Table 1.
Estimated direct medical cost per case of HPV-associated health outcomes (undiscounted and discounted), and number of years of discounting of costs
| Health outcome | Undiscounted cost per health outcome* |
Number of years of discounting** | Discounted cost per health outcome† |
||||
|---|---|---|---|---|---|---|---|
| Base case | Lower bound | Upper bound | Base case | Lower bound | Upper bound | ||
| Genital warts, females | $870 | $440 | $2,830 | 0.5 | $860 | $430 | $2,790 |
| Genital warts, males | $870 | $440 | $2,830 | 0.5 | $860 | $430 | $2,790 |
| CIN grade 1 | $1,410 | $970 | $1,840 | 1 | $1,370 | $940 | $1,790 |
| CIN grade 2 or 3 | $2,600 | $1,090 | $4,210 | 3 | $2,380 | $1,000 | $3,850 |
| Penile cancer | $66,600 | $22,500 | $81,300 | 46 | $17,100 | $5,800 | $20,900 |
| Cervical cancer | $73,900 | $44,200 | $83,800 | 26 | $34,300 | $20,500 | $38,900 |
| Vulvar & vaginal cancer | $85,300 | $28,800 | $104,100 | 44 | $23,200 | $7,800 | $28,400 |
| Anal cancer, females | $95,100 | $53,800 | $136,200 | 39 | $30,000 | $17,000 | $43,000 |
| Anal cancer, males | $95,100 | $53,800 | $136,200 | 36 | $32,800 | $18,600 | $47,000 |
| Oropharyngeal cancer, females | $128,500 | $66,400 | $149,200 | 40 | $39,400 | $20,400 | $45,700 |
| Oropharyngeal cancer, males | $128,500 | $66,400 | $149,200 | 38 | $41,800 | $21,600 | $48,500 |
CIN: cervical intraepithelial neoplasia.
All cost estimates have been updated to 2019 U.S. dollars using the personal consumption expenditures price index for health care (https://www.bea.gov/). Cost estimates were rounded to the nearest $10 for genital warts, CIN1, and CIN2/3, and to the nearest $100 for cancers.
The cost per health outcome shows the estimated average lifetime cost per diagnosed case of the given outcome, discounted to time of diagnosis. These cost estimates were obtained from a recent cost-effectiveness study44s which compiled data from a range of cost studies of CIN,45s,46s genital warts,47s,48s cervical cancer,5,49s,50s, anal cancer,6,7,52s vaginal and vulvar cancer,8,50s,52s oropharyngeal cancer,9,51s,52s and penile cancer.52s The combined cost estimate for vaginal and vulvar cancer reflects the average of the vaginal cancer cost estimate and the vulvar cancer cost estimate. We updated the penile cancer cost estimates by incorporating a 2019 study11 following the same general methods used to compile cancer cost estimates in the recent cost-effectiveness study.44s
Future costs for each outcome were discounted at an annual rate of 3% for the number of years shown. The number of years of discounting reflects assumptions regarding the median duration from HPV acquisition to diagnosis of the health outcome, based on modeling estimates,2,33s,54s studies of placebo arms of HPV vaccine trails,55s,56s and the median age of cancer diagnosis57s as described in the Appendix.
The discounted base case cost of infection shows the base case cost estimate discounted from the time of diagnosis to the time of HPV infection (year 2018) at an annual rate of 3%. For example, the value $34,300 for cervical cancer was calculated as the base case cost of cervical cancer at the time of diagnosis ($73,900) multiplied by βx, where β is (1/1.03) and the exponent x was set to 26 (the number of years that cervical cancer costs were discounted).