rural areas, and strengthening supervision to avoid unreasonable increases in medical costs[ 19 ]. Multi-factor logistic regression analysis showed that the amount of reimbursement and the number of days of hospitalization had an impact on direct costs. The more severe the disease, and the longer the number of days of hospitalization, the higher the costs, because during treatment more advanced medical equipment and more expensive drugs need to be used, which increase the expenditures as well as time costs, thus increasing the economic burden on patients [ 25 , 26 ]. An increase in the reimbursement rate of medical insurance will make cervical cancer patients more inclined to go to larger and more advanced hospitals for better treatment and medical equipment, which will further aggravate the burden on both the patient and society, as such preference may be a waste of medical resources. In response to the current health insurance situation, scholars proposed that we should build a health insurance cost control mechanism to effectively control health insurance costs, reduce unnecessary drug waste, and evenly distribute resources[ 27 ]. Scholars investigated the cost of cervical cancer and cervical intraepithelial neoplasia patients and found that the medical costs of young women patients were significantly lower than those of older women patients [ 28 , 29 ]. This difference may be related to the difference in sample selection area and sample size. In summary, the economic burden caused by cervical cancer is high, but it can be effectively reduced through cervical cancer screening. Lin Yaoquan et al.[ 30 ] adopted the survey method of a retrospective study to estimate the cost of cervical cancer screening and treatment in Cili County between 2012 and 2014, and the results showed that the costs for cervical cancer treatment decreased year by year, from 36,304.94 yuan to 31,186.51 yuan to 22,421.09 yuan, indicating cervical cancer screening facilitates early detection of the disease and achieves early diagnosis and treatment, thus reducing the economic burden on patients with cervical cancer. This result is in line with the purpose of the global strategy of accelerating the elimination of cervical cancer, which was initiated by the WHO. Only through HPV vaccination and cervical cancer screening, cervical cancer patients can be effectively treated and managed, which can lead to a decrease in the number of cervical cancer cases and deaths. Study strengths and limitations This study is the first studies the economic burden and its influencing factors on patients with cervical cancer and precancerous lesions in Inner Mongolia, which provides a reference basis for the prevention and treatment of cervical cancer in ethnic minority areas. This study is the first to evaluate the economic burden of cervical cancer treatment for women in rural areas, and the results showed that women in rural areas were in a state of excess expenditure on cervical cancer treatment, which should be improved with an appropriate medical reimbursement system to achieve the cervical cancer elimination program. The shortcomings of this study are: first, the small sample size of this study limits the credibility of the results; second, the cross-sectional study may cause bias during the study, which affects the accuracy of the results. Conclusion In conclusion, the direct and indirect economic burden on patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region is relatively high, especially for women in rural areas. We should further improve cervical cancer prevention and treatment strategies, ultimately reducing the morbidity and mortality of cervical cancer patients and increasing the survival rate of patients with cervical cancer. Abbreviations HPV Human papillomavirus WHO World Health Organization Declarations Acknowledgements All authors sincerely thank all participants for generously sharing their experiences in this study Authors' contributions You-Lin Qiao, Yan-Qin Yu, Jin-Qi Hao, Fang-Hui Zhao, Zheng-Yang Shi and Jihai Shi participated to design the study, performed data analysis, visualization, validation the whole work and prepared the manuscript, Yan-Qin Yu, Jia-Xin Li and Jinqi Hao took part in data collection, supervision and software and other resources. All authors read and approved the final manuscript. Funding This work was supported by Bill & Melinda Gates Foundation (OPP1216421). Availability of Data and Materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate We received ethical approval from the Ethics Committee of the National Cancer Center/ Cancer Hospital, the Chinese Academy of Medical Sciences and Peking Union Medical College. The informed consent was obtained from all subjects and/or their legal guardian(s). Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. Yifei Yao, Qian Zhu, Xiang Li, Kexin Sun, Rongshou Zheng. Global patterns of cervical cancer incidence and mortality: updated statistics and an overview of temporal trends from 2003 to 2017. Med Plus. 2025;2(2):100082. INTERNATIONAL AGENCY FOR RESEARCH ON CANCER (IARC). 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Lin Yaoquan; Fang Junqun; Tan Fang; Yi Chunhua; Zhang Jingjing; Cost-effectiveness analysis study of cervical cancer screening in poor counties. Practical preventive medicine. 2016;(05 vo 23):576-8. Table Tables 1 to 5 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files table.