title: Annual cost of hospitalization, inpatient rehabilitation and sick leave of anal cancer in Germany.
abstract: OBJECTIVE
  Literature on the economic burden of anal cancer in Germany is scarce. About 84% of these cancers are associated with human papillomavirus infection. This study, therefore, aimed to assess the annual costs of human papillomavirus-related anal cancer incurred by hospitalization, inpatient rehabilitation, and sick leave in 2008 in Germany.
  
  
  METHODS
  A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to anal cancer in 2008 were analyzed. Associated numbers of anal cancer hospitalizations, healthcare resource use, and costs were identified and extracted using the ICD-10 code C21 as the main diagnosis. The annual cost of human papillomavirus-related anal cancer was estimated based on the percentage of anal cancer likely to be attributable to human papillomavirus.
  
  
  RESULTS
  In 2008, there were 5774 hospitalizations (39% males, 61% females), 517 inpatient rehabilitations, and 897 sick leaves due to anal cancer representing costs of €34.11 million. The estimated annual costs associated with human papillomavirus-related anal cancer were €28.72 million, mainly attributed to females (62%). Direct costs accounted for 90% (86% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 10% of human papillomavirus-related costs.
  
  
  CONCLUSIONS
  The economic burden of human papillomavirus-related anal cancer in 2008 in Germany is under-estimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, this study is the first analysis to investigate the economic burden of anal cancer in Germany. The estimated annual costs of human papillomavirus-related anal cancer contribute to a significant economic burden in Germany and should be considered when assessing health and economic benefits of human papillomavirus vaccination in both genders.
authors.affiliation: Department of General Visceral, Vascular, and Thorax Surgery, Bogenhausen Hospital, Teaching Hospital of the Technical University of Munich, Munich, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Heitland
authors.forename: Peter K
authors.initials: PK
authors.lastname: Schädlich
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Chen
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rémy
authors.forename: Lionel
authors.initials: L
authors.lastname: Moro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000191:economics* / Q000534:rehabilitation / Q000821:virology; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics*; D012189:Retrospective Studies; D017678:Sex Distribution; D018582:Sick Leave / Q000191:economics*; D055815:Young Adult