Saxena Kunal, Sawhney Baanie, Yande Soham, Kathe Niranjan, Chatterjee Sagnik
Merck & Co., Inc., Rahway, NJ 19454, USA.
Complete HEOR Solutions (CHEORS), North Wales, PA 19454, USA.
Vaccines (Basel). 2023 Apr 5;11(4):804. doi: 10.3390/vaccines11040804.
In 2019, the United States (US) Advisory Committee on Immunization Practices (ACIP) recommended that healthcare providers engage in shared clinical decision making for adults aged 27-45 who may benefit from HPV vaccination. However, it is difficult to assess these benefits as there is a lack of data on HPV burden on young and mid-adult women. This analysis estimates the incidence of conization and the burden associated with treating pre-cancerous states related to HPV with a loop electrosurgical excision procedure (LEEP) or a cold knife conization (CKC) among commercially insured women aged 18-45. This retrospective cohort study used the IBM MarketScan commercial claims encounter database for women aged 18-45 treated with conization. We assessed the annual incidence of conization (2016-2019) and adjusted the two-year health care costs post-conization using a multivariable Generalized Linear Model (GLM)-accounting for follow-up time and other characteristics-stratified by the age groups, namely 18-26 and 27-45. The inclusion criteria were met by 6735 women, with a mean age of 33.9 years (SD = 6.2). Conization incidence was lowest for women aged 18-26 (41/100,000 to 62/100,000 women-years) and highest for women aged 31-35 (243/100,000 to 269/100,000). The GLM-adjusted, all-cause healthcare costs per patient per year were USD 7279 and USD 9249 in the 18-26 and 27-45 age groups, respectively. The adjusted costs for disease-specific care were USD 3609 and USD 4557 for women ages 18-26 and 27-45, respectively. The burden of conization and the associated costs were significant, indicating a potential healthcare benefit of HPV vaccination among young and middle-aged women.
2019年，美国免疫实践咨询委员会（ACIP）建议医疗服务提供者针对可能从人乳头瘤病毒（HPV）疫苗接种中获益的27至45岁成年人开展共同临床决策。然而，由于缺乏关于年轻及中年女性HPV负担的数据，难以评估这些益处。本分析估计了18至45岁商业保险女性中宫颈锥切术的发病率以及与采用环形电外科切除术（LEEP）或冷刀锥切术（CKC）治疗HPV相关癌前病变的负担。这项回顾性队列研究使用了IBM MarketScan商业索赔数据库中接受锥切术治疗的18至45岁女性的数据。我们评估了锥切术的年发病率（2016 - 2019年），并使用多变量广义线性模型（GLM）对锥切术后两年的医疗费用进行了调整，该模型考虑了随访时间和其他特征，并按年龄组（即18 - 26岁和27 - 45岁）进行分层。6735名女性符合纳入标准，平均年龄为33.9岁（标准差 = 6.2）。18至26岁女性的锥切术发病率最低（每10万名女性 - 年41至62例），31至35岁女性的发病率最高（每10万名女性 - 年243至269例）。18至26岁和27至45岁年龄组中，经GLM调整后，每位患者每年的全因医疗费用分别为7279美元和9249美元。18至26岁和27至45岁女性特定疾病护理的调整后费用分别为3609美元和4557美元。锥切术的负担和相关费用很高，表明HPV疫苗接种对年轻及中年女性可能具有医疗益处。
