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Reuschenbach M, Mihm S, Wölle R, Schneider KM, Jacob C, Greiner W, Hampl M, Goodman E. Healthcare resource utilization and costs in 23-25-year-old women with human papillomavirus (HPV) associated anogenital diseases in Germany - a retrospective analysis of statutory health insurance claims data. BMC Health Serv Res 2022; 22:1002. [PMID: 35932066 PMCID: PMC9356499 DOI: 10.1186/s12913-022-08397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Human papilloma virus (HPV) causes multiple anogenital diseases including cervical cancer and is the most common sexually transmitted infection. Healthcare resource utilization (HRU) associated with HPV-related anogenital diseases includes diagnostic and disease specific treatment regimens. A recent study showed disease burden of young women aged 23–25 years, who were the first populations eligible to receive HPV vaccination after its introduction in Germany. Cost for the German statutory health insurance (SHI) due to HPV‑related anogenital diseases in this population are unknown. This study aimed at assessing HRU and costs related to HPV-associated anogenital diseases for the Germany SHI. Methods We used a retrospective, matched cohort design to leverage the prior identified cohort of 23–25-year-old women born between 1989–1992 diagnosed with HPV-related anogenital disease from the Institute for Applied Health Research Berlin (InGef) Research Database. German SHI claims data from 2012–2017 were analyzed. The prior identified cases were matched (direct, without replacement) to women without anogenital diseases (1:10 ratio). HRU and costs for inpatient care, outpatient care, and pharmaceutical during a 3-year observation period were determined for both cases and controls and increments between the groups were assessed. Results 2,972 women diagnosed with anogenital diseases (cases) who were matched to 29,720 women without anogenital diseases (controls). Cases had more outpatient visits (52.4 visits vs. 39.2 visits) and more cases (45.2% vs. 31.7%) were hospitalized at least once in the 3‑year observation period. Most common outpatient procedures performed in cases were conization of the cervix uteri (4.4% cases; n < 5 controls), followed by other excision and destruction of diseased tissue of the cervix uteri (3.1% in cases; 0.0% in controls). Median difference in total healthcare costs of €684 (mean difference: €1,089, 95%CI: €752–1,426) suggest that HPV-related anogenital diseases were responsible for approximately €3.2 Million more healthcare costs for the identified cases in the four birth cohorts within the 3‑year observation period in the InGef Research Database. Costs were mainly driven by outpatient care (41.6% of total costs). Conclusion In Germany, HPV-related anogenital diseases among young women are associated with considerable HRU and financial expenditures, mostly driven by outpatient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08397-1.
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Affiliation(s)
- Miriam Reuschenbach
- Global Medical and Scientific Affairs, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Sarah Mihm
- Department of Market Access, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Regine Wölle
- Department of Market Access, MSD Sharp and Dohme GmbH, Munich, Germany
| | | | | | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Monika Hampl
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Elizabeth Goodman
- Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc, Rahway, NJ, USA.
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Orzechowska M, Cybulski M, Krajewska-Kulak E, Sobolewski M, Gniadek A, Niczyporuk W. Comparative Analysis of the Incidence of Selected Sexually Transmitted Viral Infections in Poland in 2010-2015: A Retrospective Cohort Study. J Clin Med 2022; 11:3448. [PMID: 35743518 PMCID: PMC9225430 DOI: 10.3390/jcm11123448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
Sexually transmitted infections (STIs) represent a major cause of morbidity in women and men worldwide. The main aim of this study was to perform a comparative analysis of the incidence of sexually transmitted viral infections in 2010-2015 in Poland, taking into account the administrative division of the country into provinces. This was a retrospective study. The analysed data came from the Centre for Health Information Systems of the Ministry of Health and the National Institute of Public Health-National Research Institute and constituted information from the epidemiological surveillance system in Poland. We collected data on the incidence of the following diseases: genital herpes (HSV), genital warts, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). The key groups with the highest risk of infection were young people between 20 and 29 years of age. The reported data on the incidence of genital herpes in Poland (n = 3378; 1.5/100,000) showed a downward trend, which does not coincide with global trends. Genital warts were the most frequent genital infections in Poland (n = 7980; 3.46/100,000), with significant regional variation. Over the analysed period, the situation of newly detected HIV infections seemed to be stable (n = 7144; 3.1/100,000). The incidence of these infections appeared to be highly correlated with urbanisation rates, which was not confirmed in the case of other analysed infections. The worsening epidemic situation with respect to sexually transmitted infections, the inefficiency of the current surveillance system and the reduction in funding for diagnosis and prevention, combined with inadequate legal solutions, make it necessary to undertake new legal and organisational measures aimed at improving the reproductive health in Poland in terms of sexually transmitted infections.
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Affiliation(s)
- Magda Orzechowska
- Department of Epidemiology of Infectious Diseases and Supervision, National Institute of Public Health/National Research Institute, 00-791 Warsaw, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (E.K.-K.)
| | - Elzbieta Krajewska-Kulak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (E.K.-K.)
| | - Marek Sobolewski
- Department of Quantitative Methods, Rzeszow University of Technology, 35-959 Rzeszow, Poland;
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Wiaczeslaw Niczyporuk
- Department of Medical Sciences, Faculty of Health Sciences, Lomza State University of Applied Sciences, 18-400 Lomza, Poland;
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Berrada M, Holl R, Ndao T, Benčina G, Dikhaye S, Melhouf A, Chiheb S, Guelzim K. Healthcare resource utilization and costs associated with anogenital warts in Morocco. Infect Agent Cancer 2021; 16:64. [PMID: 34775980 PMCID: PMC8591871 DOI: 10.1186/s13027-021-00403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background Human 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. Methods This 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. Results The 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). Conclusions Expert 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. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00403-1.
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Affiliation(s)
| | | | | | - Goran Benčina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Siham Dikhaye
- Department of Dermatology, Mohammed VI University Hospital of Oujda, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Abdelilah Melhouf
- Department of Gynecology - Obstetrics, Faculty of Medicine and Pharmacy Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Soumiya Chiheb
- Department of Dermatology, University Hospital Ibn Rochd of Casablanca, Casablanca, Morocco
| | - Khalid Guelzim
- Department of Gynecology and Obstetrics, Military and Training Hospital Mohammed V, Rabat, Morocco
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Denecke A, Iftner T, Iftner A, Riedle S, Ocak M, Luyten A, Üye I, Tunc K, Petry KU. Significant decline of HPV 6 infection and genital warts despite low HPV vaccination coverage in young women in Germany: a long-term prospective, cohort data analysis. BMC Infect Dis 2021; 21:634. [PMID: 34215215 PMCID: PMC8252220 DOI: 10.1186/s12879-021-06139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of human papillomavirus (HPV) vaccination has resulted in a remarkable decline of genital warts in women and men, but in Germany historical rates of vaccination are relatively low. We report long-term surveillance data on changes in HPV 6 and HPV 11 infection and the prevalence of genital warts in young women in the Wolfsburg HPV epidemiological study (WOLVES). METHODS Women born in 1983/84, 1988/89, and 1993/94 participated in four cohorts between 2009/10 and 2014/15. Quadrivalent vaccination coverage and prevalence of HPV 6/11 infection and genital warts are reported for participants aged 19-22 years and 24-27 years at the time of sample collection. Statistical analyses were done to compare similarly aged participants using 2 × 2 contingency tables (Röhmel-Mansmann unconditional exact test; two-side alpha of 0.05). RESULTS A total of 2456 women were recruited. Between 2010 and 2015, there was a statistically significant decrease in the prevalence of HPV 6 infection among women aged 24-27 years (2.1% versus 0.0%; P < 0.0001) and women aged 19-22 years (2.0% versus 0.0%; P = 0.0056). There was no significant decline in HPV 11 infection. In total, 52 of 2341 participants were diagnosed with genital warts. There was a statistically significant drop in the risk of developing genital warts in women aged 24-27 years between 2010 and 2015 (4.7% versus 1.7%, respectively; P = 0.0018). The overall risk of developing genital warts in women aged 19-27 years decreased from 3.1% in 2010 to 1.2% in 2015 (P = 0.0022). CONCLUSIONS An increase in vaccination coverage was associated with a decreased prevalence of genital warts in young women. A protective effect greater than herd immunity alone was seen despite low vaccination rates. Quadrivalent vaccine had a protective effect on genital HPV 6 infection and an almost fully protective effect on the development of genital warts in the youngest population.
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Affiliation(s)
- Agnieszka Denecke
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany. .,Department of Obstetrics, Gynecology and Reproductive Medicine, Medical Hannover School, Hannover, Germany.
| | - Thomas Iftner
- Institute of Medical Virology, University of Tübingen, Tübingen, Germany
| | - Angelika Iftner
- Institute of Medical Virology, University of Tübingen, Tübingen, Germany
| | - Sebastian Riedle
- MD research, Statistics in clinical research, Pullach i, Isartal, Germany
| | - Marion Ocak
- MD research, Statistics in clinical research, Pullach i, Isartal, Germany
| | | | - Isak Üye
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Kübra Tunc
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
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Osmani V, Klug SJ. [HPV vaccination and the prevention of genital warts and precancerous lesions-current evidence and evaluation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:590-599. [PMID: 33851224 PMCID: PMC8087596 DOI: 10.1007/s00103-021-03316-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 01/22/2023]
Abstract
Human papillomaviruses (HPVs) can cause both benign and malignant tumors. To date, more than 200 HPV types have been discovered, of which 12 are currently classified as high risk for cervical cancer. HPV types that affect the anogenital tract are sexually transmitted. Since 2006, prophylactic HPV vaccines have been available and should be administered before first sexual contact.HPVs infect epithelial cells and are worldwide the most common sexually transmitted viruses. Apart from cervical cancer, HPVs cause other anogenital cancers such as vulvar, vaginal, and anal cancer but also oropharyngeal cancer (or head and neck cancers). HPV types 16 and 18 are also found at these sites. HPV types 6 and 11 are associated with genital warts; other HPV types can cause harmless skin warts.HPV vaccines are safe and highly effective, if they are administered before exposure to HPV. Systematic reviews and meta-analyses have shown that HPV vaccination effectively prevents HPV infection, but also precancerous lesions of the anogenital tract and genital warts. Recent vaccination data also demonstrate reductions in cervical cancer incidence.The uptake rates of HPV vaccination vary worldwide by program and acceptance. In comparison to other European countries, Germany has a low uptake rate. The Standing Committee on Vaccination (STIKO) recommends HPV vaccinations for all girls and boys ages 9 to 14 years in Germany. In 2018, only half of all 18-year-old girls in Germany were completely immunized against HPV.Organized vaccination programs, whether population-based or school-based, are necessary in order to increase vaccination uptake rates.