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 15 Jul, 2025 Editor invited by journal 19 Jun, 2025 Editor assigned by journal 02 Jun, 2025 Submission checks completed at journal 02 Jun, 2025 First submitted to journal 25 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6743880","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485558280,"identity":"355824ab-6e8c-40aa-8454-49143aa67e12","order_by":0,"name":"Jin-Qi Hao","email":"","orcid":"","institution":"Baotou Medical College/ Clinical Epidemiology Research Center of The First Affiliated Hospital of Baotou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jin-Qi","middleName":"","lastName":"Hao","suffix":""},{"id":485558281,"identity":"85c2d8c1-0076-417f-8764-06620af2a98b","order_by":1,"name":"Zheng-Yang Shi","email":"","orcid":"","institution":"Baotou Medical College/ Clinical Epidemiology Research Center of The First Affiliated Hospital of Baotou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zheng-Yang","middleName":"","lastName":"Shi","suffix":""},{"id":485558282,"identity":"47647ae6-4a0d-4caa-808a-af2edff937f9","order_by":2,"name":"Jia-Xin Li","email":"","orcid":"","institution":"Baotou Medical College/ Clinical Epidemiology Research Center of The First Affiliated Hospital of Baotou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jia-Xin","middleName":"","lastName":"Li","suffix":""},{"id":485558284,"identity":"4856b2ab-9124-49bf-adce-d89fb2ac61ed","order_by":3,"name":"Ji-Hai Shi","email":"","orcid":"","institution":"Baotou Medical College/ Clinical Epidemiology Research Center of The First Affiliated Hospital of Baotou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Ji-Hai","middleName":"","lastName":"Shi","suffix":""},{"id":485558286,"identity":"f3c1ed6a-e8d8-4742-b099-6e2345fe0df4","order_by":4,"name":"Fang-Hui Zhao","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Fang-Hui","middleName":"","lastName":"Zhao","suffix":""},{"id":485558287,"identity":"e23dafae-00ed-4217-ac0e-2d50351ee878","order_by":5,"name":"You-Lin Qiao","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"You-Lin","middleName":"","lastName":"Qiao","suffix":""},{"id":485558288,"identity":"61308625-df05-430f-ab0a-495786a1b4f1","order_by":6,"name":"Yan-Qin Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIie3PsQqCQBzH8b84q1ucNNgjKEE4SL2Kh+AkzY4GcVMPUPQSjY1/ObDlwtVoKVodhKagoWipJe7GoPtsB78vfw5A035VDGTsAEfscvUkStxZRculUL+TGhsuhtyaK2z93b5szltuQiU6tArwnB5KEjFNQiq4bSz2G3S3EKzWsSTBbEQo46ZJnkkgIPaPsqRuX4nBvPaElKkkzetKaixAAJYqidu0w5CyKCFQ+WUhiPwvdp0Fhxsj4wnyy/WeR57TlyQDBCAfb/Jt+OYVSjNN07S/9gCGJFCTF1EbPQAAAABJRU5ErkJggg==","orcid":"","institution":"Baotou Medical College/ Clinical Epidemiology Research Center of The First Affiliated Hospital of Baotou Medical College","correspondingAuthor":true,"prefix":"","firstName":"Yan-Qin","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2025-05-25 13:08:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6743880/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6743880/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87012087,"identity":"526e1015-7f4c-4ff4-ba10-182f9ab5d8e9","added_by":"auto","created_at":"2025-07-18 09:27:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":722112,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6743880/v1/8bd6fbfe-a3fd-4c0a-9ebe-b973caddd54a.pdf"},{"id":87010926,"identity":"c3e87505-874a-443e-8c12-afa2b6c9816d","added_by":"auto","created_at":"2025-07-18 09:11:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":37782,"visible":true,"origin":"","legend":"","description":"","filename":"table.docx","url":"https://assets-eu.researchsquare.com/files/rs-6743880/v1/4e68732fed3d054ea330dd44.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study on economic burden and its influencing factors of patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region","fulltext":[{"header":"Background","content":"\u003cp\u003eCervical cancer is one of the common gynaecological malignancies. According to the latest data from GLOBOCAN, in the year 2022, the number of new cases and fatalities of cervical cancer are around 622 thousand and 348 thousand respectively [1].\u0026nbsp; The number of new cases and fatalities of cervical cancer in China in 2022 is 150 thousand and 55 thousand respectively, a growth of about 3.5% and 23.0% compared to 2018 [2,3].\u0026nbsp; Such data show that cervical cancer is extremely harmful to women's health, imposing a heavy psychological and economic burden on patients, as well as their families and society. In China, it is estimated that the pure cost of surgery treating an early-stage cervical cancer patient is about 30,000 RMB, and the cost of treatment with radiotherapy, chemotherapy, or targeted drug treatment for late-stage cervical cancer patients may reach hundreds of thousands of RMB[4]. Due to relatively slow economic development, poor medical conditions, and weak awareness of self-care among local women, Inner Mongolia has a high-risk area for cervical cancer in China. The Inner Mongolia Autonomous Region, located in the northern part of China, and characterized by high-altitude conditions averaging 3556 m above sea level, is characterized by the poor healthcare system and socioeconomic factors that influence its relatively underdeveloped status. The research has confirmed that the incidence of cervical cancer in Inner Mongolia was about 10 times the national average, and the incidence of cervical cancer among Mongolian people in Inner Mongolia is about 14 times the national average, with a high incidence age of 40-59 years old [5]. To our surprise, Inner Mongolia has taken a number of measures for cervical cancer prevention and control in order accelerate the elimination of this disease. As the first city in China to implement a policy of screening for cervical cancer in all women aged 35\u0026ndash;64 years and to conduct HPV vaccine immunization for all girls aged 13\u0026ndash;18 years, the WHO considered the Ordos of the city in China likely to be first eliminate cervical cancer [6], and the region has a high population of people with Mongol ethnicity, who have a higher incidence of cervical cancer. Among the 179,306 women enrolled in the baseline screening between 2016 and 2020, which was implemented by government-led cervical cancer screening program in Ordos City of Inner Mongolia, China [7]. The screening rate of the \"two cancers\" among women of appropriate age in Ordos City has reached 73%, and the vaccination rate of the cervical cancer vaccine has reached 88.9% [8]. Except the relatively good results in Ordos, the other areas of Inner Mongolia was improvement in cervical cancer prevention and control.