| This dissertation characterizes the health and economic burden associated with the management of human papillomavirus (HPV)-related genital warts and cervical disease within a set of U.S. health plans.; HPV is the most commonly occurring sexually transmitted infection in the United States. Vaccines are currently being developed to prevent HPV types associated with genital warts and cervical carcinogenesis. The adoption of an HPV vaccine into clinical practice will require a demonstration of the health and economic benefits to society associated with its implementation. Though population level data required for this task are available on the incidence and costs of cervical cancer diagnoses, similar data are unavailable for genital warts and other cervical HPV-related events (i.e., routine cervical cancer screening, initial cervical diagnoses, abnormal cervical smears with incomplete follow-up, false positive cervical smear results and cervical precancers).; As national data sources are lacking, this dissertation characterizes the annual period prevalence and costs across the health plan, and cost per case for genital wart diagnoses, using health plan administrative data from Medstat. The incidence rate, cost per case and costs across the health plan for cervical HPV-related events are analyzed using data from the Kaiser Permanente Northwest health plan (Portland, OR) and publicly available sources (for cervical cancer).; The annual period prevalence of genital warts is estimated to be 1.7 per 1,000 with an annual incidence rate for cervical precancer of 2.8 per 1,000. Individual episodes of care for genital warts are estimated to incur health care costs of {dollar}464, with analogous figures of {dollar}57 for a routine cervical smear, {dollar}376 for a false positive cervical smear, {dollar}79 for abnormal smear episodes with incomplete follow-up, {dollar}1,714 for a cervical precancer and {dollar}26,876 for cervical cancer.; Extrapolated to the U.S. general population, these conditions are estimated to result in a substantial health and economic burden. For instance, women are estimated to receive 40,000,000 routine cervical smears each year while accounting for total annual cervical HPV-related expenditures of {dollar}3.6 billion. |
