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The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada

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Abstract

Background

The total direct cost of screening and treating all human papillomavirus-related diseases (HPV-RD) has not been measured in a single study. Accurate cost estimates are needed to inform decisions on intervention priorities and evaluate the cost-effectiveness of existing programs. We used province-wide clinical, administrative, and accounting databases to measure direct medical costs of HPV infection in Manitoba (Canada).

Methods

All persons 9 years or older with health insurance coverage in Manitoba between April 2000 and March 2015 were eligible. We identified all persons with an incident HPV-RD and aggregated all medical costs (in 2014 Canadian dollars) related to that condition, including prescription drugs, diagnostic procedures, in-hospital and outpatient treatment, and physician visits.

Results

We found that the median cost of treating a case of anogenital warts was $130. An episode of cervical dysplasia had a median cost of $220, compared to $1300 for an episode of cervical carcinoma in situ. The cost of treating HPV-related invasive cancer varied from $15,000 for cervical cancer to $33,000 for oral cavity cancer. Overall, 80% ($145 million) of the total cost was attributable to HPV infection. Cervical screening and follow-up accounted for $96 million (66%) of all costs and this cost component has declined following the introduction of new screening guidelines.

Conclusions

Overall, the average direct medical cost of HPV infection was $720 per newborn. The economic burden of HPV remains significant, although changes in cervical screening guidelines, prompted by the introduction of a public HPV vaccine program, appear to have promoted a promising trend towards lower costs.

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Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available due to The Personal Health Information Act. The data can be requested from the data custodians, the Manitoba Centre for Health Policy. The software code is designed for the structure of Manitoba data and is available from the corresponding author on reasonable request.

References

  1. Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. J Clin Virol. 2005;32(Suppl 1):S16–24. https://doi.org/10.1016/j.jcv.2004.12.008.

    Article  PubMed  Google Scholar 

  2. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36(1):6–10.

    Article  PubMed  Google Scholar 

  3. Franco EL, Duarte-Franco E, Ferenczy A. Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection. CMAJ. 2001;164(7):1017–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. IARC Working Group. Human papillomaviruses. IARC Monographs on the evaluation of the carcinogenic risks to humans. Lyon: International Agency for Research on Cancer; 1995.

    Google Scholar 

  5. Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Global Health. 2016;4(9):e609–16. https://doi.org/10.1016/S2214-109X(16)30143-7.

    Article  PubMed  Google Scholar 

  6. Munoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348(6):518–27. https://doi.org/10.1056/NEJMoa021641.

    Article  PubMed  Google Scholar 

  7. Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control. 2009;20(4):449–57. https://doi.org/10.1007/s10552-008-9276-9.

    Article  PubMed  Google Scholar 

  8. De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer. 2009;124(7):1626–36. https://doi.org/10.1002/ijc.24116.

    Article  PubMed  Google Scholar 

  9. Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012;30(Suppl 5):F12–23. https://doi.org/10.1016/j.vaccine.2012.07.055.

    Article  PubMed  Google Scholar 

  10. de Sanjosé S, Alemany L, Ordi J, Tous S, Alejo M, Bigby SM, et al. Worldwide human papillomavirus genotype attribution in over 2000 cases of intraepithelial and invasive lesions of the vulva. Eur J Cancer. 2013;49(16):3450–61. https://doi.org/10.1016/j.ejca.2013.06.033.

    Article  PubMed  Google Scholar 

  11. CDC. Pinkbook: Human Papillomavirus Chapter—Epidemiology of Vaccine-Preventable Diseases. 2015. CDC—Pinkbook: Human Papillomavirus Chapter—Epidemiology of Vaccine-Preventable Diseases. 2015. http://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html. Accessed 06 April 2015.

  12. Alemany L, Saunier M, Alvarado-Cabrero I, Quirós B, Salmeron J, Shin H-R, et al. Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide. Int J Cancer. 2015;136(1):98–107. https://doi.org/10.1002/ijc.28963.

    Article  CAS  PubMed  Google Scholar 

  13. Franco EL, Mahmud SM, Tota J, Ferenczy A, Coutlée F. The expected impact of HPV vaccination on the accuracy of cervical cancer screening: the need for a paradigm change. Arch Med Res. 2009;40(6):478–85. https://doi.org/10.1016/j.arcmed.2009.06.003.