\u003c/p\u003e\n\u003cp\u003eAs we known, the increasing disease burden of cervical cancer causes considerable economic losses to patients, families, and society [9]. Published articles reporting on the economic burden of patients with cervical cancer and precancerous lesions mostly focused on studies of the direct economic burden of cervical cancer or analysis of the costs of treatment at both the initial treatment and follow-up stages of LSIL patients [10]. It was reported the economic burden of cervical cancer by considering direct costs, as well as indirect costs associated in United States [11], Canada [12]and India [13] associated with individuals who temporarily or permanently leave their employment due to illness. These costs were used to assessment the effectiveness of existing prevention and treatment programs and predict expenditures and potential economic impacts on new interventions. However, there are several studies related to the treatment costs of specific treatment stages of cervical cancer, it is challenging to evaluate the Inner Mongolia Autonomous Region.\u003c/p\u003e\n\u003cp\u003eThis study was conducted to understand the direct medical costs and indirect medical costs at different treatment stages of patients with cervical cancer and precancerous lesions within the Inner Mongolia Autonomous Region as well as their influencing factors, with the aim of providing basis for better prevention and treatment of cervical cancer, as well as providing a basis for the treatment of cervical cancer patients in the Inner Mongolia Autonomous Region.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional, hospital-based survey were used in China from August 2020 to June 2021. This study was derived from a multi-center study on the economic evaluation of patients with cervical cancer and precancerous lesions at the Cancer Hospital of the Chinese Academy of Medical Sciences [9]. This study uses stratified sampling to select patients from hospitals at the initial treatment stage, radiotherapy stage, recurrence stage, and follow-up review stage of precancerous cervical lesions (high-grade squamous intraepithelial lesions, low-grade squamous intraepithelial lesions of the uterine cervix) and cervical cancer (stage I, II, III, and IV). The basic information, overall costs of treatment, and economic burden on patients were collected by questionnaires. Ethics approval was obtained from the Cancer Hospital, Chinese Academy of Medical Sciences (No. 22/364-3566)). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for our study were as follows: 1) patients diagnosed pathologically with LSIL, HSIL, and invasive cervical cancer stages IA, IB, IIA, IIB, III, and IV;2) outpatient and inpatient who had a complete diagnosis and treatment information from the surveyed hospitals during their disease course, and the follow-up had been lasted for \u0026ge;1 year(s) and \u0026le;5 years; and 3) patients with common chronic diseases could be included in this survey as long as the treatment for these diseases did not have a significant impact on the overall treatment cost for SIL and cervical cancer. The exclusion criteria were as follows: 1) patients who had other primary neoplasms or serious complications like coronary heart disease and organ transplantation; or 2) patients who could not provide valid informed consent\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the Kendall sample size estimation method, the sample size is 5 to 10 times the number of independent variables. The study was collected a total of 151 questionnaires, which meeting the sample size requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main data in this study included basic characteristics (age, ethnicity, home address, occupation, education, marital status, etc.), clinical information (diagnosis and pathology classification, disease courses, treatment patterns, etc.), and costs (direct medical costs, direct non-medical costs, and indirect costs). ; direct economic costs, such as the cost of surgeries, medical and hospitalization fees for further treatment, cost of self-funded and reimbursed diagnosis, treatment, health care, and medicine; indirect economic costs, such as fees of transport, accommodation, meals, nutrition, care, and losses for absence from work. The questionnaire was based on the Norms for the diagnosis and treatment of cervical cancer [14], which demonstrated robust internal consistency, with Cronbach\u0026rsquo;s alpha coefficients of 0.85 and 0.89, confirming its reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe database was created through Excel, and SPSS 20.0 software was used to analyze the data. The data distribution showed that the data on cost were skewed. We use median and interquartile spacing to describe the concentration trend, dispersion trend, and the average economic burden of patient treatment. Through single factor analysis and multiple linear regression analysis in rank sum test, the economic burden and its influencing factors on patients with cervical cancer and precancerous lesions were analyzed, with a significance level of \u0026alpha;=0.05.