Societal cost of oropharyngeal cancer by human papillomavirus status, cancer stage, and subsite

Background The incidence of oropharyngeal cancer (OPC) is increasing, particularly human papillomavirus (HPV)-associated OPC. The aim of this study was to specify the total societal cost of OPC by HPV status, cancer stage, and subsite using a bottom-up cost-of-illness approach. Methods We analyzed 121 consecutive patients with OPC from the Southern Health Care Region of Sweden. We estimated the direct medical costs and indirect costs (e.g., disease-related morbidity and premature death) from 1 month prior to OPC diagnosis until 3 years after treatment completion. Results The mean total cost per patient was 103 386 for HPV-positive and 120 244 for HPV-negative OPC. Eighty-one percent of the patients analyzed were HPV-positive: Accordingly, HPV-positive OPC represented 79% of the total cost of OPC. The mean total cost of stage I, II, III, IVA, IVB, and IVC, regardless of HPV status, was 59 424, 57 000, 69 246, 115 770, 234 459, and 21 930, respectively, of which indirect costs were estimated at 22 493 (37.8%), 14 754 (25.9%), 28 681 (41.4%), 67 107 (58%), 166 280 (70.9%), and 0. Tonsillar cancer represented 64% of OPC, with a mean total cost of 117 512 per patient. Conclusion The societal cost of OPC is substantial. HPV-associated OPC comprises 79% of the total cost of this disease. The data presented in this study may be used in analytical models to aid decision makers in determining the potential value of gender-neutral HPV vaccination.