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Affiliation(s)
- Vanesa Osmani
- Lehrstuhl für Epidemiologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - Stefanie J Klug
- Lehrstuhl für Epidemiologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 56, 80992, München, Deutschland.
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Immunogenicity and safety of a nine-valent human papillomavirus vaccine in women 27-45 years of age compared to women 16-26 years of age: An open-label phase 3 study. Vaccine 2021; 39:2800-2809. [PMID: 33676783 DOI: 10.1016/j.vaccine.2021.01.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Efficacy of the nine-valent human papillomavirus (9vHPV; HPV types 6/11/16/18/31/33/45/52/58) vaccine was demonstrated in a phase 3 study in women 16-26 years of age. We present a phase 3 immunogenicity and safety study of the 9vHPV vaccine in women 27-45 versus 16-26 years of age. METHODS This international, open-label study (NCT03158220) was conducted in women 16-45 years of age. Participants (16-26 years, n = 570 and 27-45 years, n = 642) received a three-dose 9vHPV vaccination regimen (day 1, month 2, month 6). Month 7 geometric mean titers (GMTs) and seroconversion percentages to anti-HPV 6/11/16/18/31/33/45/52/58 were assessed. Participants were followed for safety throughout the study. RESULTS At month 7, anti-HPV 6/11/16/18/31/33/45/52/58 GMTs in women 27-45 years were compared to those in women 16-26 years of age. The primary hypothesis of non-inferiority of anti-HPV 16/18/31/33/45/52/58 GMTs in older versus younger women was met. The lower bound of the GMT ratio 95% confidence interval (27-45 years to 16-26 years) was 0.60-0.67 depending on HPV type, exceeding the non-inferiority margin of 0.5 for all HPV types. Month 7 seroconversion percentages in women 27-45 years of age were >99% for all HPV types. Injection-site and vaccine-related systemic adverse events (AEs) were observed in 87.5% and 25.1% of women 16-26 years, and 85.2% and 24.1% of women 27-45 years of age, respectively; no vaccine-related serious AEs were reported and no deaths occurred during the study. CONCLUSIONS The 9vHPV vaccine elicited non-inferior anti-HPV GMTs in women 27-45 years compared with women 16-26 years of age for HPV 16/18/31/33/45/52/58. The vaccine was generally well tolerated with a similar AE profile across the age groups. These data support bridging 9vHPV vaccine efficacy findings in women 16-26 years to women 27-45 years of age. Clinical trial registration NCT03158220.
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Cocchio S, Prandi GM, Furlan P, Bertoncello C, Fonzo M, Saia M, Baldovin T, Baldo V. Time-trend of hospitalizations for anogenital warts in Veneto region in the HPV vaccination era: a cross sectional study (2007-2018). BMC Infect Dis 2020; 20:857. [PMID: 33208109 PMCID: PMC7672898 DOI: 10.1186/s12879-020-05591-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a common sexually transmitted pathogen and the cause of several cancers and of anogenital warts. With this study, we estimated the trend of hospitalizations for anogenital warts (AGWs) in the Veneto region (Italy) from 2007 to 2018. METHODS The analysis included all the hospital discharge records of public and accredited private hospitals occurred in Veneto residents in the timespan 2007-2018. The ICD9-CM code 078.11 considered were those associated with condyloma acuminatum and those associated with surgical interventions for vulval/vaginal warts, penile warts anal warts. Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS We observed an overall reduction of hospitalization rates for AGWs: from 15.0 hospitalizations every 100,000 Veneto residents in years 2007-08 to 10.9 hospitalizations every 100,000 Veneto residents in year 2017-18 (- 37.4%; p < 0.05). Reduction has been caused by a drop in hospitalizations in females - from a rate of 20.4/100,000 in 2007-2008 to a rate of 10.8/100,000 in 2017-18 (AAPC: -7.1; 95%CI: - 10.6;-3.4); while in males, we observed a slight - but not statistically significant - increase in hospitalization rates. CONCLUSION The marked decline in hospitalization rates for AGWs in Veneto Region is probably attributable to the high coverage rates of HPV vaccination programs implemented since 2008.
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Affiliation(s)
- S Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - G M Prandi
- Department for Woman and Child Health, University of Padua, Padua, Italy
| | - P Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - C Bertoncello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Fonzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Saia
- "Azienda Zero" of Veneto region, Padua, Italy
| | - T Baldovin
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - V Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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Prilepskaya VN, Gomberg M, Kothari S, Yee K, Kulkarni A, Garland SM, Giuliano AR. Estimating the Burden of Illness Related to Genital Warts in Russia: A Cross-Sectional Study. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2020; 7:182-188. [PMID: 33088844 PMCID: PMC7549541 DOI: 10.36469/jheor.2020.17246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infections are the etiologic agents of genital warts (GW). HPV is one of the most frequent sexually transmitted viral infections, and nearly 65% of individuals with partners who have GW also develop GW. In Russia, as in many other countries, overall GW prevalence data are scarce. Given the lack of Russian data, our study estimated GW prevalence in physician practices and GW-related health care resource use in Russia among male and female patients aged 18-60 years. METHODS Russian physicians recorded daily patient logs for a two-week period and conducted a 30-minute survey to estimate GW prevalence and related resource use between January and June 2012. Age, gender, and GW diagnosis status was recorded. Prevalence was obtained for each physician and calculated into a single estimate across all physician types. Overall prevalence estimate and 95% confidence interval were weighted by the estimated number of physicians in each specialty and the proportion of total patients visiting each specialist type. Health care resource use was reported and compared among different physician specialties. RESULTS The overall GW prevalence estimate was 9162 cases per 100 000 for male and female patients aged 18-60 years, with 9917 for obstetrician/gynecologists (OB/GYN), 8298 for urologists (URO), and 7833 for dermatologists (DERM). For males, GW prevalence was 8769 cases per 100 000, with the highest prevalence in the 30-34 age group. In females, GW prevalence was 9304 cases per 100 000, with the highest prevalence in the 18-24 age group. Among overall existing GW cases, 63.1% were recurrent and 34.2% were resistant. For all patients in our study, GW prevalence was higher in females. Male patients had the highest prevalence for those aged 30-34 years, and female patients for those aged 18-24 years. These results are consistent with data reported in other countries. Study limitations include estimates and results representative of the urban population of Russia. Despite its limitations, this study provides a GW prevalence estimate in Russia not previously available. CONCLUSIONS GW is a significant public health concern in Russia, and the GW prevalence was higher in female patients compared to male patients.
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Affiliation(s)
- Vera N. Prilepskaya
- Ministry of Healthcare of the Russian Federation, Research Center for Obstetrics, Gynecology, and Perinatology, Moscow,
Russia
| | - Mikhail Gomberg
- Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology, Moscow,
Russia
| | | | - Karen Yee
- Cubist Pharmaceuticals, Lexington, MA,
USA
| | | | - Suzanne M. Garland
- The Royal Women’s Hospital, Murdoch Childrens Research Institute, Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria,
Australia
| | - Anna R. Giuliano
- Center for Infection Research in Cancer (CIRC) at Moffitt Cancer Center, Tampa, FL,
USA
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Buenconsejo L, Kothari-Talwar S, Yee K, Kulkarni A, Lara N, Roset M, Giuliano AR, Garland S. Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study. Infect Agent Cancer 2019; 14:26. [PMID: 31624494 PMCID: PMC6781391 DOI: 10.1186/s13027-019-0240-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18-60 years in the Philippines. Methods Prevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups. Results Overall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58-4.98%) for men and women aged 18-60 years. Genital warts prevalence was 3.39% (95% CI: 3.13-3.65%) and 8.0% (95% CI: 7.69-8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66-18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively). Conclusions Genital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.
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Affiliation(s)
| | | | - Karen Yee
- 3Cubist Pharmaceuticals, Lexington, MA USA
| | | | | | | | - Anna R Giuliano
- 5Center for Infection Research in Cancer (CIRC) at Moffitt Cancer Center, Tampa, FL USA
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10
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[Vaccination: Protection for boys against genital warts and cancer via human papillomavirus infection]. Urologe A 2019; 57:1499-1508. [PMID: 30443716 DOI: 10.1007/s00120-018-0807-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Vaccination qualifies as the most effective medical procedure worldwide. Using the example of human papillomavirus(HPV)-associated benign and malignant diseases, the incidence, diagnostics, treatment, particularly however, the option of sustainable elimination of all these entities by achieving herd immunity by a gender balanced inoculation quota of 80% at the age of 9-17 years are shown.
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Kuhdari P, Previato S, Giordani M, Biavati P, Ferretti S, Gabutti G. The burden of HPV-related diseases in Italy, 2001-12. J Public Health (Oxf) 2019; 39:730-737. [PMID: 28334854 DOI: 10.1093/pubmed/fdx025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Indexed: 01/18/2023] Open
Abstract
Background Human papillomavirus (HPV) infection is the main cause of cervical cancer and plays a relevant role in the development of genital warts and of the cancer of penis and anus, head/neck, oropharynx and genitourinary system. The aim of this study is the evaluation of hospitalizations due to HPV-related pathologies in 2001-12 in Italy. Methods The national hospital discharge forms were provided by the Ministry of Health. The HPV-related hospitalizations were identified using specific diagnostic codes, accordingly to the ICD-9-CM coding system. The proportion of hospitalizations of potentially HPV-related pathologies, obtained from the literature, was evaluated as well as the hospitalization rates (hr) and their trend over time. Results Uterine cervical cancer and CIN III accounted for 40% of hospitalizations (hr: 15.6/100 000 and 17.6/100 000, respectively). Head/neck and oropharynx pathologies accounted for 24.5% of cases (hr: 16/100 000 and 3.9/100 000, in males and females, respectively), followed by genital warts (17.3% of hospitalizations; hr: 7.5/100 000 in males and 8.52/100 000 in females), anal (8.1% of hospitalizations), genitourinary (7.7%) and penis cancers (2.2%). Conclusions The study, even if limited to the evaluation of hospitalizations, points out how HPV-related pathologies continue to be a relevant public health issue in Italy with a high impact on population.
