Objectives: Recurrent respiratory papillomatosis (RRP) has traditionally required serial surgical debridements. The juvenile-onset form of the disease is particularly costly, both financially to the healthcare system and in decreased productivity and quality of life. There have been many attempts to find systemic therapy for RRP to avoid surgery. Recently, bevacizumab has emerged as an effective systemic therapy in juvenile-onset RRP. We investigated the changes in charges associated with RRP treatment before and after initiation of systemic bevacizumab therapy.
Methods: Case series of patients with RRP on systemic bevacizumab. All patients were treated with 10 milligrams per kilogram of bevacizumab. Data for charges were obtained from the Pediatric Health Information System database and public data from the institution. Data are reported in 2021 dollars.
Results: Five patients were included in the study. Patients underwent an average of 4.2 surgeries per year prior to bevacizumab initiation (95% confidence interval [CI] 1.4-7.0) and 1.1 after (0.2-2.0, p=0.0117). Patients have required an average of 5.2 bevacizumab treatments per year for maintenance (3.4-7.0). The mean charge for RRP debridement was $12,346 ($12,104-12,588). Charges for ten milligrams of bevacizumab ranged from $3,196.34 to $6,071.95. Total surgical charges per year prior to bevacizumab were $51,992 ($17,207-86,778). Total surgical and bevacizumab charges per year after bevacizumab initiation were $83,517 ($36,470-130,564, p=0.3177).
Conclusions: Recurrent respiratory papillomatosis remains a difficult and costly condition to treat. Bevacizumab is associated with fewer surgeries per year without significant change in the charges for care.