\u003c/p\u003e\n\u003cp\u003e(1) Direct economic burden[15]\u003c/p\u003e\n\u003cp\u003eDirect economic burden = direct medical costs + direct non-medical costs\u003c/p\u003e\n\u003cp\u003eDirect medical costs = outpatient costs + hospitalization costs + out-of-hospital drug purchase costs\u003c/p\u003e\n\u003cp\u003eDirect non-medical costs = transport costs + accommodation costs + meal costs + care fees + other costs.\u003c/p\u003e\n\u003cp\u003e(2) Indirect economic burden\u003c/p\u003e\n\u003cp\u003eIndirect economic burden = days of losses for absence from work of patients \u0026times; (national per capita wage income + net operating income per capita) + days of losses for absence from work of family members who care for patients\u0026times; (national per capita wage income + net operating income per capita)\u003c/p\u003e\n\u003cp\u003eThe national average wage equals the sum of national per capita wage income and net operating income per capita. According to the data on income and consumption expenditure of residents from the National Bureau of Statistics of China, in 2020 the national per capita wage income was 17,917 yuan and the net operating income per capita was 5,307 yuan[16].\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eBasic characteristics\u003c/h2\u003e\u003cp\u003eThe survey results showed that among a total of 151 patients with cervical cancer and cervical precancerous lesions in hospitals in the Inner Mongolia Autonomous Region, the average age was (50.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6) years old. The number of hospitalization days M (P25, P75) was 8.0 (4.0, 36.0) d. Patients at the initial treatment stage accounted for 37.09%, the proportion of medical insurance or business insurance accounted for 54.30%, and the proportion of married women was 92.05%. For family financial status: the per capita annual family income was 45,894 yuan in Table\u0026nbsp;1.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eThe economic burden on patients with cervical cancer and precancerous lesions at different treatment stages\u003c/h3\u003e\n\u003cp\u003eThe direct medical costs of patients with cervical cancer and precancerous lesions at different treatment stages were statistically different (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); and which was increased as the condition of patients exacerbates. The indirect medical costs of patients with cervical cancer and precancerous lesions at the recurrence stage and radiotherapy stage were statistically different (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while there was no significant difference at the initial stage and follow-up review stage. At any stage, both direct and indirect medical costs of patients with cervical cancer were higher than those of patients with precancerous lesions, and there was a statistical difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEconomic burden after reimbursement on patients with cervical cancer and precancerous lesions at different treatment stages\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAfter direct economic costs were partially reimbursed by urban workers' medical insurance and urban residents' medical insurance, the economic burden borne by patients at the radiotherapy stage was the highest at RMB 17,500.0 (10,000.0, 25,000) and RMB 15,902.5 (8,055.3, 23750.0) respectively, which were 0.5 and 0.49 times the total annual per capita income. The lowest burden after reimbursement was the initial treatment stage, with a total of RMB 2623.8 (1380.8, 3866.8) and 6164.5 (1329.0, 11000.0) respectively. After the direct economic costs were partially reimbursed by the new rural cooperative medical insurance, the economic burden of medical treatment in rural areas was still heavy, with the heaviest for patients at the relapse stage, which was 2.05 times the total annual per capita income, following 1.94 and 1.32 times for patients at the initial stage and radiotherapy stage, respectively, showing that the economic burden after reimbursed by the new rural cooperative medical insurance was still heavy. The results are shown in Table\u0026nbsp;3.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInfluencing factors of the direct and indirect medical costs of patients with cervical cancer and precancerous lesions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of single factor analysis showed that age, marital status, medical payment method, stage of treatment, and days of hospitalization were statistically different (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the direct medical costs of patients with cervical cancer and precancerous lesions. Age, occupation, educational level, average annual income per capita, stage of treatment, and days of hospitalization were statistically different (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the indirect medical costs of patients with cervical precancerous lesions, while age, medical payment method, stage of treatment, and days of hospitalization were statistically different (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the indirect medical costs of patients with cervical cancer. Both direct and indirect medical costs of patients with cervical cancer were higher than those of patients with precancerous lesions under either influencing factor and were statistically different (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in Table\u0026nbsp;4.