Health Care Costs of Anal Cancer in a Commercially Insured Population in the United States

Abstract

BACKGROUND: The incidence and death rate of anal cancer in the United States has been increasing on average 2%-3% per year over the past 10 years. Human papillomavirus (HPV) vaccination is a potentially viable prevention strategy, since about 80% of anal cancers are attributable to HPV. To understand the effect of HPV vaccination, it is important to estimate the treatment costs for the HPV-related disease.OBJECTIVE: To estimate the 2-year per patient mean direct health care costs associated with anal cancer in a commercially insured population in the United States.METHODS: All newly diagnosed anal cancer patients were identified from a 2011-2014 Truven MarketScan database. Matched population controls were selected from the database with a 2-step matching method using demographic, comorbidity, and health care cost variables. Costs for the first 2 years were measured for cancer patients and controls. The difference in costs between the groups was calculated to estimate the costs associated with anal cancer treatment. A generalized linear model with gamma distribution and log link function was applied to estimate the costs for censored months for the patients who did not have at least 2 years of follow-up.RESULTS: 1,976 patients with anal cancer and 1,976 controls were included in the study. The first 2-year per patient adjusted mean cost associated with anal cancer treatment was $127,531 (SD = $189,064). Male sex, cancer diagnosis, higher Charlson Comorbidity Index score, and higher prediagnosis costs were significantly associated with higher monthly costs. Higher psychiatric diagnostic group scores were associated with lower monthly costs. Anal cancer treatment costs were highest in the first 6 months after diagnosis (per patient per month [PPPM] mean = $12,846), leveling off at a much lower monthly cost during the subsequent 18 months of the 2-year period (PPPM mean = $3,717). CONCLUSIONS:The first 2-year costs associated with anal cancer treatment were substantial. Given that approximately 80% of anal cancers are attributable to HPV infection, this study provides important parameters for estimating the potential economic benefit of HPV vaccination.

Updated medical care cost estimates for HPV-associated cancers: implications for cost-effectiveness analyses of HPV vaccination in the United States

“…The literature search yielded 6 studies that provided updated medical cost estimates for 5 HPV-associated cancers (Table 1). [12][13][14][15]18,19 These 6 studies suggest a notably higher cost for cancer treatment than the previous studies, particularly for oropharyngeal and vaginal cancer. Our review did not find any studies that provided an average cost per case estimate for penile cancer.…”

“…The previous (lower) cancer cost estimates and the more recent (higher) cancer cost estimates are shown in Table 1. In order to illustrate the greatest potential impact of the more recent cancer cost estimates on the estimated cost-effectiveness of HPV vaccination, for anal cancer in the more recent (higher) cost scenario, we applied the $133,300 cost estimate by Wu (2018) 18 rather than the $52,700 estimate by Deshmukh (2018). 12 Similarly, for oropharyngeal cancer, we applied the $146,100 cost estimate by Lairson (2017) 13 rather than the $65,000 estimate by Sher (2016).…”

“…Third, we focused on studies providing estimates of the lifetime cost or the multi-year cost per case of cancer. Many of the recent cost estimates reflect medical care costs per case for only the first two years [13][14][15]18 after a cancer diagnosis, which nonetheless can be a useful approximation for lifetime costs. Although lifetime cost estimates are suitable for many models of HPV vaccine costeffectiveness such as the one we applied, monthly cost estimates or annual cost estimates might be more applicable for some other HPV models.…”

The epidemiology and direct medical costs of diseases associated with human papillomavirus infection among men in Manitoba, Canada

“…The same review estimated a cost of $19,800 (in 2010 US dollars) for penile cancer and $810 for AGW (men and women combined) [12]. The costs per anal cancer patient in the US was estimated as $60,913 (in 2014 US dollars) for 66+ Medicare-covered men [31] and $127,531 (2015 US dollars) for <65 commercially insured patients (men and women) [32]. The annual purchasing power parity-adjusted per-capita health expenditure over the last 15 years averaged about $3,800 in Canada and $7,400 in the US in 2010 US dollars [33].…”

An ounce of prevention: Medicaid's role in reducing the burden of cancer in men with HIV

“…Systemic therapy for Hodgkin lymphoma exceeds $100,000 per person per year 10 . Similarly high costs exist for the treatment of anal cancer 11 . Figure 1 7,12‐14 illustrates the inflation‐adjusted annual cost of drugs for HIV and cancer from 2012 through 2018.…”