The costs of treating vaginal and vulval cancer in England (2009\u20132015)

Stephanie Stephens,Robin Crawford,Victoria Coles,Anuja Chatterjee

doi:10.1186/s12889-020-08545-4

Abstract

BackgroundHuman papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. A causal relationship also exists between HPV and cancer in other areas of the female reproductive system including the vagina and vulva. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. The objective of this study was to quantify the costs of treating these cancers on the National Health Service (NHS) in England.MethodsInpatient and outpatient episodes were derived from Hospital Episode Statistics (HES). Health Resource Group (HRG) tariffs and National Reference Costs were used to estimate the cost of treating pre-cancerous and invasive vaginal and vulval lesions in England.ResultsThe study showed that for the 5 years from 2009/2010 to 2014/2015 the total cost associated with pre-cancerous and invasive vaginal and vulval lesions was over £14 million per year on average (95% of which was attributed to inpatient costs). Vulval cancer accounted for the largest proportion; an estimated 60% of the total cost (£8.82 million). On average 4316 patients per year in England were admitted to hospital and 912 patients attended outpatient settings for pre-cancerous and invasive disease of the vagina and vulva.ConclusionThe results indicate that vaginal and vulval cancer cost the English health care system over £14 million per year. Given the causal role of HPV in a proportion of these cancers, preventative measures such as the national HPV immunisation programme have the potential to reduce the economic burden. To ensure optimal use of NHS resources, it is important that future economic evaluations of such preventative measures consider the full burden of HPV related disease.

Highlights

Human papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide
Based on advice from a clinician specializing in gynaecological oncology, admitted patient care (APC) records were identified based on the presence of primary, secondary or tertiary diagnosis of the following ICD-10 codes: C52 – vaginal cancer, C51 – vulval cancer, D072 and N89 – vaginal dysplasia, D071 and N90 – vulval dysplasia
Our findings indicate a much larger difference in overall costs when looking at data from England

Summary

Introduction

Human papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. It is estimated that 75 to 80% of sexually active individuals will become infected with HPV in their lifetime [2, 3]. Reports suggest that sexually active women under 25 years are most at risk of HPV infection. The risk of HPV infection increases with multiple sexual partners and with lower age at first intercourse. HPV is a fundamental cause of cervical cancer and is aetiologically associated with cancers at other

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