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David Bishai, MD, MPH, PhD; Haskins Kashima, MD; Keerti Shah, MD, DRPH

Arch Otolaryngol Head Neck Surg. 2000;126:935-939.

Objective  To assess the medical costs and the number of quality-adjusted life years lost owing to juvenile-onset recurrent respiratory papillomatosis (JORRP).

Design  We examined hospital and physician charges for JORRP surgical procedures in Maryland in 1994 adjusting for inflation and the cost-charge ratio. Centers for Disease Control and Prevention data on treatment intensity for JORRP were augmented with a review of treatment records for 18 patients with JORRP. Sensitivity analyses were performed. To illustrate the application of our cost estimates, we compare the costs of JORRP to the costs of the surgical procedures that would be necessary to prevent it.

Results  We find that the present value at birth of the cost of a single case of JORRP is $201,724 (range, $61,822-$474,334). The annual cost for a single case of JORRP is $57,996 (range, $32,407-$94,114). The annual cost of JORRP in the United States is between $40 million and $123 million depending on the prevalence. Cesarean section (CS) for women with condyloma has been suggested as a potential strategy to prevent JORRP, but its efficacy remains to be determined. Our results suggest that if only 1% of the CSs actually prevented JORRP, this strategy would be a cost-effective means to prevent JORRP.

Conclusions  Studies to reduce the uncertainty surrounding the efficacy of CS and the effect of both CS and JORRP on families need to precede consideration of a policy of CS for women with clinically evident genital condyloma. Patients should be kept thoroughly informed about the role of CS for the prevention of JORRP and the nature of the remaining uncertainties.

From the Department of Population and Family Health Sciences (Dr Bishai) and the W. Harry Feinstone Department of Microbiology and Immunology (Dr Shah), The Johns Hopkins School of Hygiene and Public Health, and the Department of Otolaryngology, The Johns Hopkins School of Medicine (Dr Kashima), Baltimore, Md. The authors have no commerical, proprietary, or financial interest in the products and companies described in this article.

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