The cost of juvenile-onset recurrent respiratory papillomatosis

Objective: To assess the medical costs and the number of quality-adjusted l ife years lost owing to juvenile-onset recurrent respiratory papillomatosis (JORRP). Design: We examined hospital and physician charges for JORRP surgical proce dures in Maryland in 1994 adjusting for inflation and the cost-charge ratio . Centers for Disease Control and Prevention data on treatment intensity fo r JORRP were augmented with a review of treatment records for 18 patients w ith JORRP. Sensitivity analyses were performed. To illustrate the applicati on 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 c ase of JORRP is $201 724 (range, $61822-$474334). The annual cost for a sin gle case of JORRP is $57996 (range, $32407-$94114). The annual cost of JORR P in the United States is between $40 million and $123 million depending on the prevalence. Cesarean section (CS) for women with condyloma has been su ggested 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 p revented JORRP, this strategy would be a cost-effective means to prevent JO RRP. Conclusions: Studies to reduce the uncertainty surrounding the efficacy of CS and the effect of both CS and JORRP on families need to precede consider ation 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.