Incremental healthcare resource utilization and costs for patients with cervical, vaginal, vulvar, anal, and oropharyngeal cancer in the United States

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.

Keywords:

• Papillomavirus infections
• oropharyngeal neoplasms
• anus neoplasms
• gynecological neoplasm
• health resources

Transparency

Declaration of funding

This paper was funded by Merck Sharp & Dohme.

Declaration of financial/other relationships

VP, KS, and AW are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and may own Merck & Co., Inc., Kenilworth, NJ, USA restricted stock units and/or stock options. ME is an employee of New Jersey Medical School which has received research payments from J&J (Ovarian Cancer Trial), Astra Zeneca (Ovarian Cancer Trial), Pfizer (Ovarian Cancer Trial), Inovio (cervical dysplasia therapeutic), VBL (Ovarian Cancer Trial), Merck (Cervical Cancer Trial), Iovance (Cervical Cancer trial), Papivax (investigational therapeutic vaccines), PDS Biotechnologies (investigational therapeutic vaccines, and Asieris (investigational therapeutics). ME has received consultation fees from Merck & Co., Inc. NK and RM are employees of Complete HEOR Solutions. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

VP contributed to the designing of the study, and drafting the manuscript. NK and RM contributed to the study design, drafting the manuscript and conducted the data analysis. AW, KS, EM, and ME contributed to the designing of the study, and drafting the manuscript.

Acknowledgements

All authors who met the ICJME criteria for authorship have been listed as authors.