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Cervical, Vaginal, and Vulvar Cancer Costs Incurred by the Medicaid Program in Publicly Insured Patients in Texas

Fu, Shuangshuang, PhD1,2; Fokom Domgue, Joel, MD, MPH3; Chan, Wenyaw, PhD4; Zhao, Bo, MD, MS4; Ramondetta, Lois M., MD3; Lairson, David R., PhD5

Journal of Lower Genital Tract Disease: April 2019 - Volume 23 - Issue 2 - p 102–109
doi: 10.1097/LGT.0000000000000472
HPV-Associated Disease: Diagnosis and Management
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Objectives To determine from the perspective of the State of Texas, the direct medical care costs associated with cervical, vaginal, and vulvar cancers in Texas Medicaid enrollees.

Materials and Methods We conducted a case-control study and searched Texas Medicaid databases between 2008 and 2012 for eligible cancer patients. A comparison group was selected for each cancer site using a 2-step 1:1 propensity score matching method. Patients were followed for 2 years after cancer diagnosis to estimate monthly and yearly direct medical costs. For each cancer site, the differential cost between patients and the matched comparison individuals was the estimated cost associated with cancer.

Results The study included 583 cervical, 62 vaginal, and 137 vulvar cancer patients and equal numbers of cancer-free comparison individuals. Among the cases, 322 cervical cancer patients, 46 vaginal cancer patients, and 102 vulvar cancer patients were Medicaid-Medicare dual eligible enrollees. For Medicaid-only enrollees, the adjusted first- and second-year mean total differential costs were US $19,859 and $3,110 for cervical cancer, US $19,627 and $4,582 for vaginal cancer, and US $7,631 and $777 for vulvar cancer patients, respectively. For Medicaid-Medicare dual eligible enrollees, adjusted first- and second-year mean total differential costs incurred by Medicaid were US $2,565 and $792 for cervical cancer, US $1,293 and $181 for vaginal cancer, and US $1,774 and $1,049 for vulvar cancer patients, respectively.

Conclusions The direct medical costs associated with cervical, vaginal, and vulvar cancers in Texas Medicaid were substantial in the first 2 years after cancer diagnosis, but dual eligibility for Medicare coverage attenuated Medicaid costs.

1Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX;

2Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX;

3Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;

4Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX; and

5Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX

Reprint requests to: David R. Lairson, PhD, 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. E-mail: David.R.Lairson@uth.tmc.edu

This study was supported by the Christopher and Susan Damico Chair in Viral Associated Malignancies, the Stiefel Oropharyngeal Research Fund, a Cancer Prevention Fellowship supported by the Cancer Prevention and Research Institute of Texas (CPRIT) grant award, RP170259 (J.F.D), and the contribution from the Lyda Hill Foundation to the Moon Shots Program of The University of Texas MD Anderson Cancer Center.

The authors have declared they have no conflicts of interest.

The study was reviewed by the Committee for the Protection of Human Subjects from The University of Texas Health Science Center at Houston and judged to be exempt from further review because of the use of deidentified claims data.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jlgtd.com).

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology