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

<div><p>Objective</p><p>Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented.</p><p>Methods and Materials</p><p>Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts.</p><p>Results</p><p>From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million.</p><p>Conclusion</p><p>Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden.</p></div

Cost of treating genital warts in Sweden, expressed in 2009 Euros (€).

<p>Cost of treating genital warts in Sweden, expressed in 2009 Euros (€).</p

Unit cost of resources expressed in 2009 Euros (€).

<p>^a) Indirect productivity-related costs are estimated based on travel time to and from care site, wait time and visit time [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref020" target="_blank">20</a>], treatment, and follow-up or sick leave due to cervical cancer [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref021" target="_blank">21</a>].</p><p>^b) KPP [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref032" target="_blank">32</a>].</p><p>^c) KPP 2009.</p><p>^d) Total cost including staging, treatment, and follow up [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref021" target="_blank">21</a>].</p><p>^e) Costs included procedure and pharmacological treatment at home and hospice care retrieved from the palliative care unit and advanced home care unit, Långbro Park, Stockholm County Council. Average cost per day of care at home was based on calculations from a previous Swedish report on advanced care at home in Sweden [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref025" target="_blank">25</a>].</p><p>^f) KPP 2009, clinical expert panel.</p><p>^g) The Dental and Pharmaceutical Benefits Agency (available in English at <a href="http://www.tlv.se" target="_blank">http://www.tlv.se</a>)</p><p>CIN: cervical intraepithelial neoplasia; LEEP: loop electrode excision procedure; KPP: cost per patient</p><p>Unit cost of resources expressed in 2009 Euros (€).</p

Number and mean percentage of patients undergoing different treatment procedures for genital warts based on estimates from the clinical expert panel.

<p>Number and mean percentage of patients undergoing different treatment procedures for genital warts based on estimates from the clinical expert panel.</p

Annual cost of prevention, management, and treatment of CIN and cervical cancer in Sweden, expressed in 2009 Euros (€).

<p>N = number of women</p><p>^a) Cases were multiplied by the number of follow up-procedures according to recommendations after treatment as previously described in detail [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref021" target="_blank">21</a>].</p><p>^b) Average cost of LEEP and other procedure included 1 follow-up procedure according to current national guidelines (available at <a href="http://www.sfog.se" target="_blank">http://www.sfog.se</a>).</p><p>CIN: cervical intraepithelial neoplasia; LEEP: loop electrode excision procedure</p><p>Annual cost of prevention, management, and treatment of CIN and cervical cancer in Sweden, expressed in 2009 Euros (€).</p