Health and Economic Burden of HPV-related Diseases in Singapore

Jeffrey Jen Hui Low,Yu Ko,Puneet K Singhal,Arunachalam Ilancheran,Xu Hao Zhang,Sun Kuie Tay

doi:10.7314/apjcp.2012.13.1.305

Abstract

To assess the health and economic burden of human papillomavirus (HPV)-related diseases (cervical cancer, cervical intraepithelial neoplasia (CIN) 1/2/3, and genital warts) in Singapore over a period of 25 years beginning in 2008. Incidence-based modeling was used to estimate the incidence cases and associated economic burden, with the assumption that age-stratified incidence rates will remain the same throughout the period of 25 years. The incidence rates in 2008 were projected based on data obtained from the National Cancer Registry for cervical cancer, and from a combination of published data and hospital registry review for CIN1/2/3 and genital warts. The population growth rate was factored into the projection of incidence cases over time. Direct cost data per cervical cancer and per CIN1/2/3 case were obtained from the financial database of large local hospitals while cost data for genital warts were obtained from the National Skin Center; these costs were multiplied by the number of incidence cases to produce an aggregate estimate of the economic burden over the 25-year period (in 2008 Singapore dollars) using a 3% discount rate. The total number of incidence cases of HPV-disease over 25 years beginning in 2008 was estimated to be 60,183, including 8,078 for cervical cancer, 11,685 for CIN 2/3, 8,849 for CIN1, and 31,572 for genital warts. The estimated total direct cost was 83.2 million Singapore Dollars over 25 years: 57.6 million attributable to cervical cancer, 13.0 million to CIN2/3, 6.83 million to CIN1, and 5.70 million to genital warts. HPV-related diseases are expected to impose significant health and economic burden on the Singapore healthcare resources in the next 25 years.

Highlights

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) (Ebrahim et al, 2005), and it is associated with substantial clinical, social, and economic burdens
Direct cost data per cervical cancer and per CIN1/2/3 case were obtained from the financial database of large local hospitals while cost data for genital warts were obtained from the National Skin Center; these costs were multiplied by the number of incidence cases to produce an aggregate estimate of the economic burden over the 25-year period using a 3% discount rate
The majority of infections are self-limited, acquisition of specific types of human papillomavirus (HPV) can cause genital warts, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer, all of which produce significant morbidity and, in the case of cervical cancer, mortality.(Wiley and Masongsong, 2006) cervical cancer is the second most common cancer in women worldwide, with 492,800 incident cases and 274,000 deaths annually.(Parkin and Bray, 2006) Because infection with HPV is a necessary cause of cervical cancer, virtually all cases of cervical cancers, and all the deaths resulting from those cases, can be attributed to HPV (Walboomers et al, 1999)

Summary

Introduction

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) (Ebrahim et al, 2005), and it is associated with substantial clinical, social, and economic burdens. The present study aimed to estimate the incidence cases and associated economic burden of HPV-related diseases in Singapore, focusing on cervical cancer, cervical dysplasia, and genital warts, over a period of 25 years beginning in 2008. The results of this BOI study could be used to evaluate the potential benefits of new medical technologies for preventing, diagnosing, or treating HPVrelated diseases, including HPV vaccines(Paavonen et al, 2009; Dillner et al, 2010) and HPV DNA testing. The results of this BOI study could be used to evaluate the potential benefits of new medical technologies for preventing, diagnosing, or treating HPVrelated diseases, including HPV vaccines(Paavonen et al, 2009; Dillner et al, 2010) and HPV DNA testing. (Kulasingam et al, 2002) the study could aid the development of health policies to optimize healthcare resource allocation

Materials and Methods

Results

Discussion