The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada
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).
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.
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.
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.
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.
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.
Compliance with Ethical Standards
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.
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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