title: Phase-specific healthcare costs of cervical cancer: estimates from a population-based study.
abstract: There is a lack of evidence on the economic burden of managing cervical cancer in the public payer Canadian setting.
  
  
  
  We used individual patient-level data to obtain a comprehensive estimate of the cost of managing cervical cancer in the province of Ontario, identifying main cost drivers and predictors of increased costs.
  
  
  
  The cost-of-illness technique was used to estimate the incremental costs associated with cervical cancer in 4 phases: prediagnosis, initial care, continuing care, and terminal care. All patients with cervical cancer diagnosed between 2005 and 2009 in the province of Ontario were propensity-score matched to 5 noncancer controls on birth year, income quintile, rurality, comorbidities, and patterns of healthcare utilization pattern during the 2 years before cancer diagnosis. Both cases and the noncancer comparison group were followed to death or March 31, 2013. Costs for all healthcare services paid for by the Ontario Ministry of Health and Long-term Care during the follow-up period were estimated by the use of linked administrative data. Incremental costs for managing cervical cancer were calculated through generalized estimating equations. Predictors of greater health costs were explored using multivariate quantile regression models.
  
  
  
  All costs were presented in 2012 Canadian dollars ($1.00CDN = $1.00USD). The total incremental costs for managing cervical cancer were $362 in the pre-diagnosis phase, $15,722 in the initial phase, $3924 per year in the continuing phase, and $52,539 in the terminal phase. Inpatient care accounted for 34%, 28%, and 52% of total healthcare cost in the initial, continuing, and terminal phase, respectively. Physician services ranked first in the continuing phase (30%) and second in the initial (26%) and terminal (13%) phases. Advanced age, advanced cancer stage at diagnosis, and comorbidities were significant predictors of greater costs in most care phases.
  
  
  
  Aggregate costs of care for cervical cancer are substantial and vary by cancer stage, phase of care, patient age at diagnosis, and comorbidities before diagnosis. These estimates can serve as baseline data in economic analyses that aim to evaluate interventions for managing cervical cancer.
authors.affiliation: Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON, Canada. Electronic address: nicole.mittmann@cancercare.on.ca.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.affiliation: Health System Strategy and Policy Division, Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hancock-Howard
authors.affiliation: Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON, Canada.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Seung
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009864:Ontario / Q000453:epidemiology; D057216:Propensity Score; D019472:Universal Health Insurance / Q000191:economics; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000473:pathology
keywords: attributable cost; cervical cancer; cost of illness; economic evaluation