Economic Burden of HPV-Related Cancers in Bulgaria

OBJECTIVES: Human papillomavirus (HPV) plays a pivotal role in the etiology of various cancers, including cervical, vulvar, vaginal, anal, penile, and head and neck (H&N) cancers. The economic burden associated with these HPV-related cancers is substantial, encompassing direct medical costs and indirect costs. The aim of the study is to identify direct healthcare costs of HPV-related cancers in Bulgaria and to calculate indirect costs and years of life lost associated with these cancers.

METHODS: This was a retrospective, cost of illness study conducted from the payer perspective. Patients with a confirmed diagnosis of vulvar (C51), vaginal (C52), cervical (C53), anal (C21), penile (C60), and H&N cancers - hypopharynx, larynx, nasopharynx, oral cavity, oropharynx (C01 – C06; C09-C13; C32) were included. Data on drug use and administration costs as well as healthcare costs were collected from the National Health Insurance Fund from January 2018 through December 2020. Years of life lost were calculated based on the country and gender-specific life expectancy. The human capital approach was used to calculate indirect costs due to productivity loss.

RESULTS: The total treatment costs for all HPV-related cancer patients in Bulgaria were 15 743 961 € (2018), 17 398 890 € (2019), and 18 119 267 € (2020). 30% of all costs are due to cervical cancer. The costs associated with drug acquisition and administration contributed most to the result (40-45%) followed by radiotherapy costs (30-36%). Diagnostic and follow-up costs represented only 10% of total expenditures. An estimated 53 371 years of life were lost due to HPV-related cancers for the period 2018-2020. Total productivity losses were estimated at 21 691 279 €.

CONCLUSIONS: The economic burden of HPV-related cancers in Bulgaria is substantial and primarily driven by medicines and radiotherapy costs. A focus on prevention, early diagnosis, and higher vaccination coverage rates could contribute to lower costs.