    Article  PubMed  Google Scholar 

  14. Insinga R, Dasbach E, Elbasha E. Assessing the annual economic burden of preventing and treating anogenital human papillomavirus-related disease in the US. Pharmacoeconomics. 2005;23(11):1107–22. https://doi.org/10.2165/00019053-200523110-00004.

    Article  PubMed  Google Scholar 

  15. Lairson DR, Fu S, Chan W, Xu L, Shelal Z, Ramondetta L. Mean direct medical care costs associated with cervical cancer for commercially insured patients in Texas. Gynecol Oncol. 2017. https://doi.org/10.1016/j.ygyno.2017.02.011.

    Google Scholar 

  16. Insinga RP, Glass AG, Rush BB. The health care costs of cervical human papillomavirus–related disease. Am J Obstet Gynecol. 2004;191(1):114–20. https://doi.org/10.1016/j.ajog.2004.01.042.

    Article  PubMed  Google Scholar 

  17. Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine. 2012;30(42):6016–9. https://doi.org/10.1016/j.vaccine.2012.07.056.

    Article  PubMed  Google Scholar 

  18. Helms LJ, Melnikow J. Determining costs of health care services for cost-effectiveness analyses: the case of cervical cancer prevention and treatment. Med Care. 1999;37(7):652–61.

    Article  CAS  PubMed  Google Scholar 

  19. Erickson LJ, De Wals P, Farand L. An analytical framework for immunization programs in Canada. Vaccine. 2005;23(19):2470–6. https://doi.org/10.1016/j.vaccine.2004.10.029.

    Article  CAS  PubMed  Google Scholar 

  20. Joura EA, Giuliano AR, Iversen O-E, Bouchard C, Mao C, Mehlsen J, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372(8):711–23. https://doi.org/10.1056/NEJMoa1405044.

    Article  CAS  PubMed  Google Scholar 

  21. Roos L, Mustard C, Nicol J, McLerran D, Malenka D, Young T, et al. Registries and administrative data: organization and accuracy. Med Care. 1993;31(3):201–12.

    Article  CAS  PubMed  Google Scholar 

  22. Kozyrskyj AL, Mustard CA. Validation of an electronic, population-based prescription database. Ann Pharmacother. 1998;32(11):1152–7. https://doi.org/10.1345/aph.18117.

    Article  CAS  PubMed  Google Scholar 

  23. Robinson JR, Young TK, Roos LL, Gelskey DE. Estimating the burden of disease: comparing administrative data and self-reports. Med Care. 1997;35(9):932–47.

    Article  CAS  PubMed  Google Scholar 

  24. Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. Apmis. 2010;118(6–7):450–4.

    Article  PubMed  Google Scholar 

  25. Mahmud SM, Kliewer EV, Lambert P, Bozat-Emre S, Demers AA. Effectiveness of the quadrivalent human papillomavirus vaccine against cervical dysplasia in Manitoba, Canada. J Clin Oncol. 2014;32(5):438–43. https://doi.org/10.1200/jco.2013.52.4645.

    Article  PubMed  Google Scholar 

  26. Kliewer EV, Demers AA, Elliott L, Lotocki R, Butler JR, Brisson M. Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in Canada. Sex Transm Dis. 2009;36(6):380–6. https://doi.org/10.1097/OLQ.0b013e318198de8c.

    Article  PubMed  Google Scholar 

  27. Canadian Cancer Statistics 2016. Toronto: Canadian Cancer Society’s Advisory Committee on Cancer Statistics; 2016. http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2016-EN.pdf?la=en. Accessed 10 Oct 2017.

  28. Finlayson GS, Ekuma O, Yogendran M, Burland E, Forget E. The Additional Cost of Chronic Disease in Manitoba. Winnipeg; 2010. https://www.researchgate.net/publication/275649026_Chronic_Disease_in_Manitoba_What_are_the_costs_Winnipeg_Manitoba_Centre_for_Health_Policy. Accessed 10 Aug 2017.

  29. Owusu-Edusei K Jr, Chesson HW, Gift TL, Tao G, Mahajan R, Ocfemia MC, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40(3):197–201. https://doi.org/10.1097/OLQ.0b013e318285c6d2.

    Article  PubMed  Google Scholar 

  30. OECD. Health expenditure indicators. http://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics/system-of-health-accounts-health-expenditure-by-function_data-00349-en. Accessed 4 Sept 2017.

