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

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

人乳头瘤病毒（Human papillomavirus, HPV）可在多种解剖部位引发癌症，且疾病呈现不同分期。当前的经济学评估均基于九价人乳头瘤病毒疫苗（nonavalent HPV vaccine）于2014年上市前的HPV相关癌症成本估算数据。本研究旨在评估并描述当前美国HPV相关癌症的直接医疗负担。本研究依托Clinformatics Data Mart数据库，将2012至2015年美国新确诊宫颈癌、外阴癌、阴道癌、肛门癌及口咽癌的患者，与经倾向得分（propensity score）匹配的非癌症对照人群进行比较。从支付方视角出发，评估了首次确诊后2年随访周期内的医疗资源利用情况与直接医疗成本（以2020年美元计价）。删失时间的成本通过广义线性模型（generalized linear model）进行估算，并借助Cox比例风险模型（Cox-proportional hazard model）校正生存概率的影响。采用自助法（bootstrapping technique）计算置信区间。本次分析共纳入4128例宫颈癌、1580例外阴癌、538例阴道癌、1827例肛门癌、6106例口咽癌患者及其匹配对照人群。病例组与对照组的基线临床特征及随访时长均无显著差异。宫颈癌、外阴癌、阴道癌、肛门癌及口咽癌患者的2年增量直接医疗成本分别为93272美元、81676美元、141096美元、129366美元及134045美元。门诊医疗成本为增量总医疗成本的首要驱动因素。多数癌症相关成本产生于随访初始的6个月内，后续随访周期内成本趋于平稳。HPV相关癌症每年可造成数额可观的医疗费用支出。