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Affiliation(s)
- P Kuhdari
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - S Previato
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - M Giordani
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - P Biavati
- Azienda USL Bologna, Registro Tumori Area Vasta Emilia Centrale, 40124 Bologna, Italy
| | - S Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.,Azienda USL Ferrara, Registro Tumori Area Vasta Emilia Centrale, 44121 Ferrara, Italy
| | - G Gabutti
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy.,Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
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12
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Widschwendter A, Böttcher B, Riedl D, Coban S, Mutz-Dehbalaie I, Matteucci Gothe R, Ciresa-König A, Marth C, Fessler S. Recurrence of genitals warts in pre-HPV vaccine era after laser treatment. Arch Gynecol Obstet 2019; 300:661-668. [PMID: 31286210 PMCID: PMC6694085 DOI: 10.1007/s00404-019-05242-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 11/27/2022]
Abstract
Purpose Human papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. Our aim was to evaluate the long-term recurrence of genital warts after primary carbon dioxide laser treatment before the introduction of the vaccination against HPV. Methods Recurrence rate and localization of genital warts were analysed in a retrospective study in 1798 women presenting with a new diagnosis of genital warts from 1992 to 2009 at a University hospital and had received laser treatment. Additionally, data on topography, pregnancy status, and cervical smear were available for women treated from 2003 to 2009 (n = 825, data subset 1) and systematic follow-up data for women treated in 2006 and 2007 (n = 242, data subset 2). Results Median time from laser treatment to first recurrence was 14.6 weeks (data subset 2). The site most affected was the vulva (90.7%) followed by the perineum/perianal region (59.3%) and the vagina (47.3%). Abnormal Pap smear was observed in 22.6%. Systematic follow-up with a median follow-up time of 3.1 years revealed at least one recurrence in 68 (28.1%) of 242 women. Women with multifocal genital warts had a 2.9 times increased risk for recurrence compared to women with unifocal lesions (p = 0.01). Conclusions Nearly 30% of women presenting with genital warts experienced at least one recurrence after treatment with carbon dioxide laser. Multifocal lesions are the strongest indicator of recurrence. These data provide an important insight to recurrence rates of genital warts before HPV vaccination and underline the significance of a long-term follow-up and HPV vaccination.
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Affiliation(s)
- Andreas Widschwendter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bettina Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - David Riedl
- University Clinic of Medical Psychology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Serab Coban
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Irene Mutz-Dehbalaie
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Raffaella Matteucci Gothe
- Department of Public Health, Medical Informatics and Technology, Health Services Research and Health Technology Assessment, UMIT University for Health Sciences, Eduard-Wallnöfer-Zentrum 1, 6060, Hall i.T, Austria
| | - Alexandra Ciresa-König
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Siegfried Fessler
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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13
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García PJ, Carcamo CP, Valderrama M, La Rosa S, James C, Gutiérrez R, Lindsay BR. Burden of genital warts in Peru: an observational study. Int J STD AIDS 2018; 30:264-274. [PMID: 30396319 DOI: 10.1177/0956462418796088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Genital warts (GW) are mucosal or skin lesions caused by sexual transmission of human papillomavirus (HPV). This study estimates the frequency of GW cases in physicians' clinics and physicians' usual practices of GW referral and diagnosis in Peru. Participants in this study were a convenience sample of 100 physicians in five specialties: primary care (17), gynecology (37), urology (10), dermatology (31), and infectious diseases (5). Physicians completed a survey and daily log of all patients aged 18-60 years seen over ten days in their offices located in Peru. The survey recorded GW referral patterns and the daily log recorded patient demographic information and GW diagnosis. Among 12,058 patients, the annual GW prevalence (95% confidence interval [CI]) was 2.28% (2.02-2.56) and cumulative incidence (95% CI) was 1.60% (1.38-1.84). Physicians reported that most GW patients were direct consult (73.5% of male and 67.9% of females) and physicians treated most GW patients themselves (73.4% of males and 76.7% of females). As reported, the most common reasons for referring were 'serious cases requiring more specialized treatment' (73.2% of male and 72.2% of female) and 'lack of resources to treat' (26.8% of male and 27.8% of female). We conclude that GW cases are commonly seen by physicians in Peru.
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Affiliation(s)
- Patricia J García
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Valderrama
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sayda La Rosa
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cerise James
- 2 Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Raul Gutiérrez
- 2 Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Brianna R Lindsay
- 2 Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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14
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Dahlstrom KR, Fu S, Chan W, Shelal Z, Ramondetta LM, Lairson DR. Medical Care Costs Associated with Genital Warts for Commercially Insured US Patients. PHARMACOECONOMICS 2018; 36:1355-1365. [PMID: 30019118 DOI: 10.1007/s40273-018-0691-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Genital warts are caused by infection with human papillomavirus (HPV) and are associated with significant morbidity. Primary prevention of genital warts is possible through HPV vaccination, but vaccination rates remain low in the USA. When deciding to implement HPV vaccination programs, public health officials and policy makers rely on cost-effectiveness studies that accurately reflect costs associated with morbidity and mortality. However, previous information on the cost of treating genital warts was outdated. OBJECTIVES We estimated the mean direct medical care costs associated with genital warts in the USA. METHODS This was a retrospective case-control study of patients diagnosed with genital warts and matched controls. We used commercial healthcare claims data from 2011 through 2014 to estimate total 1- and 2-year costs from date of diagnosis. We used a generalized linear model to identify factors associated with monthly costs. RESULTS We identified 34,686 eligible cases of genital warts during the period 2011-2014. The first 2-year mean direct medical cost differences between cases and controls were US$6737 for the USA. Costs were significantly higher in the first 3 months following diagnosis and were higher among older individuals, women, those with co-morbidities or psychiatric illnesses, and those located in the south and southwest USA. CONCLUSIONS The mean direct cost of treating genital warts is approximately US$6700 in the first 2 years after diagnosis in the USA. These data can assist policy makers in decisions with respect to allocation of resources to implement HPV vaccine programs.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Shuangshuang Fu
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA
| | - Zeena Shelal
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA.
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15
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Jacob L, Duse DA, Kostev K. Prevalence and treatment of sexually transmitted infections in men followed by urologists in Germany - a cross sectional study with 347,090 men. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2018; 16:Doc03. [PMID: 30250416 PMCID: PMC6124731 DOI: 10.3205/000265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/15/2018] [Indexed: 11/30/2022]
Abstract
Aim: The goal of this retrospective analysis was to study the prevalence and treatment of the most common sexually transmitted infections (STI) in men followed by urologists in Germany. Methods: This study included a total of 347,090 men followed in 71 urology practices in Germany between 2013 and 2015. The first outcome was the prevalence of individuals diagnosed with STI between 2013 and 2015. The following eight types of STI infections were included in the analysis: chlamydial infection, gonococcal infection, anogenital warts, anogenital herpes infection, trichomoniasis, ulcus molle, phthiriasis, and syphilis. The second outcome was the prevalence of individuals with STI who received an appropriate therapy within 90 days of their initial STI diagnosis. Results: The most frequent STI was anogenital warts (0.64%), whereas the least frequent STI was syphilis (0.03%). The median age at diagnosis ranged from 30.3 years for chlamydia infection to 47.5 years for trichomoniasis. The proportion of individuals receiving treatment was the highest for trichomoniasis (90.6%) and the lowest for anogenital warts (49.9%). Conclusions: Overall, approximately 1.25% of men followed in urology practices in Germany between 2013 and 2015 were diagnosed with at least one STI. Further research is needed to gain a better understanding of the factors potentially associated with the risk of being diagnosed with STI in this setting in Germany. Moreover, there is a need for enabling higher rates of diagnosis and thus treatment of infected persons.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
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16
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Ki M, Choi HY, Han M, Oh JK. The economic burden of human papillomavirus infection-associated diseases in the Republic of Korea, 2002-2015. Vaccine 2018; 36:4633-4640. [PMID: 29961603 DOI: 10.1016/j.vaccine.2018.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND This prevalence-based, cost-of-illness study estimated the health care costs of human papillomavirus (HPV) infection-associated diseases in the era before the introduction of organized HPV vaccination for 12-year-old girls in 2016, South Korea. METHODS The claims data provided by the National Health Insurance Service was used to estimate the prevalence of HPV-associated diseases and their direct medical costs, including costs related to hospitalizations, outpatient visits, and medications. RESULTS A total of 1.3 million men and women used medical services for HPV-attributed diseases between 2002 and 2015. Among women, the most common diseases attributable to HPV were cervical dysplasia (64.4%), anogenital warts (12.9%), cervical carcinoma in situ (10.7%) and cervical cancer (2.6%), whereas anogenital warts (80.6%), benign neoplasms of larynx (14.3%), and anal cancers (8.9%) were most common among men. In 2015, the healthcare cost attributable to HPV was 124.9 million US dollars (USD) representing 69.0% of the annual cost of all HPV-associated diseases. At a cost of 75.1 million USD, cervical cancer contributed the largest economic burden in 2015 followed by cervical dysplasia (19.4 million USD) and cervical carcinoma in situ (10.7 million USD). These three conditions represented 58.2% of the total annual cost of all HPV-associated diseases, while 84.2% of the total annual cost was attributable to HPV. Annual health care costs increased from 42.6 million USD in 2002 to 180.9 million USD in 2015. CONCLUSION The healthcare costs associated with HPV-related diseases in Korea are substantial and increased between 2002 and 2015 mainly caused by increased number of patients. Expanding the target age for HPV vaccination of girls and introducing HPV vaccination for boys are possible ways of reducing the economic burden of HPV-associated disease and should be considered.
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Affiliation(s)
- Moran Ki
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
| | - Hwa Young Choi
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea; Department of Health Sciences, Hanyang University, Seoul, Republic of Korea.
| | - Minji Han
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea; Cancer Risk Appraisal and Prevention Branch, National Cancer Center, Goyang, Republic of Korea.
