Costs of cervical cancer treatment: population-based estimates from Ontario.

OBJECTIVES The objectives of the present study were to estimate the overall and specific medical care costs associated with cervical cancer in the first 5 years after diagnosis in Ontario. METHODS Incident cases of invasive cervical cancer during 2007-2010 were identified from the Ontario Cancer Registry and linked to administrative databases held at the Institute for Clinical Evaluative Sciences. Mean costs in 2010 Canadian dollars were estimated using the arithmetic mean and estimators that adjust for censored data. RESULTS Mean age of the patients in the study cohort (779 cases) was 49.3 years. The mean overall medical care cost was $39,187 [standard error (se): $1,327] in the 1st year after diagnosis. Costs in year 1 ranged from $34,648 (se: $1,275) for those who survived at least 1 year to $69,142 (se: $4,818) for those who died from cervical cancer within 1 year. At 5 years after diagnosis, the mean overall unadjusted cost was $63,131 (se: $3,131), and the cost adjusted for censoring was $68,745 (se: $2,963). Inpatient hospitalizations and cancer-related care were the two largest components of cancer treatment costs. CONCLUSIONS We found that the estimated mean costs that did not account for censoring were consistently undervalued, highlighting the importance of estimates based on censoring-adjusted costs in cervical cancer. Our results are reliable for estimating the economic burden of cervical cancer and the cost-effectiveness of cervical cancer prevention strategies.

[1]  Kelvin K. W. Chan,et al.  Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study. , 2013, CMAJ open.

[2]  E. Feuer,et al.  Estimating medical costs from incomplete follow-up data. , 1997, Biometrics.

[3]  Walter P. Wodchis,et al.  Guidelines on Person-Level Costing Using Administrative Databases in Ontario , 2013 .

[4]  M. Roy.  Surgery for cervical cancer: a time for reassessment. , 1999, Gynecologic oncology.

[5]  Hongwei Zhao,et al.  On the equivalence of some medical cost estimators with censored data. , 2007, Statistics in medicine.

[6]  A. Jemal,et al.  Global Cancer Statistics , 2011 .

[7]  Five-year trends in mortality indices among gynecological cancer patients in Canada. , 2012, Gynecologic oncology.

[8]  P. Singhal,et al.  Healthcare resource use and costs associated with cervical, vaginal and vulvar cancers in a large U.S. health plan. , 2008, Gynecologic oncology.

[9]  Andrew H Briggs,et al.  Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. , 2002, Annual review of public health.

[10]  Anastasios A. Tsiatis,et al.  Estimating medical costs with censored data , 2000 .

[11]  Yijian Huang,et al.  Cost analysis with censored data. , 2009, Medical care.

[12]  Kelvin K. W. Chan,et al.  Trends in use and cost of initial cancer treatment in Ontario: a population-based descriptive study. , 2013, CMAJ open.

[13]  Phillip E. Pfeifer,et al.  Non-parametric estimation of mean customer lifetime value , 2005 .