The High Cost of Neglect: Why Investing in Women’s Preventative Health Saves Everyone Money.

Written by Christine Vaccaro, DO, FACOG, FPMRS

SHE+ Medical Advisory Board Member

My name is Dr. Christine Vaccaro, a member of the SHE+ Medical Advisory Board, and double board-certified and fellowship trained urogynecologist and reconstructive pelvic surgeon with advanced training in sexual medicine. I am incredibly passionate about women’s pelvic health and sexuality - both because it is integral in the clinical and surgical management of pelvic floor disorders and because it is essential to women’s overall quality of life. 

We are at a critical moment in women’s health, and most especially in women’s sexual health. 

When we fail to invest in women’s preventative sexual healthcare, we do not just put lives at risk - we waste billions - yes, billions, with a b - of dollars each year. 

From HPV vaccines to contraception to menopause hormone therapy to cancer screening, there is overwhelming evidence that prevention is not just good practice of medicine, but it’s good economics too. 

So let’s start with the HPV Vaccine - a missed opportunity in cancer prevention. 

The HPV vaccine is one of the most effective tools we have to prevent cervical cancer and other HPV related diseases (including genital warts). 

The Human Papillomavirus (HPV) vaccine could prevent more than 90% of HPV related cancers. This includes cervical cancer, yes, but also vaginal, vulvar, anal, penile, and oropharyngeal (throat) cancers.

When you take the time to compare costs, the evidence is clear as day: 

• The lifetime cost of treating a single case of cervical cancer ranges from $25,000 to $100,000 - and can be higher with advanced disease. 

• Each year, HPV-related cancers cost the United States Healthcare system an estimated $775 million in direct medical cost. 

  • Indirect costs - like lost productivity, caregiving burden, or disability, add hundreds of millions more in cost. 

• According to a study published in the Clinical Infectious Disease Journal, the prevalence of health insurance and out-of-pocket costs associated with genital warts were the highest among women ages 20 to 24, and men ages 25 to 29. 

  • On average, individual episodes of care for genital warts involved 3.1 visits to the doctor, and incurred costs for the patient of $436. 

By contrast: 

• The HPV vaccine series (2-3 doses based on your age) costs between $400 and $600 total.  

• At the moment I am writing this, the vaccine is covered by most insurance plans, Medicaid, and free for uninsured children and teens through the Vaccines for Children program. 

And let me be clear, the impact of HPV in our communities is significant. Roughly 14 million people are diagnosed with a new HPV infection each year, and over 36,000 people are diagnosed with an HPV-related cancer each year. 

We are missing the window, though, on preventing HPV. Vaccination is most effective when administered between the ages of 9 years old and 12 years old. Only about 62% of teens in the U.S. are up to date on the HPV vaccine - well below the targets of public health experts. 

But we aren’t too far gone. Every year, a 1% increase in HPV vaccination could save the United States $27 million annually in future cancer treatment costs. 

But, not all preventative care begins with vaccines. 

Vaginal estrogen (creams, inserts, suppositories and rings) can be used to prevent recurrent urinary tract infections - an incredibly common and costly issue for menopausal women.   

One in two women over the age of 55 will experience recurring UTIs, often requiring multiple rounds of antibiotics, leading to antibiotic resistance, not to mention burdensome trips to the doctor. 

Vaginal estrogen therapy reduces UTIs by up to 70%, and can cost as little as $13 per prescription through the Cost Plus Drugs pharmacy.  In fact, a recent study by Dr Rachel Rubin demonstrated that Medicare could save $34 BILLION dollars per year if we gave all menopausal women vaginal hormones, which are the most preventative therapy for urinary tract infections (which can be lethal, by the way). 

What we cannot assign a dollar amount to, though, is the cost of avoidance of intimacy and subsequent decline in quality of life associated with other genitourinary symptoms, such as overactive bladder and sexual pain due to vaginal dryness.

SYSTEMIC MENOPAUSE HORMONE THERAPY

Full body (aka systemic) estrogen therapy is FDA approved to prevent osteoporosis.  It also reduces the risk for dementia, cardiovascular disease and cancer. When women lose estrogen during menopause, their risk—and health care costs—skyrocket.

• Hip fractures due to osteoporosis cost $30 BILLION per year and affect women more than men with 3 out 4 hip fractures occurring in women, and 20% will die within 1 year of hip fracture. 

• The annual cost of dementia care per person in the U.S. is over $50,000. FDA-approved hormone therapy? About $10–$50/month. 

• One in three Americans are impacted by cardiovascular disease - when instituted before the age of 60, hormone replacement therapy can reduce the risk of coronary heart disease.

When we think about the benefits of investing in women’s health prevention, we also invest in women’s quality of life long term, including their sexual health. 

And prevention is not a one stop shop. Continued investment in preventative care means cost-effective and life-saving routine screenings. 

• Mammograms reduce breast cancer mortality by up to 40%, yet 1 in 4 women skip them due to access or cost concerns.

• Osteoporosis screenings allow early detection of low bone density (osteopenia) and risk for major fracture (osteoporosis), yet only 25% of eligible women over 65 receive these scans.  And many women aren’t getting early screening based on risk factors (family history of osteoporosis, low weight, thyroid problems, etc). 

Whether it is cervical cancer screening, mammogram, or bone density screening, they do not just save lives—they prevent expensive, late-stage interventions.

Catching conditions early means less invasive treatment, fewer surgeries, and fewer disability claims, as well as continued socio-economic benefit.

That doesn’t just save funds for the individual, but for the U.S. Healthcare system at large.

Investing in women’s health is not a luxury—it’s a necessity. When we skip preventative care, we don’t just fail women. We pay for it. We pay for it in spades in rising insurance premiums, avoidable ER visits, long-term care expenses, and lost productivity… and worst of all, reduced health span and reduced quality of life.