The economic burden of cervical cancer from diagnosis to one year after final discharge in Henan Province, China: A retrospective case series study

Abstract

Background: In China, the disease burden of cervical cancer remains substantial. Human papillomavirus (HPV) vaccines are expensive and not yet centrally funded. To inform immunization policy, understanding the economic burden of the disease is necessary. This study adopted a societal perspective and investigated costs and quality of life changes associated with cervical cancer from diagnosis to one year after final discharge in Henan province, China.

Methods: Inpatient records of cervical cancer patients admitted to the largest cancer hospital in Henan province between Jan. 2017 and Dec. 2018 were extracted. A telephone interview with four modules was conducted in Jun.-Jul. 2019 with a 40% random draw of patients to obtain direct non-medical costs and indirect costs associated with inpatients, costs associated with outpatient visits, and changes in quality of life status using the EQ-5D-5L instrument. Direct medical expenditures were converted to opportunity costs of care using cost-to-charge ratios obtained from hospital financial reports. For each clinical stage (IA-IV), total costs per case from diagnosis to one year after final discharge were extrapolated based on inpatient records, responses to the telephone interview, and recommendation on outpatient follow-ups by Chinese cervical cancer treatment guidelines. Loss in quality-adjusted life years was obtained using the 'under the curve' method and regression predictions.

Results: A total of 3,506 inpatient records from 1,323 patients were obtained. Among 541 randomly selected patients, 309 completed at least one module of the telephone interview. The average total costs per case associated with cervical cancer from diagnosis to one year after final discharge ranged from $8,066-$22,888 (in 2018 US Dollar) and the quality-adjusted life years loss varied from 0.05-0.26 for IA-IV patients.

Conclusions: The economic burden associated with cervical cancer is substantial in Henan province. Our study provided important baseline information for cost-effectiveness analysis of HPV immunization program in China.

Fig 1. Conceptual diagram of data collection and analysis processes.

After inclusion criteria were applied, patients experienced final discharges were identified (n = 844) and then a 40% random sample of all eligible patients was drawn. The two samples that labelled with * contained overlapping patients. During the telephone survey, samples were generated based on complete responses to each module. The four samples that labelled with ** also contained overlapping patients.

Fig 2. Costs per inpatient episodes and costs per case from diagnosis to final discharge, by clinical stages.

Costs per inpatient episode were described in panel A1. The proportion of costs per inpatient episode by components was presented in panel A2. Costs per case from diagnosis to final discharge were described in panel B1. The proportion of costs per inpatient episode by components was presented in panel B2. Values presented in the figure were rounded to one digit decimal place.