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Model for predicting the burden and cost of treatment in cervical cancer and HPV-related diseases in Thailand.

PURPOSE
Cervical cancer is a significant health burden in many countries. Long-term cost of care is still not well understood. We aimed to evaluate the long-term burden of illness and healthcare resource utilization associated with cervical cancer, cervical intraepithelial neoplasia (CIN) and genital warts from the care provider perspective.


METHOD
We developed a health state-transition Markov model to portray the algorithm of treatment of stages of cervical cancer, CIN and genital warts by tracking a hypothetical lifetime cohort of 12-year-old girls. Costs in this study were unit cost; capital costs and labor costs were included in the unit cost for inpatients and out-patients.


RESULTS
The highest incidence of CIN and genital warts was observed in women aged 20-30 years old. For cervical cancer, the highest incidence was 45-55 years. Death rate was estimated at 2%, 8%, 84% and 94% in cervical cancer Stage IA1, IA2-IIA, IIB-IVA and IVB, respectively. The estimated mean direct cost per patient with cervical cancer Stage IA1, IA2-IIA, IIB-IVA, IVB, CIN1, CIN2/3 and genital warts were 41,117 Thai Baht ($1,277 US), 97,250 Thai Baht ($3,020 US), 402,683 Thai Baht ($12,506 US), 322,619 Thai Baht ($10,019 US), 5,381 Thai Baht ($167 US), 49,933 Thai Baht ($1.551 US) and 3,585 Thai Baht ($111 US), respectively. Cost for survival or death case was indifferent. The overall lifetime costs from the provider perspective were evaluated at 859.1 million Baht ($26.7 million US) per a cohort of 100,000 women which corresponds to approximately 4,244 million Baht ($131.8 million US) for the current number of Thai 12-year-old girls.


CONCLUSIONS
HPV-related diseases impose health and cost burdens in Thailand. The national immunization programme to reduce this burden as well as further research to evaluate the impact is keenly expected.