Department of Health Management and Health Economics, University of Oslo, PO BOX 1089, Blindern, 0137, Oslo, Norway.
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA, 02115, USA.
BMC Cancer. 2019 May 7;19(1):426. doi: 10.1186/s12885-019-5596-2.
Public health efforts to prevent human papillomavirus (HPV)-related cancers include HPV vaccination and cervical cancer screening. We quantified the annual healthcare cost of six HPV-related cancers in order to provide inputs in cost-effectiveness analyses and quantify the potential economic savings from prevention of HPV-related cancers in Norway.
Using individual patient-level data from three unlinked population-based registries, we estimated the mean healthcare costs 1) annually across all phases of disease, 2) during the first 3 years of care following diagnosis, and 3) for the last 12 months of life for patients diagnosed with an HPV-related cancer. We included episodes of care related to primary care physicians, specialist care (private specialists and hospital-based care and prescriptions), and prescription drugs redeemed at pharmacies outside hospitals between 2012 and 2014. We valued costs (2014 €1.00 = NOK 8.357) based on diagnosis-related groups (DRG), patient copayments, reimbursement fees and pharmacy retail prices.
In 2014, the total healthcare cost of HPV-related cancers amounted to €39.8 million, of which specialist care accounted for more than 99% of the total cost. The annual maximum economic burden potentially averted due to HPV vaccination will be lower for vulvar, penile and vaginal cancer (i.e., €984,620, €762,964 and €374,857, respectively) than for cervical, anal and oropharyngeal cancers (i.e., €17.2 million, €6.7 million and €4.6 million, respectively). Over the first three years of treatment following cancer diagnosis, patients diagnosed with oropharyngeal cancer incurred the highest total cost per patient (i.e. €49,774), while penile cancer had the lowest total cost per patient (i.e. €18,350). In general, costs were highest the first year following diagnosis and then declined; however, costs increased rapidly again towards end of life for patients who did not survive.
HPV-related cancers constitute a considerable economic burden to the Norwegian healthcare system. As the proportion of HPV-vaccinated individuals increase and secondary prevention approaches advance, this study highlights the potential economic burden avoided by preventing these cancers.
预防人乳头瘤病毒（HPV）相关癌症的公共卫生措施包括 HPV 疫苗接种和宫颈癌筛查。我们量化了六种 HPV 相关癌症的年度医疗保健成本，以便为成本效益分析提供投入，并量化挪威预防 HPV 相关癌症的潜在经济节省。
使用来自三个不相关的基于人群的登记处的个体患者水平数据，我们估算了 1）在疾病的所有阶段，2）在诊断后前 3 年的护理期间，以及 3）在诊断为 HPV 相关癌症的患者的生命的最后 12 个月的医疗保健成本。我们包括了与初级保健医生、专科护理（私人专家和医院内护理和处方）以及医院外药店的处方药物相关的护理发作，时间范围为 2012 年至 2014 年。我们根据诊断相关组（DRG）、患者自付额、报销费用和药店零售价格，对成本（2014 年 1.00 欧元=8.357 挪威克朗）进行了估值。
2014 年，HPV 相关癌症的总医疗保健成本为 3980 万欧元，其中专科护理占总成本的 99%以上。由于 HPV 疫苗接种而潜在避免的每年最大经济负担对于外阴癌、阴茎癌和阴道癌（即分别为 984620 欧元、762964 欧元和 374857 欧元）将低于宫颈癌、肛门癌和口咽癌（即分别为 1720 万欧元、670 万欧元和 460 万欧元）。在癌症诊断后的头三年治疗期间，诊断为口咽癌的患者的每位患者总费用最高（即 49774 欧元），而阴茎癌的每位患者总费用最低（即 18350 欧元）。一般来说，成本在诊断后的第一年最高，然后下降；然而，对于未存活的患者，成本在生命的最后阶段迅速增加。
HPV 相关癌症给挪威医疗保健系统带来了相当大的经济负担。随着 HPV 疫苗接种人群比例的增加和二级预防方法的进步，本研究强调了预防这些癌症所避免的潜在经济负担。