  31. Baio G, Capone A, Marcellusi A, Mennini FS, Favato G. Economic burden of human papillomavirus-related diseases in Italy. PLoS One. 2012;7(11):e49699. https://doi.org/10.1371/journal.pone.0049699.

    Article  CAS  PubMed  Google Scholar 

  32. Borget I, Abramowitz L, Mathevet P. Economic burden of HPV-related cancers in France. Vaccine. 2011;29(32):5245–9. https://doi.org/10.1016/j.vaccine.2011.05.018.

    Article  CAS  PubMed  Google Scholar 

  33. de Oliveira C, Bremner KE, Pataky R, Gunraj N, Chan K, Peacock S, et al. Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study. CMAJ Open. 2013;1(1):E1–8. https://doi.org/10.9778/cmajo.20120013.

    Article  PubMed  Google Scholar 

  34. Cromwell I, Ferreira Z, Smith L, van der Hoek K, Ogilvie G, Coldman A et al. Cost and resource utilization in cervical cancer management: a real-world retrospective cost analysis. Curr Oncol (Tor Ont). 2016;23(Suppl 1):S14–S22. https://doi.org/10.3747/co.23.2914.

  35. Insinga RP, Ye X, Singhal PK, Carides GW. Healthcare resource use and costs associated with cervical, vaginal and vulvar cancers in a large US health plan. Gynecol Oncol. 2008;111(2):188–96. https://doi.org/10.1016/j.ygyno.2008.07.032.

    Article  PubMed  Google Scholar 

  36. McCrory D, Matchar D, Bastian L, Datta S, Hasselblad V, Hickey J. Evaluation of cervical cytology. Evidence report/technology assessment No. 5. Rockville: Agency for Health Care Policy and Research; 1999.

    Google Scholar 

  37. Annemans L, Rémy V, Lamure E, Spaepen E, Lamotte M, Muchada J-P, et al. Economic burden associated with the management of cervical cancer, cervical dysplasia and genital warts in Belgium. J Med Econ. 2008;11(1):135–50. https://doi.org/10.3111/13696990801961611.

    Article  PubMed  Google Scholar 

  38. Low JJ, Ko Y, Ilancheran A, Zhang XH, Singhal PK, Tay SK. Health and economic burden of HPV-related diseases in Singapore. Asian Pac J Cancer Prev. 2012;13(1):305–8.

    Article  PubMed  Google Scholar 

  39. Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, et al. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004;96(8):604–15.

    Article  PubMed  Google Scholar 

  40. Copeland G, Lake A, Firth R, Wohler B, Wu X-C, Schymura MJ et al. Cancer in North America: 2009-2013. Volume One: Combined Cancer Incidence for the United States, Canada and North America; 2016.

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Acknowledgements

The authors thank Dr. Randall Gieni for assistance with reviewing the literature relating to medical costs related to HPV-RDs. The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under project # 2016-025 (HIPC # 2015/2016-67; REB # HS19155 (H2015:431); RRIC #2016-028). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred.

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Authors and Affiliations

  1. Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, 337–750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada

    Christiaan H. Righolt, Gurpreet Pabla & Salaheddin M. Mahmud

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  1. Christiaan H. Righolt
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  3. Salaheddin M. Mahmud
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Contributions

SM designed the study, GP and CR analyzed the data, CR and SM interpreted the data and drafted the manuscript. All authors revised the manuscript and approved the final version.

Corresponding author

Correspondence to Salaheddin M. Mahmud.

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Conflict of interest

SM has received unrestricted research grants from GlaxoSmithKline, Merck, Sanofi Pasteur, Pfizer, and Roche-Assurex for unrelated studies. CR and GP do not have any conflicts to report.

Funding sources

This work was supported by the Merck Investigator Studies Program with a grant to the International Centre for Infectious Diseases (ICID). SM is a Canada Research Chair in Pharmaco-epidemiology and Vaccine Evaluation. The sponsors had no role in the design or conduct of the study, including but not limited to, data identification, collection, management, analysis and interpretation, or preparation, review, or approval of the final results. The opinions presented in the report do not necessarily reflect those of the sponsors.

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Righolt, C.H., Pabla, G. & Mahmud, S.M. The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada. Appl Health Econ Health Policy 16, 195–205 (2018). https://doi.org/10.1007/s40258-017-0367-1

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