Abstract

Introduction

Human papillomavirus (HPV) cause cancers in a variety of anatomic sites presenting at various stages of disease. Current economic assessments rely on HPV-related cancer cost estimates from data prior to the launch of the nonavalent HPV vaccine (2014). The goal of the present study was to assess and describe the current direct medical care burden of HPV-related cancers in the US.

Methods

Using Clinformatics Data Mart, patients in the US who were newly diagnosed with cervical, vulvar, vaginal, anal, and oropharyngeal cancers between 2012 and 2015 were compared to non-cancer matched (propensity score) controls. Health care resource utilization and direct medical cost (2020 USD) were assessed over a 2-year follow-up period following index diagnosis from a payer perspective. The cost for censored time was estimated using generalized linear model while adjusting for survival probability using cox-proportional hazard model. Confidence intervals were calculated with bootstrapping technique.

Results

The analyses included 4128 cervical, 1580 vulvar, 538 vaginal, 1827 anal, and 6106 oropharyngeal cancers and matched controls. Cases and controls had similar baseline clinical characteristics and length of follow-up. The 2-year incremental direct medical costs were $93,272, $81,676, $141,096, $129,366, and $134,045 for cervical, vulvar, vaginal, anal, and oropharyngeal cancers respectively. Outpatient care costs was the biggest driver of the total incremental medical costs. Most cancer costs were incurred during the first 6 months of follow-up and then stabilized during follow-up.

Conclusion

HPV-related cancers are responsible for substantial health care expenditure each year.

中文翻译：

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美国宫颈癌、阴道癌、外阴癌、肛门癌和口咽癌患者的增量医疗资源利用和成本

摘要

介绍

人乳头瘤病毒 (HPV) 会导致处于不同疾病阶段的各种解剖部位的癌症。当前的经济评估依赖于九价 HPV 疫苗推出之前的数据对 HPV 相关癌症成本的估计（2014 年）。本研究的目的是评估和描述美国当前 HPV 相关癌症的直接医疗负担。

方法

使用 Clinformatics Data Mart，将 2012 年至 2015 年间在美国新诊断出患有宫颈癌、外阴癌、阴道癌、肛门癌和口咽癌的患者与非癌症匹配（倾向评分）对照进行比较。从付款人的角度，在指数诊断后的 2 年随访期内评估了医疗资源利用率和直接医疗费用（2020 美元）。使用广义线性模型估计审查时间的成本，同时使用 cox 比例风险模型调整生存概率。使用自举技术计算置信区间。

结果

分析包括 4128 例宫颈癌、1580 例外阴癌、538 例阴道癌、1827 例肛门癌和 6106 例口咽癌和匹配的对照。病例和对照具有相似的基线临床特征和随访时间。宫颈癌、外阴癌、阴道癌、肛门癌和口咽癌的 2 年增量直接医疗费用分别为 93,272 美元、81,676 美元、141,096 美元、129,366 美元和 134,045 美元。门诊护理费用是总增量医疗费用的最大驱动因素。大多数癌症费用发生在随访的前 6 个月期间，然后在随访期间趋于稳定。

结论

HPV 相关癌症是每年大量医疗保健支出的原因。