Abstract
BackgroundHigh-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country.Materials and methodsThis prevalence-based cost-of-illness study used diagnosis-specific data from national registries to determine the number of HR HPV-related precancers and cancers. The HR HPV-attributable fractions of these diseases were derived from a literature review and applied to the total burden to estimate HR HPV-attributable costs. Direct costs were based on health care utilization and indirect costs on loss of productivity due to morbidity (i.e., sick leave and early retirement) and premature mortality.ResultsThe total annual cost of all HR HPV-attributable precancers and cancers was €94 million (€10.3/inhabitant). Direct costs accounted for €31.3 million (€3.4/inhabitant) of the total annual cost, and inpatient care amounted to €20.7 million of direct costs. Indirect costs made up €62.6 million (€6.9/inhabitant) of the total annual cost, and premature mortality amounted to €36 million of indirect costs. Cervical precancer and cancer was most costly (total annual cost €58.4 million). Among cancers affecting both genders, anal precancer and cancer, and oropharyngeal cancer were the most costly (€11.2 million and €11.9 million, respectively). For oropharyngeal cancer, males had the highest health care utilization and represented 71% of the total annual cost. Penile precancer and cancer was least costly (€2.6 million).ConclusionThe economic burden of HR HPV-related precancers and cancers is substantial. The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden.
Highlights
Infection with high-risk (HR) human papillomavirus (HPV) types is the established cause of several significant diseases, namely precancer and cancer of the cervix, vulva, vagina, anus, penis, and head and neck [1]
The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden
The objective of this study was to estimate the costs associated with HR HPV-related cervical, vulvar, vaginal, anal, and penile precancers and cancers, and tonsillar and base of tongue cancer in Sweden in 2006, 1 year before HPV vaccines became available in the country
Summary
Infection with high-risk (HR) human papillomavirus (HPV) types is the established cause of several significant diseases, namely precancer and cancer of the cervix, vulva, vagina, anus, penis, and head and neck (oral and oropharynx) [1]. For head and neck cancer, HR HPV types ( HPV16) have been linked to oral and oropharyngeal cancer, and the highest HR HPV prevalence has been found in the tonsils, with HPV DNA being present in around 45–70% of cases [4]. Incidence rates of HPV-positive oropharyngeal cancer are increasing and are significantly higher among males than females [8, 9]. The increasing trend in the incidence of and mortality from oropharyngeal cancer among males is similar in most Western countries [10, 11]. High-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country
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