Cost of Preventing, Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination

PLoS One. 2015 Sep 23;10(9):e0139062. doi: 10.1371/journal.pone.0139062. eCollection 2015.

Abstract

Objective: Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented.

Methods and materials: Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts.

Results: From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million.

Conclusion: Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Condylomata Acuminata / economics
  • Condylomata Acuminata / prevention & control
  • Condylomata Acuminata / therapy
  • Female
  • Health Care Costs / statistics & numerical data*
  • Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / economics
  • Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / therapeutic use*
  • Humans
  • Middle Aged
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / economics*
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Infections / therapy
  • Sweden / epidemiology
  • Uterine Cervical Dysplasia / economics
  • Uterine Cervical Dysplasia / prevention & control
  • Uterine Cervical Dysplasia / therapy
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control
  • Uterine Cervical Neoplasms / therapy
  • Young Adult

Substances

  • Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18

Grants and funding

This study received funding from the Swedish Cancer Foundation (www.cancerfonden.se; 070623, CAN 2007/1044, 11 0544, CAN 2011/471), KI Cancer Strategic Grants (www.ki.se; 5888/05-722), the Swedish Research Council (www.vr.se; 521-2008-2899), and the Stockholm County Council (www.skl.s; 20130097). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.