Abstract
BackgroundHuman papillomavirus (HPV), primarily genotypes 6 and 11, cause the majority of cases of anogenital warts (AGW). Although benign, AGW are associated with a substantial economic and psychosocial burden. Several vaccines have been developed to prevent HPV. The objective of this study was to describe the epidemiology and healthcare resource utilization of AGW in Morocco, as well as the associated costs of treatment from the public healthcare perspective.MethodsThis was a descriptive analysis of questionnaire data obtained via a Delphi panel. The panel consisted of 9 physicians practicing in public hospitals in Morocco (4 dermatologists and 5 obstetricians/gynecologists). The questionnaire collected data on physician and practice characteristics, diagnostic tests and procedures, treatments, and follow-up (including recurrence) of patients with AGW. Questionnaire items on which ≥ 70% of respondents agreed were considered as having consensus. Costs associated with diagnosis, treatment, and follow-up were calculated in Moroccan dirham (MAD) and converted to euros (€) based on official national price lists for public hospitals and the HCRU estimates from the questionnaire.ResultsThe physician-estimated prevalence of AGW in Morocco was 1.6%-2.6% in women and 2.0%-5.3% in men. A mean (median) of 6.4 (4) patients per month per physician sought medical attention for AGW. Simple observation was the most common diagnostic method for AGW in both men and women, and excision was the most prescribed therapy (75%), requiring a mean of 2 visits. Recurrence occurred in approximately 27% of patients. The cost per case of managing AGW, including recurrence, was estimated at 2182–2872 MAD (€207–272) for women and 2170–2450 MAD (€206–233) for men. The total annual cost of medical consultations for AGW in Morocco ranged from 3,271,877 MAD to 4,253,703 MAD (€310,828–404,102).ConclusionsExpert consensus indicates that AGW represent a significant burden to the Moroccan public healthcare system. These data can inform policy makers regarding this vaccine-preventable disease.
Highlights
Human papillomavirus (HPV), primarily genotypes 6 and 11, cause the majority of cases of anogenital warts (AGW)
AGW were present in 1.9% of men and 0.4% of women attending a sexually transmitted infection clinic in Harare, Zimbabwe, in 1980 [10]; and among female sex workers in Burkina Faso in 2003–2006, AGW were present in 1.6% of Human immunodeficiency virus (HIV)-negative women and 7.0% of HIV-positive women [11]
Among patients with AGW, panelists estimated that 73% were female, 20% were under age 20, and 79% were presenting for the first time
Summary
Human papillomavirus (HPV), primarily genotypes 6 and 11, cause the majority of cases of anogenital warts (AGW). Human papillomavirus (HPV) is well known as a causative agent of anogenital cancers [1], and several vaccines have been developed to prevent cancers associated with. AGW are associated with a substantial economic and psychosocial burden [6, 7]. Both the quadrivalent and the nonavalent HPV vaccines target HPV 6 and 11, providing protection against the cause of 90% of AGW [2]. Based on a systematic review of studies from Europe, the Americas, East Asia, and Australia, AGW are present in 0.2% to 5.0% of the general population (both males and females), but epidemiological data from Africa are limited [8].
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