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultiple linear regression model analysis on influencing factors of economic burden on patients with cervical cancer and precancerous lesions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results showed that different occupations, educational levels, treatment stages, the amount of reimbursement, and hospitalization days were related to the direct economic cost of patients with cervical cancer and precancerous lesions. Patients at the radiotherapy stage were generally in the middle and late stages of the disease, therefore the more severe the disease was, the greater the economic burden; the more reimbursed by medical insurance, the greater the severity of the disease; the more days of hospitalization, the higher the cost of treating the disease for patients, and the greater the economic burden. The results are shown in Table\u0026nbsp;5.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCervical cancer is one of the most common tumours among women [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The incidence rate of cervical cancer is high in China, especially in the west less developed areas. Inner Mongolia Autonomous Region is one of the regions with a high incidence of cervical cancer in China[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e It has face challenges including vast territory area, scattered population in ethnic minority areas, weak availability of medical resources and clinicians\u0026rsquo; professional capabilities vary greatly among regions at different levels of development in Inner Mongolia Autonomous Region.Therefore, it is crucial to strengthen skills training for healthcare providers and increase the assistance of medical resources to enable clinicians to choose optimized individualized treatment strategies according to local medical resources and standard treatment guidelines. However, there is no report on the economic burden of patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region. Nationally, the economic burden of cervical cancer patients is limited to direct medical costs, and there are few reports on indirect medical costs. This study is the first report that analyses the direct medical costs and indirect medical costs of patients at different treatment stages of cervical cancer and precancerous lesions as well as their influencing factors in Inner Mongolia, which can provide a basis for the prevention and treatment of cervical cancer in the Inner Mongolia Autonomous Region.\u003c/p\u003e\u003cp\u003eThis study found out that the direct medical costs of patients with cervical cancer and precancerous lesions at the initial stage, radiotherapy stage, follow-up review stage, and recurrence stage were gradually increased as the severity of the disease increased, which may be related to the fact that the more severe the cervical cancer disease is, the more drugs are used for treatment, which is consistent with the reason of the World Health Organization taking measures to eliminate cervical cancer. This study also found that at either stage, the direct medical costs of patients with precancerous lesions were always lower than those of patients with cervical cancer. Through early screening for cervical cancer, the incidence of cervical cancer can be effectively reduced, thus reducing the cost of treatment. Compared to patients with precancerous lesions, patients with cervical cancer in the middle and late stages have to pay a huge treatment cost for radiotherapy[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Patients with precancerous lesions at the recurrence stage and follow-up review stage should pay more attention to cervical cancer screening, as timely follow-up and review can prevent precancerous lesions from converting to cervical cancer to a greater extent, thus saving more treatment costs. Comparing the direct medical costs of patients with cervical cancer at different stages of treatment, we found that patients at the radiotherapy stage bore the highest costs, consistent with the national research results[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e],which can be explained by the fact that patients at the radiotherapy stage were mostly at the middle and late stages of cervical cancer, i.e., the higher the stage of cervical cancer cases, the more severe the disease, which incurred higher surgical and medical costs and heavier economic burden. Notably, this study found that the direct medical costs of cervical cancer treatment at any stage accounted for more than 90% of the total costs, which is higher than the result reported by Righolt in Canada[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and is also in line with many studies[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], indicating that direct medical costs impose a heavier economic burden on cervical cancer patients. In our study, direct medical costs accounted for the majority of the total costs, and were the dominant treatment-related expenditures for patients. To reduce unnecessary treatment costs fundamentally, it is essential to standardize and transparentize charges items, avoid bundled and repeated fee-for-service, and adjust the charges standards for medical services appropriately. Therefore, it is important to improve the cervical cancer screening rate and promote early diagnosis and treatment so that the incidence of cervical cancer can be effectively reduced, thus reducing the economic burden on patients with cervical cancer.