Economic Evaluation of Cervical Cancer and HPV Vaccination Programs in the United States
Introduction: Economic evaluations have helped cervical cancer policy decision-making in the US, yet cost measurement is still a concern. There is a lack of updated estimates of medical costs for cervical cancer patients. Also, there is little knowledge on cost-effectiveness, measured by dollars per quality-adjusted life year (QALY), for behavioral interventions to promote HPV vaccination, especially among heterogeneous populations. Methods: Three studies address the following aims: 1) critique published economic evaluations of cervical cancer and HPV vaccination programs to examine the age (reported year minus year when cost was collected from original sources) of cost estimates and sources of cost data; 2) use the MarketScan dataset to update medical cost estimates (in 2015 US$) for cervical cancer patients and explore cost-associated factors using a mixed-effects analysis of covariance model, and 3) use micro-costing to analyze the cost of a behavioral intervention to promote HPV vaccination among girls seen at safety-net clinics and modify a published Markov model to evaluate the cost-effectiveness of this intervention considering age and race/ethnicity heterogeneity (healthcare payer perspective, willingness-to-pay threshold $100,000/QALY). Results: Study 1 revealed that most reported studies focused on screening, followed by HPV vaccination, and treatment. Overall, liquid-based cytology (LBC) cost was used most often and used in 25 studies. Half of these twenty-five studies had LBC cost age ≥ 5 years. Additionally, we could not identify this age in seven studies because the reporting lacked transparency. Study 2 found the total average annual medical cost for cervical cancer patients was $44,477, primarily for outpatient services. Having a Charlson Comorbidity Index score of ≥ 2 (β=0.485, p<0.001) and making claims for antipsychotic drugs (β=0.359, p<0.001) were associated with the highest medical cost. Study 3 found the intervention cost $9 per participant. At base-case, the incremental cost-effectiveness ratio of the intervention compared with no-intervention was $133,572/QALY. The probabilistic sensitivity analysis showed this intervention had a 94% chance of being cost-effective. Conclusion: We recommend transparency in reporting costs. We provided recent estimates of medical costs for patients with cervical cancer, which would be helpful in allocating healthcare resources and in future economic evaluations. Evaluating the cost-effectiveness of the intervention to promote HPV vaccination, we presented results that will facilitate enhanced cervical cancer policy decision-making.
Nghiem, Van Thi Ha, "Economic Evaluation of Cervical Cancer and HPV Vaccination Programs in the United States" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10601399.