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17
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Kirigia JM, Mburugu GN. The monetary value of human lives lost due to neglected tropical diseases in Africa. Infect Dis Poverty 2017; 6:165. [PMID: 29249201 PMCID: PMC5733961 DOI: 10.1186/s40249-017-0379-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/29/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are an important cause of death and disability in Africa. This study estimates the monetary value of human lives lost due to NTDs in the continent in 2015. METHODS The lost output or human capital approach was used to evaluate the years of life lost due to premature deaths from NTDs among 10 high/upper-middle-income (Group 1), 17 middle-income (Group 2) and 27 low-income (Group 3) countries in Africa. The future losses were discounted to their present values at a 3% discount rate. The model was re-analysed using 5% and 10% discount rates to assess the impact on the estimated total value of human lives lost. RESULTS The estimated value of 67 860 human lives lost in 2015 due to NTDs was Int$ 5 112 472 607. Out of that, 14.6% was borne by Group 1, 57.7% by Group 2 and 27.7% by Group 3 countries. The mean value of human life lost per NTD death was Int$ 231 278, Int$ 109 771 and Int$ 37 489 for Group 1, Group 2 and Group 3 countries, respectively. The estimated value of human lives lost in 2015 due to NTDs was equivalent to 0.1% of the cumulative gross domestic product of the 53 continental African countries. CONCLUSIONS Even though NTDs are not a major cause of death, they impact negatively on the productivity of those affected throughout their life-course. Thus, the case for investing in NTDs control should also be influenced by the value of NTD morbidity, availability of effective donated medicines, human rights arguments, and need to achieve the NTD-related target 3.3 of the United Nations Sustainable Development Goal 3 (on health) by 2030.
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Affiliation(s)
| | - Gitonga N Mburugu
- Meru University of Science and Technology, P.O. Box 972-60200, Meru, Kenya
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18
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Damm O, Horn J, Mikolajczyk RT, Kretzschmar MEE, Kaufmann AM, Deleré Y, Ultsch B, Wichmann O, Krämer A, Greiner W. Cost-effectiveness of human papillomavirus vaccination in Germany. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:18. [PMID: 28878573 PMCID: PMC5583986 DOI: 10.1186/s12962-017-0080-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 08/23/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the cost-effectiveness of human papillomavirus (HPV) vaccination in addition to the current cervical cancer screening programme in Germany using a dynamic transmission model. METHODS Based on a mathematical model simulating the transmission dynamics and the natural history of HPV infection and associated diseases (cervical intraepithelial neoplasia, cervical cancer, and genital warts), we estimated the epidemiological and economic consequences of HPV vaccination with both the quadrivalent and bivalent vaccines. In our base case analysis, we assessed the cost-effectiveness of vaccinating 12-year-old girls with a 3-dose schedule. In sensitivity analysis, we also evaluated the use of a 2-dose schedule and assessed the impact of vaccinating boys. RESULTS From a health care payer perspective, incremental cost-effectiveness ratios (ICERs) of a 3-dose schedule were €34,249 per quality-adjusted life year (QALY) for the bivalent and €14,711 per QALY for the quadrivalent vaccine. Inclusion of indirect costs decreased ICERs by up to 40%. When adopting a health care payer perspective, ICERs of a 2-dose approach decreased to €19,450 per QALY for the bivalent and to €3645 per QALY for the quadrivalent vaccine. From a societal perspective, a 2-dose approach using the quadrivalent vaccine was a cost-saving strategy while using the bivalent vaccine resulted in an ICER of €13,248 per QALY. Irrespective of the perspective adopted, additional vaccination of boys resulted in ICERs exceeding €50,000 per QALY, except for scenarios with low coverage (20%) in girls. CONCLUSIONS Our model results suggest that routine HPV vaccination of 12-year-old girls with three doses is likely to be cost-effective in Germany. Due to the additional impact on genital warts, the quadrivalent vaccine appeared to be more cost-effective than the bivalent vaccine. A 2-dose schedule of the quadrivalent vaccine might even lead to cost savings when adopting a societal perspective. The cost-effectiveness of additional vaccination of boys was highly dependent on the coverage in girls.
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Affiliation(s)
- Oliver Damm
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Johannes Horn
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Rafael T. Mikolajczyk
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research, Site Hannover-Braunschweig, Hannover/Braunschweig, Germany
| | - Mirjam E. E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| | - Andreas M. Kaufmann
- Gynecologic Tumor Immunology, Clinic for Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ole Wichmann
- Immunisation Unit, Robert Koch Institute, Berlin, Germany
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
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Ginindza TG, Sartorius B, Dlamini X, Östensson E. Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland. PLoS One 2017; 12:e0177762. [PMID: 28531205 PMCID: PMC5439687 DOI: 10.1371/journal.pone.0177762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has proven to be the cause of several severe clinical conditions on the cervix, vulva, vagina, anus, oropharynx and penis. Several studies have assessed the costs of cervical lesions, cervical cancer (CC), and genital warts. However, few have been done in Africa and none in Swaziland. Cost analysis is critical in providing useful information for economic evaluations to guide policymakers concerned with the allocation of resources in order to reduce the disease burden. MATERIALS AND METHODS A prevalence-based cost of illness (COI) methodology was used to investigate the economic burden of HPV-related diseases. We used a top-down approach for the cost associated with hospital care and a bottom-up approach to estimate the cost associated with outpatient and primary care. The current study was conducted from a provider perspective since the state bears the majority of the costs of screening and treatment in Swaziland. All identifiable direct medical costs were considered for cervical lesions, cervical cancer and genital warts, which were primary diagnoses during 2015. A mix of bottom up micro-costing ingredients approach and top-down approaches was used to collect data on costs. All costs were computed at the price level of 2015 and converted to dollars ($). RESULTS The total annual estimated direct medical cost associated with screening, managing and treating cervical lesions, CC and genital warts in Swaziland was $16 million. The largest cost in the analysis was estimated for treatment of high-grade cervical lesions and cervical cancer representing 80% of the total cost ($12.6 million). Costs for screening only represented 5% of the total cost ($0.9 million). Treatment of genital warts represented 6% of the total cost ($1million). CONCLUSION According to the cost estimations in this study, the economic burden of HPV-related cervical diseases and genital warts represents a major public health issue in Swaziland. Prevention of HPV infection with a national HPV immunization programme for pre-adolescent girls would prevent the majority of CC related deaths and associated costs.
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Affiliation(s)
- Themba G. Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ellinor Östensson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Cocchio S, Baldovin T, Bertoncello C, Buja A, Furlan P, Saia M, Baldo V. Decline in hospitalization for genital warts in the Veneto region after an HPV vaccination program: an observational study. BMC Infect Dis 2017; 17:249. [PMID: 28381294 PMCID: PMC5382454 DOI: 10.1186/s12879-017-2361-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is one of the most common sexually transmitted pathogens. This observational study was conducted to estimate the trend of hospitalization for genital warts (GWs) in the Veneto region (Italy) from 2004 to 2015. METHODS All patients with GWs were identified in the hospital discharge records of all public and accredited private hospitals that related to Veneto residents and contained the ICD9-CM code 078.11 associated with a genital surgical procedure (vulval/vaginal warts, penile warts and anal warts). Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS An annual rate of 11.8 per 100,000 population (8.6 per 100,000 males, and 14.8 per 100,000 females) was found, corresponding to 6076 hospitalizations for condyloma (53.3% vulval/vaginal, 35.8% anal, 8.3% penile, and 2.6% both penile or vulval/vaginal and anal). Among females, the rate of overall GWs remained stable to 2007 (19.1 per 100,000), then dropped significantly, reaching a rate of 11.3 per 100,000 in 2015 (average annual percent changes [AAPC]: -6.1%; 95% CI: -8.4; -3.7). For males, the overall rate increased over the study period (from 6.4 per 100,000 in 2004 to 10.8 per 100,000 in 2015; AAPC: 3.8%; 95% CI: 1.2; 6.4). Among the potentially vaccinated females (12- to 20-year-olds) there was a 62.1% decrease in the number of vulval/vaginal warts from the years 2010-2012 to the years 2013-2015 due to an increase in the HPV coverage rate. A similar reduction among males was observed in the same period and the same age group for penile warts (-68.2%). CONCLUSION GWs have an important impact on the health services and data suggest that GW-related hospitalization rates rapidly decline in a population with a high HPV vaccination coverage (about 75%). Further efforts should be made to better clarify the epidemiological picture regarding HPV-related diseases, with particular regard to sexual behavior.
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Affiliation(s)
- Silvia Cocchio
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Tatjana Baldovin
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Chiara Bertoncello
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Alessandra Buja
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Patrizia Furlan
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy
| | - Mario Saia
- EuroHealth Net, Venice, Veneto Region Health Directorate, Venice, Italy
| | - Vincenzo Baldo
- Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Via Loredan 18, 35121, Padua, Italy.
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Suligoi B, Vittori G, Salfa MC, Timelli L, Corsini D, Fattorini G, Mariani L. Prevalence and incidence of external genital warts in a sample of Italian general female population. BMC Infect Dis 2017; 17:126. [PMID: 28166736 PMCID: PMC5294736 DOI: 10.1186/s12879-017-2202-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background The Human papillomavirus is the most common sexually transmitted virus worldwide. The objective of this study was to estimate: 1) the prevalence and the incidence of external genital warts (eGW) in a sample of women attending community outpatient clinics and 2) the total number of eGW cases in the Italian female population aged 15–64 years. Methods A prospective study was performed for a 12-month period between 2009 and 2010, among a sample of women attending community gynecological outpatient clinics located throughout Italy. Demographic data, for every woman aged 15–64 years, were collected. For women diagnosed with eGW, behavioral and clinical data were recorded. Prevalence of eGW was calculated as the proportion between the number of women with eGW and that of women visiting any of the participating gynecologists; incidence of eGW was calculated as the proportion between the number of women with a new diagnosis of eGW and that of women visiting any of the participating gynecologists. Standardized prevalence by age was used to estimate the number of eGW cases occurring in the Italian female population aged 15–64 years. Results In 2009–2010, 44 community gynecologists were included in the network. In one-year period, 16,410 women visited any of the participating gynecologists; 63 women were diagnosed with eGW, corresponding to a prevalence of 3.8 cases per 1,000 women per year (95%CI: 2.9-4.9). The incidence of eGW was 3.0 cases per 1,000 women per year (95%CI: 2.2-3.9). Women aged 15–24 years showed both the highest prevalence and incidence. Prevalence and incidence significantly decreased by increasing age group (p <0.001), and were higher in Southern Italy compared to Central-Northern Italy. The estimated number of women with eGW among women aged 15–64 years in Italy, in 2010, was approximately 69,000. Conclusions These data show a high prevalence and incidence of eGW among young women in Italy, stress the effectiveness of community clinical networks in investigating STI epidemiology among women from the general population, confirm the relevance of HPV vaccination programs among adolescents, and underscore the need of promoting safe sex, implementing early diagnosis, treatment and prevention of genital warts.
