Cost of treating recurrent respiratory papillomavirus in commercially insured and medicaid patients

Abstract

Objectives: The study objective was to estimate the first 2 years' direct costs of treating new cases of juvenile-onset and adult-onset recurrent respiratory papillomatosis (RRP) and determine the predictors of treatment costs.Methods: Cases were patients diagnosed with RRP in commercial insurance claims in 2011-2014 and Texas Medicaid in 2008-2012 for treatment of RRP. Controls were patients without a diagnosis of HPV-related cancer or RRP, matched with cases by age, sex, geographic area, date of diagnosis of RRP, and propensity score. Total health care costs in the first 2 years after diagnosis were obtained from cases and matched controls. A generalized linear model was created to identify predictors of monthly costs.Results: In commercially insured patients, a total of 122 cases of juvenile-onset (<18 years old) and 1824 cases of adultonset (≥18 years old) RRP were identified. The mean first 2 years' cost difference between cases and controls was $58,733 for juvenile-onset disease and $11,185 for adult-onset disease after model adjustments. In the Texas Medicaid population, 73 cases of juvenile-onset and 96 cases of adult-onset RRP were identified. The mean first 2 years' cost difference between cases and controls was $76,115 for juvenile-onset disease and $4,633 for adult-onset disease after model adjustments.Conclusion: The first 2 years' medical costs difference of juvenile-onset and adult-onset RRP among commercially insured and Medicaid population were approximately $60,000 to $70,000 and $5,000 to $11,000, respectively, and should be considered in HPV vaccination promotion investment decisions.

Efficacy of Systemic Bevacizumab for Recurrent Respiratory Papillomatosis with Pulmonary Involvement

“…22 The fiscal implications of RRP too are immense, with one study showing greater than $60,000 in a two-year cost difference for patients with RRP compared with controls. 23 Given that the average RRP patient receives around 4 surgeries every year, 1,24 it is unsurprising that the total annual cost for RRP-related healthcare nationally amounts to an estimated $120,000,000. 23,25 When considering that pulmonary RRP represents the most morbid, refractory manifestation of RRP, it is reasonable to assume that RRP patients with pulmonary involvement experience even greater quality of life impairments and medical costs, although no study directly investigating this question exists to date.…”

“…23 Given that the average RRP patient receives around 4 surgeries every year, 1,24 it is unsurprising that the total annual cost for RRP-related healthcare nationally amounts to an estimated $120,000,000. 23,25 When considering that pulmonary RRP represents the most morbid, refractory manifestation of RRP, it is reasonable to assume that RRP patients with pulmonary involvement experience even greater quality of life impairments and medical costs, although no study directly investigating this question exists to date. Our study, however, provides preliminary evidence for this notion, with our cohort of pulmonary RRP patients receiving an average of nearly 7 surgeries per year before induction of systemic bevacizumab, which is greater than what has been previously reported for non-pulmonary RRP cohorts.…”

“…Furthermore, a 2017 study by San Giorgi et al found that patients with RRP experienced greater levels of depression and worse scores on the Voice Handicap Index compared to non‐RRP patients 22 . The fiscal implications of RRP too are immense, with one study showing greater than $60,000 in a two‐year cost difference for patients with RRP compared with controls 23 . Given that the average RRP patient receives around 4 surgeries every year, 1,24 it is unsurprising that the total annual cost for RRP‐related healthcare nationally amounts to an estimated $120,000,000 23,25 …”

Juvenile laryngeal papillomatosis: a rare cause of upper airway obstruction with possible dysplasia

“…However, in a randomized controlled trial of 2-dose bivaalent (Cervarix) vaccination in girls aged 4-6 years, the vaccine had an acceptable safety profile as well as producing a high and sustained immunological response during 30 months of follow-up (20). A study conducted in USA concluded in very high direct costs of treating new cases of juvenile RRP and suggested to consider its results in HPV vaccination promotion investment decisions (21). The 2020, the world health organization (WHO) Global Strategy recommends that HPV vaccines should be included in all national immunization programs and should reach 90% of all girls by age 15 by 2030 (22).…”

Recurrent respiratory papillomatosis: A 2020 perspective

“…With the advent of vaccinations for HPV initially intended to reduce the morbidity and mortality of cervical cancer and genital warts, the incidence of RRP is rapidly changing but has previously been estimated to be 4.3 per 100 000 children and 1.8 per 100 000 adults 1 . The initial 2 year direct cost of treating RRP can be as high as $76 000 and the annual cost of all RRP patients has been estimated to be between $40‐123 million, which highlights the importance of prevention 10,11 . The most substantial improvements to our understanding of RRP have been made in prevention and adjuvant therapies which will be highlighted in this review.…”