\u003c/p\u003e\u003cp\u003eWHO pointed out that annual per capita medical expenditure accounting for more than 40% of annual per capita gross income can be considered as excess expenditure, indicating that the medical expenditure has seriously affected residents\u0026rsquo; normal quality of life[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This study found that in urban areas, patients with cervical cancer or precancerous lesions at the radiotherapy stage were still overspending, although their costs were partially reimbursed through urban employees' medical insurance or urban residents' medical insurance. The costs for other patients at other stages were within the normal expenditure range. However, in rural areas, the annual per capita medical expenses at the initial treatment stage, radiotherapy stage, and recurrence stage were 1.94 times, 1.32 times, and 2.05 times the annual total income per capita, although such costs were partially reimbursed by the new rural cooperative medical insurance, indicating that such costs for patients with cervical cancer in rural areas were overspending, thus the medical insurance reimbursement system in rural areas needs to be improved subsequently. Based on our study, it still needs further increase in government funding and universal health insurance coverage and investment in medicare for rural residents, especially in critical diseases, are significant measures to prevent catastrophic medical expenditure and ensure health equity. Tao Siyuan et al.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] analysed the direct economic burden of patients with cervical cancer and precancerous lesions in 23 hospitals in 14 provinces or municipalities, and their results showed that the annual per capita medical expenditure spent by patients in the middle and late stages after using rural cooperative medical reimbursement was 4.12 times their annual per capita income, which was higher than the results of this study. Such difference may be caused by the variation in time as well as different reimbursed percentages in each region. However, even if the medical expenses can be partially reimbursed, the costs of treatment still increase with the severity of the disease. Therefore, it is necessary to improve the cervical cancer screening rate, establish a sound health insurance system, and increase the reimbursement rate of rural cooperative medical care. We suggest reducing outpatient bills, increasing the reimbursement rate of hospitalization in rural areas, and strengthening supervision to avoid unreasonable increases in medical costs[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMulti-factor logistic regression analysis showed that the amount of reimbursement and the number of days of hospitalization had an impact on direct costs. The more severe the disease, and the longer the number of days of hospitalization, the higher the costs, because during treatment more advanced medical equipment and more expensive drugs need to be used, which increase the expenditures as well as time costs, thus increasing the economic burden on patients [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. An increase in the reimbursement rate of medical insurance will make cervical cancer patients more inclined to go to larger and more advanced hospitals for better treatment and medical equipment, which will further aggravate the burden on both the patient and society, as such preference may be a waste of medical resources. In response to the current health insurance situation, scholars proposed that we should build a health insurance cost control mechanism to effectively control health insurance costs, reduce unnecessary drug waste, and evenly distribute resources[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Scholars investigated the cost of cervical cancer and cervical intraepithelial neoplasia patients and found that the medical costs of young women patients were significantly lower than those of older women patients [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This difference may be related to the difference in sample selection area and sample size. In summary, the economic burden caused by cervical cancer is high, but it can be effectively reduced through cervical cancer screening. Lin Yaoquan et al.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] adopted the survey method of a retrospective study to estimate the cost of cervical cancer screening and treatment in Cili County between 2012 and 2014, and the results showed that the costs for cervical cancer treatment decreased year by year, from 36,304.94 yuan to 31,186.51 yuan to 22,421.09 yuan, indicating cervical cancer screening facilitates early detection of the disease and achieves early diagnosis and treatment, thus reducing the economic burden on patients with cervical cancer. This result is in line with the purpose of the global strategy of accelerating the elimination of cervical cancer, which was initiated by the WHO. Only through HPV vaccination and cervical cancer screening, cervical cancer patients can be effectively treated and managed, which can lead to a decrease in the number of cervical cancer cases and deaths.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStudy strengths and limitations\u003c/h2\u003e\u003cp\u003eThis study is the first studies the economic burden and its influencing factors on patients with cervical cancer and precancerous lesions in Inner Mongolia, which provides a reference basis for the prevention and treatment of cervical cancer in ethnic minority areas. This study is the first to evaluate the economic burden of cervical cancer treatment for women in rural areas, and the results showed that women in rural areas were in a state of excess expenditure on cervical cancer treatment, which should be improved with an appropriate medical reimbursement system to achieve the cervical cancer elimination program.\u003c/p\u003e\u003cp\u003eThe shortcomings of this study are: first, the small sample size of this study limits the credibility of the results; second, the cross-sectional study may cause bias during the study, which affects the accuracy of the results.