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Affiliation(s)
- Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy.
| | | | - Maria Cristina Salfa
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy
| | | | | | - Giovanni Fattorini
- Associazione ginecologi territoriali (AGITE), Via G. Abamonti 1, Milan, Italy
| | - Luciano Mariani
- HPV-unit, Istituto Nazionale Tumori Regina Elena, Via Elio Chianesi 53, Rome, Italy
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Thurgar E, Barton S, Karner C, Edwards SJ. Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation. Health Technol Assess 2017; 20:v-vi, 1-486. [PMID: 27034016 DOI: 10.3310/hta20240] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Typically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited. OBJECTIVES To systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments. DATA SOURCES Electronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies. REVIEW METHODS A systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources. RESULTS Of 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of treatment. Podophyllotoxin 0.5% solution (Condyline(®), Takeda Pharmaceutical Company Ltd; Warticon(®) solution, Stiefel Laboratories Ltd) was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. In total, 84 treatment strategies were assessed using the economic model. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if AGWs did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000-30,000 per additional quality-adjusted life-year gained. The result was robust to most sensitivity analyses conducted. LIMITATIONS Limited reporting in identified studies of baseline characteristics for the enrolled population generates uncertainty around the comparability of the study populations and therefore the generalisability of the results to clinical practice. Subgroup analyses were planned based on type, number and size of AGWs, all of which are factors thought to influence treatment effect. Lack of data on clinical effectiveness based on these characteristics precluded analysis of the differential effects of treatments in the subgroups of interest. Despite identification of 60 studies, most comparisons in the MTC are informed by only one RCT. Additionally, lack of head-to-head RCTs comparing key treatments, together with minimal reporting of results in some studies, precluded comprehensive analysis of all treatments for AGWs. CONCLUSIONS The results generated by the MTC are in agreement with consensus opinion that ablative techniques are clinically more effective at completely clearing AGWs after treatment. However, the evidence base informing the MTC is limited. A head-to-head RCT that evaluates the comparative effectiveness of interventions used in clinical practice would help to discern the potential advantages and disadvantages of the individual treatments. The results of the economic analysis suggest that podophyllotoxin 0.5% solution is likely to represent a cost-effective first-line treatment option. More expensive effective treatments, such as CO2 laser therapy or surgery, may represent cost-effective second-line treatment options. No treatment and podophyllin are unlikely to be considered cost-effective treatment options. There is uncertainty around the cost-effectiveness of treatment with imiquimod, trichloroacetic acid and cryotherapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005457. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Largeron N, Petry KU, Jacob J, Bianic F, Anger D, Uhart M. An estimate of the public health impact and cost-effectiveness of universal vaccination with a 9-valent HPV vaccine in Germany. Expert Rev Pharmacoecon Outcomes Res 2016; 17:85-98. [DOI: 10.1080/14737167.2016.1208087] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nathalie Largeron
- Health Economics Department, Sanofi Pasteur MSD - Health Economics, Lyon, France
| | | | - Jorge Jacob
- Mapi Group Ringgold - RSW&A, Uxbridge, London, UK
| | | | | | - Mathieu Uhart
- Health Economics Department, Sanofi Pasteur MSD - Health Economics, Lyon, France
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Boiron L, Joura E, Largeron N, Prager B, Uhart M. Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria. BMC Infect Dis 2016; 16:153. [PMID: 27084683 PMCID: PMC4833954 DOI: 10.1186/s12879-016-1483-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/25/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria. METHOD A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60% and 40% for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered. RESULTS Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92%, the related CIN2/3 cases by 96% and anal cancer by 83% and 76% respectively in females and males after 100 years, relative to 75%, 76%, 80% and 74% with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective. CONCLUSION The present evaluation showed that vaccinating 60% of girls and 40% of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.
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Affiliation(s)
- L. Boiron
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
| | - E. Joura
- />Department of Gynecology and Obstetrics, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - N. Largeron
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
| | - B. Prager
- />Sanofi Pasteur MSD, Campus 21, Europarin F11/402, Brunn am Gebirge, A-2345 Austria
| | - M. Uhart
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
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Andersen LK, Davis MDP. Sex differences in the incidence of skin and skin-related diseases in Olmsted County, Minnesota, United States, and a comparison with other rates published worldwide. Int J Dermatol 2016; 55:939-55. [PMID: 27009931 DOI: 10.1111/ijd.13285] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/01/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022]
Abstract
Many skin and skin-related diseases affect the sexes unequally, with attendant implications for public health and resource allocation. To evaluate better the incidence of skin and skin-related diseases affecting males vs. females, we reviewed published population-based epidemiology studies of skin disorders performed utilizing Rochester Epidemiology Project data. Females had a higher incidence of the following diseases: connective tissue diseases (scleroderma, morphea, dermatomyositis, primary Sjögren syndrome, systemic lupus erythematosus [not in all studies]), pityriasis rosea, herpes progenitalis, condyloma acuminatum, hidradenitis suppurativa, herpes zoster (except in children), erythromelalgia, venous stasis syndrome, and venous ulcers. Males had a higher incidence of psoriasis and psoriatic arthritis, basal cell carcinoma (exception, females aged ≤40 years), squamous cell carcinoma, and lentigo maligna. Incidence rates were equal in males and females for cutaneous malignant melanoma (exception, higher in females aged 18-39 years), lower-extremity cellulitis, cutaneous nontuberculous mycobacterial infection, Behçet disease, delusional infestation, alopecia areata, and bullous pemphigoid. Many of the population-based sex-specific incidence rates of skin and skin-related diseases derived from the Rochester Epidemiology Project are strikingly different from those estimated elsewhere. In general, females are more commonly affected by skin and skin-related diseases. The reasons for this imbalance remain to be determined and are likely multifactorial.
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Affiliation(s)
- Louise K Andersen
- Department of Dermato-Venereology, Aarhus University Hospital, Aarhus C, Denmark
| | - Mark D P Davis
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN, USA
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Kotsopoulos N, Connolly MP, Remy V. Quantifying the broader economic consequences of quadrivalent human papillomavirus (HPV) vaccination in Germany applying a government perspective framework. HEALTH ECONOMICS REVIEW 2015; 5:23. [PMID: 26198884 PMCID: PMC4510306 DOI: 10.1186/s13561-015-0054-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
HPV infections can cause substantial burden in females and males as it is associated with several genital cancers, in addition to genital warts. Traditional economic evaluations often focus on quantifying cost-effectiveness, however, it is increasingly recognized that vaccinations may generate broader benefits not captured in cost-effectiveness analysis. Τhe aim of this study was to evaluate the broader economic consequences associated with HPV vaccination in males and females and to conduct a lifetime cost-benefit analysis of investing in universal vaccination in Germany from the perspective of government. Methodologies from generational accounting, human capital and health economics were combined to estimate the broader economic consequences of HPV vaccination including the fiscal impact for the government. A cohort model was developed simulating the medical costs and average lifetime fiscal transfers between the government and 12-year-old immunized and non-immunized males and females. To estimate tax revenue attributed to vaccination-related changes in morbidity and mortality, direct and indirect tax rates were linked to differences in age- and gender-specific earnings. Based on HPV vaccination costs, the base case cost-benefit analysis demonstrated that investing <euro>1 in universal HPV vaccination could yield <euro>1.7 in gross tax revenue over the lifetime of the cohorts. After taking into consideration the governmental transfers, universal HPV vaccination in Germany could result in incremental positive net discounted taxes (i.e. tax revenue-transfers) from <euro>62 million for the German government. The vaccination of males and females with the quadrivalent HPV vaccine is likely to have positive effects on public finances.
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Affiliation(s)
- Nikolaos Kotsopoulos
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Global Market Access Solutions (GMAS), St-Prex, Switzerland
| | - Mark P Connolly
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Global Market Access Solutions (GMAS), St-Prex, Switzerland
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Evaluating the Early Benefit of Quadrivalent HPV Vaccine on Genital Warts in Belgium: A Cohort Study. PLoS One 2015; 10:e0132404. [PMID: 26147096 PMCID: PMC4492693 DOI: 10.1371/journal.pone.0132404] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/14/2015] [Indexed: 11/21/2022] Open
Abstract
Genital warts (GWs) are common, with about 5% to 10% of people having at least one episode in their lifetime. They develop about 2–3 months after infection with human papillomavirus (HPV) genotypes 6 and 11. The prophylactic quadrivalent HPV vaccine (qHPV), protects against HPV6/11 infections and diseases. In Belgium, HPV vaccines started to be reimbursed in 2007 and have been fully reimbursed since December 2008 for women 12 to 18 years old. This study aimed at evaluating the real-life benefit of qHPV vaccine introduction in Belgium on GWs by measuring both vaccine impact (VI) at a population level and the direct effect of the qHPV vaccine at an individual level (vaccine effectiveness (VE)), using data from a large sick-fund (MLOZ) reimbursement database. A first reimbursement for imiquimod (most common first-line GWs treatment in Belgium) was used as a surrogate for a first GWs episode; reimbursement of qHPV vaccine was used as surrogate for vaccination. VI was estimated by comparing the incidence of GWs before and after qHPV vaccine introduction in Belgium (ecologic evaluation). VE was assessed by comparing GWs incidences in vaccinated vs. unvaccinated women, among women eligible for HPV vaccination. VI was evaluated in 9,223,384 person-years. Overall, GWs incidence rates decreased significantly between the pre- and post-vaccination periods (-8.1% (95% CI: -15.3; -0.3) for men and women aged 18–59 years. This decrease was highest in women targeted by the HPV vaccination programme (-72.1% (95% CI: -77.9; -64.7) in women aged 16–22 years, with a 43% vaccine uptake in 2013). A significant decrease was also observed in men aged 16-22 years (-51.1%, 95%CI: -67.6; -26.2), suggesting herd-protection. VE was evaluated in 369,881 person-years. Age-adjusted VE for fully vaccinated women was 88.0% (95% CI: 79.4; 93.0). VE was higher when the first dose was given younger and remained high for over 4 years post-vaccination in all ages. High VI and VE of the qHPV vaccine were observed in a real-life setting in Belgium.
