title: Mean direct medical care costs associated with cervical cancer for commercially insured patients in Texas.
abstract: To determine the mean cervical cancer medical care costs for patients enrolled in commercial insurance in Texas. Cost is represented by insurer and patient payments for care.
  
  
  
  We estimated the mean medical care costs during the first 2years after the index diagnosis date for patients with cervical cancer (cases). Cases were identified using claims-based International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), diagnosis codes and matched to controls without a claims-based ICD-9 code for cancer using a 2-step propensity score matching method. Index dates for the cases were randomly assigned to potential controls, and cases and controls were matched by index date. Data for cancer cases and controls were obtained from the de-identified 2011-2014 U.S. MarketScan databases. A generalized linear model was employed to compute the cost for censored months during the 2-year follow-up period. Differential costs were assessed by subtracting the medical costs incurred by controls from those incurred by cases.
  
  
  
  During 2011-2014, 475 commercially insured Texas patients with newly diagnosed cervical cancer met the inclusion criteria. The first-year and second-year mean medical costs were $60,828 and $37,721 for cases and $9982 and $10,066 for controls, respectively. The differential costs of cervical cancer for the first and second years were $50,846 and $27,656, respectively. The major correlates of higher monthly cervical cancer costs were higher Charlson Comorbidity Index score during 6months period prior to diagnosis, higher healthcare costs between 6months and 3months prior to diagnosis, and residence in the western region of Texas. Costs for cervical cancer patients decreased steeply between month 1 and month 5 after diagnosis and then were stable, while costs for the control group were stable throughout the follow-up period.
  
  
  
  Mean direct medical costs associated with cervical cancer in Texas were substantial. These data will serve as key cost parameters in models of costs associated with human papillomavirus (HPV)-related cancers in Texas and the economic evaluation of HPV vaccination dissemination in Texas.
authors.affiliation: Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX 77030, USA. Electronic address: David.R.Lairson@uth.tmc.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.affiliation: Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX 77030, USA. Electronic address: Shuangshuang.fu@uth.tmc.edu.
authors.forename: Shuangshuang
authors.initials: S
authors.lastname: Fu
authors.affiliation: Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX 77030, USA. Electronic address: Wenyaw.Chan@uth.tmc.edu.
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: LXu1@mdanderson.org.
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: ZShelal@mdanderson.org.
authors.forename: Zeena
authors.initials: Z
authors.lastname: Shelal
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: lramonde@mdanderson.org.
authors.forename: Lois
authors.initials: L
authors.lastname: Ramondetta
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health; D016014:Linear Models; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control; D012189:Retrospective Studies; D013781:Texas; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000628:therapy / Q000821:virology
keywords: Cancer; Cervical cancer; Cervix; Claims; Health care costs; Health expenditures; Insurance