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the direct and indirect economic burden on patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region is relatively high, especially for women in rural areas. We should further improve cervical cancer prevention and treatment strategies, ultimately reducing the morbidity and mortality of cervical cancer patients and increasing the survival rate of patients with cervical cancer.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman papillomavirus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors sincerely thank all participants for generously sharing their experiences in this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYou-Lin Qiao, Yan-Qin Yu, Jin-Qi Hao, Fang-Hui Zhao, Zheng-Yang Shi and Jihai Shi participated to design the study, performed data analysis, visualization, validation the whole work and prepared the manuscript, Yan-Qin Yu, Jia-Xin Li and Jinqi Hao took part in data collection, supervision and software and other resources. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Bill \u0026amp; Melinda Gates Foundation (OPP1216421).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe received ethical approval from the Ethics Committee of the National Cancer Center/ Cancer Hospital, the Chinese Academy of Medical Sciences and Peking Union Medical College. The informed consent was obtained from all subjects and/or their legal guardian(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263.\u003c/li\u003e\n\u003cli\u003eYifei Yao, Qian Zhu, Xiang Li, Kexin Sun, Rongshou Zheng. Global patterns of cervical cancer incidence and mortality: updated statistics and an overview of temporal trends from 2003 to 2017. Med Plus. 2025;2(2):100082.\u003c/li\u003e\n\u003cli\u003eINTERNATIONAL AGENCY FOR RESEARCH ON CANCER (IARC). GLOBOCAN2020,estimated number of deaths in 2020, China, females, all ages [Internet]. [cited 2023 Jan 4]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf\u003c/li\u003e\n\u003cli\u003eChen M, Xia C F, Liu B, Zhou Y L, Sun H Y, Wang W J, Xue L, Zhao F H, et al. Economic burden analysis of patients with low-grade squamous intraepithelial lesions of the uterine cervix in China. China Oncology. 2021;(11 vo 30):827-33.\u003c/li\u003e\n\u003cli\u003eWu Richahu, Duan Xianzhi. Analysis of the Disease Burden of Cervical Cancer among Women in Inner Mongolia Region [J]. Acta Academia Medicine Baotou, 2016, 32(01): 15 - 16.\u003c/li\u003e\n\u003cli\u003eWang S, Dang L, Yin J, et al. Risk assessment of careHPV testing for the detection of cervical precancerous lesions: 5-year follow-up of a screening program in China. J Infect Public Health. 2025 Jan;18(1):102611\u003c/li\u003e\n\u003cli\u003ehttps://wjw.ordos.gov.cn/xwzx/tpxw_xwzx/202504/t20250414_3782748.html\u003c/li\u003e\n\u003cli\u003eChen H, Zhao X, Hu S, You T, Xia C, Gao M, Dong M, Qiao Y, Zhao F. Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China: A nationwide multicenter cross-sectional study. Chin J Cancer Res. 2023 Dec 30;35(6):675-685.\u003c/li\u003e\n\u003cli\u003eNational Health Commission of the People\u0026rsquo; Republic of China. National guidelines for diagnosisand treatment of cervical cancer 2022 in China (English version). Chin J Cancer Res 2022; 34:256-69.\u003c/li\u003e\n\u003cli\u003eShah R, Nwankwo C, Kwon Y, et al. Economic and humanistic burden of cervical cancer in the United States: Results from a nationally representative survey.J Womens Health (Larchmt) 2020;29:799-805.\u003c/li\u003e\n\u003cli\u003eRigholt CH, Pabla G, Mahmud SM. The direct medical costs of diseases associated with human papillomavirus infection in Manitoba, Canada. Appl Health Econ Health Policy 2018; 16:195-205.\u003c/li\u003e\n\u003cli\u003eSingh MP, Chauhan AS, Rai B, et al. Cost of treatment for cervical cancer in India. Asian Pac J Cancer Prev 2020; 21:2639-46.\u003c/li\u003e\n\u003cli\u003eNational Health Commission of People\u0026rsquo;s Republic of China. Chinese guidelines for diagnosis and treatment of cervical cancer 2018 (English version). Chin J\u003c/li\u003e\n\u003cli\u003eCancer Res 2019; 31:295-305\u003c/li\u003e\n\u003cli\u003eLi Juan; Yu Baorong; A review of studies on the economic burden of disease. China Health Economics. 2007;(11):72-4.\u003c/li\u003e\n\u003cli\u003eIncome and consumer expenditure in 2020 [Internet]. [cited 2023 Jan 5]. Available from: http://www.stats.gov.cn/tjsj/zxfb/202101/t20210118_1812425.html\u003c/li\u003e\n\u003cli\u003eLiu X, Wang W, Hu K, Zhang F, Hou X, Yan J, et al. A Risk Stratification for Patients with Cervical Cancer in Stage IIIC1 of the 2018 FIGO Staging System. Sci Rep. 2020 Jan 15;10(1):362.\u003c/li\u003e\n\u003cli\u003eDuan Xianzhi; Bai Penglai; Wang Shaoming; A study on population screening of cervical cancer and precancerous cervical lesions in eastern Inner Mongolia. Chinese Journal of Clinical Obstetrics and Gynecology. 2012;(03 vo 13):190-3\u003c/li\u003e\n\u003cli\u003eTao SY; Peng I; Wang Y; et al. Study on the direct economic burden of patients with cervical cancer and precancerous lesions and its influencing factors. Chinese Journal of Preventive Medicine. 2018;(12 vo 52):1281-6.\u003c/li\u003e\n\u003cli\u003eRigholt CH, Pabla G, Mahmud SM. The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada. Appl Health Econ Health Policy. 2018 Apr;16(2):195\u0026ndash;205.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;stensson E, Silfverschi\u0026ouml;ld M, Greiff L, et al. The economic burden of human papillomavirus-related precancers and cancers in Sweden. PloS One. 2017;12(6):e0179520.\u003c/li\u003e\n\u003cli\u003eHailu A, Mariam DH. Patient side cost and its predictors for cervical cancer in Ethiopia: a cross-sectional hospital-based study. BMC Cancer. 