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Petráš M, Adámková V. Rates and predictors of genital warts burden in the Czech population. Int J Infect Dis 2015; 35:29-33. [PMID: 25869075 DOI: 10.1016/j.ijid.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/30/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the burden and the predictors of genital warts (GWs) in Czech men and women. METHODS A population-based cross-sectional study was conducted of 32 974 randomly selected health clinic attendees from all 14 regions of the Czech Republic. Information on GWs and lifestyle behaviour was collected using a questionnaire. RESULTS Results revealed a 5.8% prevalence rate of self-reported GWs in the Czech population aged 16-55 years. There was an increase in the incidence of GWs in the years 2010-2013 when compared to lifetime incidence rates, from 205.4 (95% confidence interval (CI) 191.0-219.7) to 441.8 (95% CI 393.1-490.6) per 100 000 person-years. No significant differences were observed between genders. The strongest risk factors found for GWs were an infected sexual partner (adjusted odds ratio (OR) 114.3, 95% CI 78.9-165.4) and a high number of lifetime sexual partners (adjusted OR 3.36, 95% CI 2.72-4.17 for >14 partners vs. one partner). A novel finding was that 22.7% (95% CI 20.9-24.6%) of participants claimed that the pathology had disappeared spontaneously without medical assistance. CONCLUSIONS The results provide baseline information for the development and monitoring of prevention strategies against GWs in the Czech Republic.
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Affiliation(s)
- Marek Petráš
- Charles University in Prague, Second Faculty of Medicine, V Úvalu 84, 150 06 Prague 5, Czech Republic.
| | - Věra Adámková
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Kashino W, Piyaphanee W, Kittitrakul C, Tangpukdee N, Sibunruang S, Lawpoolsri S, Yamashita H, Muangnoicharoen S, Silachamroon U, Tantawichien T. Incidence of potential rabies exposure among Japanese expatriates and travelers in Thailand. J Travel Med 2014; 21:240-7. [PMID: 24845015 DOI: 10.1111/jtm.12124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rabies has become a forgotten and neglected disease in Japan. In 2006, there was a slight increase in social awareness of rabies when Japan had two reported cases of human rabies, originating in the Philippines. Although the number of Japanese either traveling or living in other Asian countries has been increasing, the exact risk of this population contracting rabies is unknown. Thus, this study utilized a questionnaire to investigate the incidence of rabies exposure, as well as the knowledge, attitude, and practice toward rabies prevention among Japanese expatriates and travelers in Thailand. METHODS Japanese travelers and expatriates were asked questions related to knowledge, attitude, practice toward rabies risk, and experiences of potential rabies exposure such as animal bites, licks, and scratches. Questionnaires were either completed at the Bangkok Suvarnabhumi International Airport and other tourist areas or distributed within Japanese associations in Thailand. RESULTS A total of 1,208 questionnaires from Japanese expatriates and 590 from Japanese travelers were collected and analyzed. We found high incidence rates of potential exposure events among these populations. In particular, Japanese travelers had the highest incidence rate compared to previous studies of international travelers in Thailand. While expatriates' incidence rates of animal bites, licks, and scratches were 1.7, 6.9, and 1.8/1,000 person-months, travelers have much higher incidence rates of 43.1, 136.1, and 33.0/1,000 person-months. Generally, travelers, compared to expatriates, tended to have less accurate knowledge and less often had the pre-exposure prophylaxis vaccination. Moreover, survey answers indicated that 55.0% of expatriates and 88.9% of travelers who were bitten would not seek proper treatment. CONCLUSIONS Since rabies is a preventable disease as long as one has the appropriate knowledge, attitude, and practice, it is essential to promote prevention activities for the Japanese population in Thailand to avert serious consequences of this disease.
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Affiliation(s)
- Wataru Kashino
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
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Shavit O, Roura E, Barchana M, Diaz M, Bornstein J. Burden of human papillomavirus infection and related diseases in Israel. Vaccine 2014; 31 Suppl 8:I32-41. [PMID: 24229717 DOI: 10.1016/j.vaccine.2013.05.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/16/2012] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
This manuscript provides the available data on the burden of human papillomavirus (HPV) infections and HPV-related diseases in Israel. The incidence of cervical intraepithelial neoplasia grade 3 (CIN3) among Jewish women was 17.4 per 100,000 in 2007, showing an increase since 1997. The incidence of cervical cancer was 5.3 per 100,000 Israeli Jewish women and 2.3 per 100,000 Israeli non-Jewish women in 2007. This rate is relatively low compared to other developed countries, and could be explained by cultural and religious factors such as male circumcision or sexual behavior. Mortality rates were around 1.5 per 100,000 Israeli women in 2007. Incidences of other anogenital, oral cavity, and pharynx cancers are very low, below 1.0 per 100.000 Israeli women and men. Information is scarce on HPV prevalence and HPV type distribution among women with cervical cancer. HPV types 16 and 18 were the two most common types in both preneoplastic lesions and cervical cancer, representing 60% of total invasive cases. Data on genital warts show an incidence rate of 239 per 100,000 men and 185 per 100,000 women, similar to that found in other Western countries. Despite these low incidences, it is important to improve the information on the overall burden of HPV-related morbidity and on the HPV prevalence to evaluate an organized cervical cancer screening program and the introduction of the HPV vaccine in the national school-based vaccine program. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in Israel" Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Oren Shavit
- Division of Clinical Pharmacy, The School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel; Health Technology Assessment, MSD-Israel, Hod Hasharon, Israel.
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Saha S, Gerdtham UG. Cost of illness studies on reproductive, maternal, newborn, and child health: a systematic literature review. HEALTH ECONOMICS REVIEW 2013; 3:24. [PMID: 24229450 PMCID: PMC4177189 DOI: 10.1186/2191-1991-3-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/09/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The term ?reproductive, maternal, newborn, and child health (RMNCH)? describes an integrated continuum of health states which is central to Millennium Development Goals 4 and 5. While the burden of mortality and morbidity associated with RMNCH is well known, knowledge is still limited about the economic burden of RMNCH. Concrete evidence of cost of illness (COI) of RMNCH may help policy makers in supporting investment in RMNCH. METHODS A systematic literature search of COI studies was performed in electronic databases. The time frame for the analysis was January 1990 ? April 2011. The databases checked were Medline (Pubmed), Embase and ECONbase, EconLit, the Cumulative Index to Nursing and Allied Health (CINAHL), the National Bureau of Economic Research, the Latin American and Caribbean Literature on Health Sciences Database (LILACS), and Popline. Furthermore, we searched working papers and reference lists of selected articles. RESULTS All the studies investigated address particular complications and issues of RMNCH, e.g., preterm birth, non-exclusive breastfeeding, and sexually transmitted diseases (STDs), but not RMNCH as an entire continuum. Most of the studies were conducted in high income countries, with limited data on low and middle income countries. The burden of disease is very high even for single complications. For example, the disease burden related to non-exclusive breastfeeding was given as 14.39 billion international dollars (ID) (2012, purchasing power parity) per year in the USA. Methodological differences in study design, costing approach, perspective of analysis, and time frame make it difficult to compare different studies. CONCLUSION The continuum of RMNCH covers a large portion of the lifespan from birth through the reproductive age. From a methodological perspective, an ideal COI study would clearly describe the perspective of analysis and, hence, the cost items (direct or indirect), cost collection procedure, discounting, quality of data, time frame of analysis, related comorbidities, and robust sensitivity analysis for all the assumptions. Further research is needed to measure the economic impact of RMNCH, including identification of the most cost-effective policy and interventions for prevention, reduction, and elimination of the complications of RMNCH.
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Affiliation(s)
- Sanjib Saha
- Center for Primary Healthcare Research, Skåne University Hospital, Lund University/Region Skåne,, Jan Waldenströms gata 35, Malmö SE-205 02, Sweden
- Health Economics & Management, Institute of Economic Research, Lund University, Tycho Brahes väg 1, SE- 220 07, Lund, Sweden
| | - Ulf G Gerdtham
- Center for Primary Healthcare Research, Skåne University Hospital, Lund University/Region Skåne,, Jan Waldenströms gata 35, Malmö SE-205 02, Sweden
- Health Economics & Management, Institute of Economic Research, Lund University, Tycho Brahes väg 1, SE- 220 07, Lund, Sweden
- Department of Economics, Lund University, Tycho Brahes väg 1, Lund SE- 220 07, Sweden
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Garnock-Jones KP, Giuliano AR. Quadrivalent human papillomavirus (HPV) types 6, 11, 16, 18 vaccine for the prevention of genital warts in males: profile report. demail@springer.com. Drugs R D 2013; 12:235-8. [PMID: 23017129 PMCID: PMC3585902 DOI: 10.2165/11207000-000000000-00000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Significant decrease in the incidence of genital warts in young Danish women after implementation of a national human papillomavirus vaccination program. Sex Transm Dis 2013; 40:130-5. [PMID: 23324976 DOI: 10.1097/olq.0b013e31827bd66b] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Approximately 90% of genital warts (GWs) are caused by human papillomavirus (HPV) types 6 and 11. Denmark has provided the quadrivalent HPV vaccine to all 12-year-old girls since 2009 and catch-up vaccination to girls up to 15 years since 2008, with up to 80% to 85% vaccine coverage. We determined the incidence of GWs in Denmark since 1996, focusing on the period after licensing of HPV vaccination (October 2006). METHODS From the Danish National Patient Register, we identified all hospitalizations and outpatient consultations for GWs between January 1995 and July 2011. Poisson regression was used to estimate average annual percentage changes. RESULTS The overall incidence of GWs in women increased significantly until 2007, followed by an average yearly decline of 3.1% (95% confidence interval [CI], -5.5 to -0.7). In men, the incidence increased by 6.2% per year from 2004 (95% CI, 4.6-7.8). Stratifying on age, a significant decline was seen only for young women, particularly those aged 16 to 17 years, in whom GWs were virtually eliminated (average annual percentage change, -45.3%; 95% CI, -55.8 to -33.3). The incidences of genital Chlamydia, syphilis, and gonorrhea were stable or increased during the study period. CONCLUSIONS The incidence of GWs decreased substantially among women with high HPV vaccine coverage, pointing to the effect of the national HPV vaccination program.