2013 Feb 8; 13:69.\u003c/li\u003e\n\u003cli\u003eLi Yaqing; Construction of a dynamic adjustment mechanism for financing basic medical insurance for urban and rural residents. Journal of Northwest Agriculture and Forestry University of Science and Technology (Social Science Edition). 2018;(05 vo 18):86-93.\u003c/li\u003e\n\u003cli\u003eWang Yanqiu; Huang Xingli; A comparative analysis of three models of outpatient remission in new rural cooperative medical care in Yunnan Province. China Primary Health Care. 2007;(09):10-1.\u003c/li\u003e\n\u003cli\u003eWen G. H.; Cost analysis of time and cost of first hospitalization of cervical cancer patients based on case home page. China Hospital Statistics. 2021;(03 vo 28):229-31.\u003c/li\u003e\n\u003cli\u003eShi, L.; Wang, S. F.; Yang, L. P.; Bai, Y. N.; Cheng, N.; A study on changes in hospitalization costs and factors influencing cervical cancer patients in Lanzhou. Modern preventive medicine. 2009;(06 vo 36):1029-30.\u003c/li\u003e\n\u003cli\u003eZhou Lulin. A study on cost control of medical insurance in China. 2008.\u003c/li\u003e\n\u003cli\u003eKim J, Lee D, Son KB, Bae S. The Burden of Cervical Cancer in Korea: A Population-Based Study. Int J Environ Res Public Health. 2020 Aug 30;17(17):6308.\u003c/li\u003e\n\u003cli\u003eShah R, Nwankwo C, Kwon Y, Corman SL. Economic and Humanistic Burden of Cervical Cancer in the United States: Results from a Nationally Representative Survey. J Womens Health 2002. 2020 Jun;29(6):799\u0026ndash;805.\u003c/li\u003e\n\u003cli\u003eLin Yaoquan; Fang Junqun; Tan Fang; Yi Chunhua; Zhang Jingjing; Cost-effectiveness analysis study of cervical cancer screening in poor counties. Practical preventive medicine. 2016;(05 vo 23):576-8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer, Precancerous cervical lesions, Economic burden, Influencing factors","lastPublishedDoi":"10.21203/rs.3.rs-6743880/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6743880/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The Inner Mongolia Autonomous Region, located in the northern part of China, and characterized by high-altitude conditions averaging 3556 m above sea level, is characterized by the poor healthcare system and socioeconomic factors that influence its relatively underdeveloped status. Previous studies have indicated that cervical cancer is one of the common gynecological malignancies. This studied the economic burden of patients with cervical cancer and precancerous lesions within the Inner Mongolia Autonomous Region, providing a scientific basis for the development and implementation of cervical cancer prevention and control measures locally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was a cross-sectional, population-based, and multi-center survey. We selected patients with precancerous lesions and cervical cancer in the initial stage, radiotherapy stage, recurrence stage and follow-up review stage by using multi-stage stratified sampling method to collected the basic information and overall cost data from patients in Inner Mongolia Autonomous Region from August 2020 to June2021. 151 patients with cervical cancer and cervical precancerous lesions aged 23-76 years old were invited to participate in investigation by questionnaires. SPSS 20.0 was used for statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The average age of 151 patients with cervical cancer and precancerous lesions was (50.7±11.6) years, and the direct medical costs of patients with cervical cancer and precancerous lesions at different treatment stages were statistically different (P\u0026lt;0.05). The direct medical costs gradually increased as the cervical cancer stages progressed (initial stage, radiotherapy stage, recurrence stage, and follow-up review stage). After the direct medical costs were reimbursed by urban workers' or residents' medical insurance, the economic burden on patients at the radiotherapy stage was the heaviest, reaching 0.5 and 0.49 times the total annual per capita income. The highest economic burden after being reimbursed by rural medical insurance on patients at the recurrence stage could reach 2.05 times the total annual per capita income. Multi-factor logistic regression analysis showed that different occupations, education levels, treatment stages, reimbursement amounts, and days of hospitalization all affected the direct economic burden of cervical cancer (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The economic burden on patients with cervical cancer and precancerous lesions at different stages varied greatly. Marital status and reimbursement amount had a greater impact on the economic burden of patients in the Inner Mongolia Autonomous Region.\u003c/p\u003e","manuscriptTitle":"Study on economic burden and its influencing factors of patients with cervical cancer and precancerous lesions in Inner Mongolia Autonomous Region","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 09:11:19","doi":"10.21203/rs.3.rs-6743880/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-15T06:13:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-19T08:22:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T08:03:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-02T08:00:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-05-25T13:05:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12c3c82b-785b-49d8-8db9-1aff5e98f0f8","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T09:11:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 09:11:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6743880","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6743880","identity":"rs-6743880","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}