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Incidence of Genital Warts in Adolescents and Young Adults in an Integrated Health Care Delivery System in the United States Before Human Papillomavirus Vaccine Recommendations. Sex Transm Dis 2013; 40:534-8. [DOI: 10.1097/olq.0b013e3182953ce0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Monteiro DL, Sodré DC, Russomano FB, Trajano AJ, Silva KS. Incidence of genital warts in adolescents and their association with cervical intraepithelial lesions. Eur J Obstet Gynecol Reprod Biol 2013; 168:80-2. [DOI: 10.1016/j.ejogrb.2012.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/23/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
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Temporal Trends in Genital Warts Among Individuals Covered by the Public Prescription Drug Insurance Plan in the Province of Quebec, Canada, From 1998 to 2007. J Low Genit Tract Dis 2013; 17:147-53. [DOI: 10.1097/lgt.0b013e31825c3915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis 2013; 13:39. [PMID: 23347441 PMCID: PMC3618302 DOI: 10.1186/1471-2334-13-39] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anogenital warts (AGWs) are a common, highly infectious disease caused by the human papillomavirus (HPV), whose high recurrence rates contribute to direct medical costs, productivity loss and increased psychosocial impact. Because of the lack of a systematic review of the epidemiology of AGWs in the literature, this study reviewed the published medical literature on the incidence and prevalence of AGWs. METHODS A comprehensive literature search was performed on the worldwide incidence and prevalence of AGWs between 2001 and 2012 using the PubMed and EMBASE databases. An additional screening of abstracts from relevant sexual health and infectious disease conferences from 2009 to 2011 was also conducted. Only original studies with general adult populations (i.e., at least including ages 20 through 40 years) were included. RESULTS The overall (females and males combined) reported annual incidence of any AGWs (including new and recurrent) ranged from 160 to 289 per 100,000, with a median of 194.5 per 100,000. New AGW incidence rates among males ranged from 103 to 168 per 100,000, with a median of 137 per 100,000 and among females from 76 to 191 per 100,000, with a median of 120.5 per 100,000 per annum. The reported incidence of recurrent AGWs was as high as 110 per 100,000 among females and 163 per 100,000 among males. Incidence peaked before 24 years of age in females and between 25 and 29 years of age among males. The overall prevalence of AGWs based on retrospective administrative databases or medical chart reviews or prospectively collected physician reports ranged from 0.13% to 0.56%, whereas it ranged from 0.2% to 5.1% based on genital examinations. CONCLUSIONS The literature suggests that AGWs are widespread and the prevalence depends on study methodology as suggested by higher rates reported from routine genital examinations versus those from treatment records. However, there remains a need for more population-based studies from certain regions including Africa, Latin America and Southern Asia to further elucidate the global epidemiology of this disease.
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Affiliation(s)
- Harshila Patel
- LA-SER Analytics, 1405 TransCanada Highway, Suite 310, Montréal, Quebec H9P 2V9, Canada
| | - Monika Wagner
- LA-SER Analytics, 1405 TransCanada Highway, Suite 310, Montréal, Quebec H9P 2V9, Canada
| | - Puneet Singhal
- Merck & Co., Inc. Global Health Outcomes, Whitehouse Station, NJ, USA
| | - Smita Kothari
- Merck & Co., Inc. Global Health Outcomes, Whitehouse Station, NJ, USA
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Changes in Incidence of Anogenital Warts Diagnoses After the Introduction of Human Papillomavirus Vaccination in Germany—An Ecologic Study. Sex Transm Dis 2013; 40:28-31. [DOI: 10.1097/olq.0b013e3182756efd] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Petry KU, Luyten A, Justus A, Iftner A, Strehlke S, Schulze-Rath R, Iftner T. Prevalence of low-risk HPV types and genital warts in women born 1988/89 or 1983/84 -results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany. BMC Infect Dis 2012; 12:367. [PMID: 23259726 PMCID: PMC3536688 DOI: 10.1186/1471-2334-12-367] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wolfsburg HPV Epidemiological Study (WOLVES) is a population-based cohort study on HPV infections and associated diseases in the pre-vaccination era in young women in Wolfsburg, Germany. METHODS Women born 1983/84 or 1988/89 were invited to participate. Participants were recruited in gynecology practices, and completed a questionnaire with socioeconomic, sexual and medical data including vaccination status. Pelvic examination with Pap smear and HPV testing (HC2 = Hybrid Capture 2) was obligatory. HC2-positive and 10% of HC2-negative samples were tested for specific HPV types with SPF-10-PCR, and in inconclusive cases with DNA sequencing. Women with genital warts (GW) and those with atypical Pap smears were transferred for colposcopy. GWs were classified as typical condylomata acuminata (TCA), flat condyloma (FC) and seborrheic wart-like (SWL). RESULTS In total, 1258 subjects were recruited from the target population of 2850 (44.1%). Overall the prevalence of HC2 low-risk (LR) types was 8.5%. HPV6 was the most frequent LR type (2.1%), followed by HPV42 (1.1%), HPV11 and HPV44 (each 0.4%). LiPA showed a low sensitivity for HPV types 42, 90 and 91, which were detected only by HC2 and HPV sequencing. Nine women (0.7%) were transferred with incident GW: five TCA, two FC and two SWL. All TCA were associated with HPV6 in corresponding cervical swabs and warts. Tissues of SWL contained HPV6 (n = 1) and HPV16 (n = 1). The cumulative life-risk for GW was 1.4% in the 1988/89 and 4.8% in the 1983/84 cohort. Eight of 107 HC2-LR + and five of nine cases of GW had concomitant abnormal Pap smears. All CIN lesions could be linked to high-risk HPV types but borderline and low-grade abnormal smears were explained by vaginal and cervical TCA in four cases. CONCLUSIONS HC2 was a specific test for the detection of established and potential LR types. In this first WOLVES analysis, HPV6 was the most frequent HPV type and the single LR type linked to disease. The observed GW incidence of 715 per 100,000 fits well with estimates of healthcare providers. Although life risks for GW were lower than in Scandinavian analyses, the societal burden within the WOLVES populations was considerable.
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Affiliation(s)
- Karl Ulrich Petry
- Klinikum Wolfsburg, Frauenklinik, Schwerpunkt gynäkologische Onkologie, Sauerbruchstr, 7, 38440, Wolfsburg, Germany.
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Kuznetsov AV, Müller RA, Ruzicka T, Herzinger T, Kuznetsov L. Knowledge of sexually transmitted HPV infection, genitoanal warts, cancer and their prevention among young females after vaccine introduction in Germany. J Eur Acad Dermatol Venereol 2012; 27:1527-34. [PMID: 23216713 DOI: 10.1111/jdv.12045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sexually transmitted human papillomavirus (HPV) high-risk types cause carcinoma and low-risk types lead to warts of genitoanal area. Since the HPV vaccine has been introduced, awareness of HPV infection, prevention and health-related behaviour have not been studied in a large sample of young women in Germany. OBJECTIVES Assessment of awareness and health-related behaviour regarding HPV infection and prevention among young German females. METHODS In 2010, a postal cross-sectional survey was conducted with a random representative sample size (n = 2000) of females aged 19-35 attending Germany's largest (comprehensive) university, which was designed to obtain data about socio-demographics, the awareness of sexually transmitted HPV, genitoanal neoplasms and their prevention, HPV vaccine, immunisation and cervical cancer screening. RESULTS Of the 547 (27.3%) participants, 69.1% had heard of HPV, 62.5% were aware of the vaccine, 14.4% were vaccinated and 6.9% reported a history of sexually transmitted infection, including HPV (2.7%). The HPV-related knowledge among those who had heard of it was high (75.1-99.7%), except of that HPV affects men (52.9%) and HPV's causative role in genital (54.2%) and anal (35.6%) warts, and smoking (11.3%) as an HPV risk factor. The lower HPV knowledge score (<median = 12, ranged 1-17) was predicted by studying social sciences/humanities (OR = 3.68, 95% CI 1.99-6.79) and non-participation in cervical cancer screening (OR = 2.04, 95% CI 1.02-4.07). CONCLUSION This survey reveals an insufficient HPV awareness and low vaccination prevalence among young German women, underscoring the urgent need for HPV-related education aimed at reducing the burden of HPV-induced genitoanal neoplasms.
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Affiliation(s)
- A V Kuznetsov
- Prevention Research Group, Department of Dermatology & Allergology, Ludwig-Maximilian University, Munich, GermanyCancer Research UK Cambridge Research Institute, University of Cambridge, Cambridge, UKDepartment of Dermatology & Allergology, Ludwig-Maximilian University, Munich, Germany
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Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer: a Danish study of nearly 50 000 patients with genital warts. J Infect Dis 2012; 205:1544-53. [PMID: 22427679 DOI: 10.1093/infdis/jis228] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We conducted a large national cohort study to examine the risk of cancer among men and women with genital warts (GW). METHODS By use of the Danish National Patient Register, we identified 16,155 men and 32,933 women who received a diagnosis of GW during 1978-2008. Standardized incidence ratios (SIRs) were computed as estimates of the relative risk of specific cancers or sites. RESULTS A diagnosis of GW was strongly related to anal (SIR for men, 21.5; SIR for women, 7.8), vulvar (SIR, 14.8), vaginal (SIR, 5.9), cervical (SIR, 1.5), penile (SIR, 8.2), and head and neck cancer (SIR, 2.8), including subsites of head and neck cancer with confirmed HPV association (SIR for men, 3.5; SIR for women, 4.8). The risks remained elevated for >10 years following GW diagnosis. In addition, we found moderately increased SIR estimates for nonmelanoma skin cancer, smoking-related cancers, and Hodgkin and non-Hodgkin lymphoma. CONCLUSIONS Individuals with GW have a long-term increased risk of anogenital cancers and head and neck cancers. The elevated risks of nonmelanoma skin cancers might indicate an association with HPV, while excess risks of other cancers could point to differences in other risk factors between individuals with GW and the general population.
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Affiliation(s)
- Maria Blomberg
- Institute of Cancer Epidemiology, Danish Cancer Society, Denmark
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Raymakers AJN, Sadatsafavi M, Marra F, Marra CA. Economic and humanistic burden of external genital warts. PHARMACOECONOMICS 2012; 30:1-16. [PMID: 22201520 DOI: 10.2165/11591170-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
External genital warts (EGW) are a sexually transmitted infection caused by various strains of human papillomavirus (HPV). Several studies have described the direct and indirect costs of EGW, while others have reported on the burden of EGW in terms of the impact on the quality of life (QOL) of patients. The arrival of a quadrivalent HPV vaccine that protects against both cervical cancer and EGW requires a proper understanding of the impact of vaccines on costs and QOL. Using pre-defined search terms and inclusion/exclusion criteria, we performed a systematic review of the economic and humanistic burden of EGW. The focus of our review was on literature describing the direct and indirect costs of EGW per episode of care (EoC) or per year, as well as the impact of EGW on disease-specific, generic, or preference-based QOL measures. We also reviewed the literature on the national economic burden of EGW from the perspectives of different countries. Other aspects of EGW management that can inform economic modelling studies, such as length of EoC, number of physician visits and indirect costs, were also explored. Our review sheds light on the high economic and humanistic burden of EGW and important differences in the costs between men and women, as well as the differences in health resource utilization and costs across countries. Our study also highlights the dearth of information on the impact of EGW on the QOL and productivity of patients.
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Affiliation(s)
- Adam J N Raymakers
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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Desai S, Wetten S, Woodhall SC, Peters L, Hughes G, Soldan K. Genital warts and cost of care in England. Sex Transm Infect 2011; 87:464-8. [PMID: 21813567 PMCID: PMC3253068 DOI: 10.1136/sti.2010.048421] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives To estimate the total number of cases of, and cost of care for, genital warts (GWs) in England, to inform economic evaluations of human papillomavirus vaccination. Methods The number of GW cases seen in general practices (GPs) and in genitourinary medicine (GUM) clinics was estimated using the General Practice Research Database and the GUM Clinic Activity Dataset. The overlap in care of cases in the two settings was estimated. The calculated costs of care in GP and hospitals were added to the costs of care in GUM clinics (estimated elsewhere) to estimate the cost of care for GWs in England. Results In England, in 2008, GP and GUM saw 80 531 new (157/100 000 population) and 68 259 recurrent (133/100 000 population) episodes, giving a total of 148 790 episodes of care of GWs (289/100 000 population). Seventy-three per cent of cases were seen only in GUM clinics, 22% were seen by a GP before being referred to GUM, and 5% by GPs only. Hospital care was given in 1.3% of cases and contributed 8% of the costs. The average cost of care per episode was £113, and the estimated annual cost of care in England was £16.8 million. Conclusions This study provides a fairly comprehensive measure of GW frequency and care in England. GWs exert a considerable impact on health services, a large proportion of which could be prevented through immunisation using the quadrivalent human papillomavirus vaccine.
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Garnock-Jones KP, Giuliano AR. Quadrivalent human papillomavirus (HPV) types 6, 11, 16, 18 vaccine: for the prevention of genital warts in males. Drugs 2011; 71:591-602. [PMID: 21443282 DOI: 10.2165/11205980-000000000-00000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The quadrivalent HPV types 6, 11, 16, 18 vaccine (Gardasil®) is a recombinant vaccine comprising purified virus-like particles derived from the L1 capsid proteins of HPV types 6, 11, 16 and 18. The vaccine was highly immunogenic. Geometric mean titres (GMTs) and seroconversion rates for all four HPV types at month 7 in males aged 10-15 years were noninferior to those in females aged 16-23 years, and those in males aged 9-15 years were noninferior to those in females aged 9-15 years. In addition, GMTs and seroconversion rates in males aged 16-26 years receiving the vaccine were higher than those receiving amorphous aluminium hydroxyphosphate sulfate adjuvant (AAHS) control. The quadrivalent HPV vaccine was significantly more effective than AAHS control at decreasing the incidence of HPV 6-, 11-, 16- or 18-related external genital lesions (primary endpoint) in a randomized, double-blind, placebo-controlled, multicentre study in males aged 16-26 years. The most common clinical endpoint was HPV 6- and 11-related condyloma; efficacy was robust against these lesions. The vaccine is also expected to be protective against genital warts in males aged 9-15 years, as the immune response in males of this age group was noninferior to that in males aged 16-26 years. The quadrivalent HPV vaccine was generally well tolerated in males aged 9-26 years. The most common adverse events reported were injection-site related, and most of these were of mild to moderate severity.
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Cost–consequences evaluation between bivalent and quadrivalent HPV vaccines in Italy: The potential impact of different cross-protection profiles. Gynecol Oncol 2011; 121:514-21. [DOI: 10.1016/j.ygyno.2011.01.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 01/20/2011] [Accepted: 01/25/2011] [Indexed: 11/20/2022]
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Hampl M, Huppertz E, Schulz-Holstege O, Kok P, Schmitter S. Economic burden of vulvar and vaginal intraepithelial neoplasia: retrospective cost study at a German dysplasia centre. BMC Infect Dis 2011; 11:73. [PMID: 21426562 PMCID: PMC3072942 DOI: 10.1186/1471-2334-11-73] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 03/22/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Human papillomavirus is responsible for a variety of diseases including grade 2 and 3 vulvar and vaginal intraepithelial neoplasia. The aim of this study was to assess parts of the burden of the last diseases including treatment costs. The direct medical resource use and cost of surgery associated with neoplasia and related diagnostic procedures (statutory health insurance perspective) were estimated, as were the indirect costs (productivity losses) associated with surgical treatment and related gynaecology visits for diagnostic purposes. METHODS Data from 1991-2008 were retrospectively collected from patient records of the outpatient unit of the Gynaecological Dysplasia Clinic, Heinrich Heine University, Dusseldorf, Germany. Two subgroups of patients were analysed descriptively: women undergoing one surgical procedure related to a diagnosis of vulvar and/or vaginal intraepithelial neoplasia, and women undergoing two or more surgical procedures. Target measures were per-capita medical resource consumption, direct medical cost and indirect cost. RESULTS Of the 94 women analysed, 52 underwent one surgical intervention and 42 two or more interventions (mean of 3.0 interventions during the total period of analysis). Patients undergoing one surgical intervention accrued €881 in direct costs and €682 in indirect costs; patients undergoing more than one intervention accrued €2,605 in direct costs and €2,432 in indirect costs. CONCLUSIONS The economic burden on German statutory health insurance funds and society induced by surgical interventions and related diagnostic procedures for grade 2/3 vulvar and vaginal neoplasia should not be underrated. The cost burden is one part of the overall burden attributable to human papillomavirus infections.
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Affiliation(s)
- Monika Hampl
- Universitätsfrauenklinik Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | | | | | - Patrick Kok
- Institut für Experimentelle Psychologie, Heinrich-Heine-Universtität, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - Sarah Schmitter
- Sanofi Pasteur MSD GmbH, Paul-Ehrlich-Straße 1, 69181 Leimen, Germany
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Abstract
Despite some recent hopeful therapeutic developments such as topical green tea derivatives, the therapy of anogenital warts remains a medical problem. Both physician- and self-administered therapeutic approaches are not fully satisfactory. The high recurrence rates associated with the current therapy of anogenital warts together with their increasing incidence and burden of disease further support the use of the prophylactic quadrivalent VLP HPV 6,11,16,18 vaccine for control of HPV-associated neoplasias in women and men.
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Salih MM, Safi ME, Hart K, Tobi K, Adam I. Genotypes of human papilloma virus in Sudanese women with cervical pathology. Infect Agent Cancer 2010; 5:26. [PMID: 21192803 PMCID: PMC3022610 DOI: 10.1186/1750-9378-5-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of the distribution of human papillomavirus (HPV) genotypes among women with cervical lesion and in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. There is no published data concerning HPV and cervical abnormalities in Sudan. This study aimed to define the prevalence of HPV and its subtypes in the cervical smears of women presenting with gynecological complains at Omdurman Military Hospital, Sudan.During the period between March 2003 and April 2004, 135 cervical smears collected from these women, were screened using cytological techniques, and analysed by PCR for (beta)-globin and HPV DNA using gel electrophoresis and ELISA. RESULTS Of these 135 smears, there were 94 (69.3%) negative, 22 (16.3%) positive for inflammation, 12(8.9) mild dyskaryosis, 5 (3.7) moderate dyskaryosis and 2 (1.8) severe dyskaryosis. There were 60.7% ß. globin positive samples for HPV indicating DNA integrity. HPV DNA was identified in three samples (2.2%) by gel electrophoresis and. was positive in four samples (2.9%) as single and multiple infections by PCR-ELISA. The high risk HPV types 16 and 58 were identified in one sample as a mixed infection. The low risk HPV types 40 and 42 were also found as a mixed infection in another patient. HPV types 58 and 42 were identified in the other two patients. CONCLUSION HPV type distribution in Sudan appears to differ from that in other countries. The HPV genotypes identified were not associated with cancer.
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Affiliation(s)
- Magdi M Salih
- Department of Histopathology and Cytology, Faculty of Medical Laboratory Sciences, University of Khartoum, Sudan
| | - Mohamed El Safi
- Department of Pathology, Al Ribat National University, Sudan
| | - Keith Hart
- Central Biotechnology Service, Henry Wellcome Building, School of Medicine, Cardiff University, Cardiff, UK
| | - Khater Tobi
- Department of Obstetrics and Gynecology, Omdurman Military Hospital, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Kraut AA, Schink T, Schulze-Rath R, Mikolajczyk RT, Garbe E. Incidence of anogenital warts in Germany: a population-based cohort study. BMC Infect Dis 2010; 10:360. [PMID: 21182757 PMCID: PMC3022833 DOI: 10.1186/1471-2334-10-360] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 12/23/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Human papilloma virus (HPV) types 6 and 11 account for 90 percent of anogenital warts (AGW). Assessment of a potential reduction of the incidence of AGW following introduction of HPV vaccines requires population-based incidence rates. The aim of this study was to estimate incidence rates of AGW in Germany, stratified by age, sex, and region. Additionally, the medical practitioner (gynaecologist, dermatologist, urologist etc.) who made the initial diagnosis of AGW was assessed. METHODS Retrospective cohort study in a population aged 10 to 79 years in a population-based healthcare insurance database. The database included more than 14 million insurance members from all over Germany during the years 2004-2006. A case of AGW was considered incident if a disease-free period of twelve months preceded the diagnosis. To assess regional variation, analyses were performed by federal state. RESULTS The estimated incidence rate was 169.5/100,000 person-years for the German population aged 10 to 79 years. Most cases occurred in the 15 to 40 years age group. The incidence rate was higher and showed a peak at younger ages in females than in males. The highest incidence rates for both sexes were observed in the city-states Berlin, Hamburg and Bremen. In females, initial diagnosis of AGW was most frequently made by a gynaecologist (71.7%), whereas in males, AGW were most frequently diagnosed by a dermatologist (44.8%) or urologist (25.1%). CONCLUSIONS Incidence of AGW in Germany is comparable with findings for other countries. As expected, most cases occurred in the younger age groups. The frequency of diagnoses of AGW differs between sexes and women and men receive treatment by doctors of different specialties.
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Affiliation(s)
- Angela A Kraut
- Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine (BIPS), Achterstrasse 30, 28359 Bremen, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine (BIPS), Achterstrasse 30, 28359 Bremen, Germany
| | | | - Rafael T Mikolajczyk
- Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine (BIPS), Achterstrasse 30, 28359 Bremen, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine (BIPS), Achterstrasse 30, 28359 Bremen, Germany
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