Original Research Article

Applied Health Economics and Health Policy

, Volume 10, Issue 2, pp 87-97

First online:

Evaluating the epidemiology and morbidity burden associated with human papillomavirus in Israel

Accounting for CIN1 and genital warts in addition to CIN2/3 and cervical cancer
  • Oren ShavitAffiliated withThe School of Pharmacy, The Hebrew University of JerusalemDivision of Clinical Pharmacy, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem Email author 
  • , Raanan RazAffiliated withMedical Informatics, Maccabi Healthcare Services
  • , Michal SteinAffiliated withMSD Israel Co. Ltd
  • , Gabriel ChodickAffiliated withMedical Informatics, Maccabi Healthcare ServicesSackler Faculty of Medicine, Tel Aviv University
  • , Eduardo SchejterAffiliated withTel-Aviv Women’s Health Center, Maccabi Healthcare Services
  • , Yehuda Ben-DavidAffiliated withDivision of Gynecologic Oncology, HaEmek Medical Center
  • , Raanan CohenAffiliated withMSD Israel Co. Ltd
  • , Daphna ArbelAffiliated withMSD Israel Co. Ltd
  • , Varda ShalevAffiliated withMedical Informatics, Maccabi Healthcare ServicesSackler Faculty of Medicine, Tel Aviv University

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Human papillomavirus (HPV) infection is mostly associated with cervical cancer (CC). However, it can cause other illnesses as well, all of which impact on people’s wellbeing and consume healthcare resources. Measures for prevention or early detection of these conditions differ in their effectiveness and cost. An informative evaluation of the projected benefit of these measures depends on understanding the current unmet need, not only limited to CC.


To evaluate the burden of HPV-related conditions in Israel, including CC, cervical precancerous lesions and genital warts.


A retrospective database analysis was conducted for the second largest health management organization (HMO) in Israel, covering approximately 1.8 million people. Records were drawn following a search for key words indicative of related diagnoses, lab results, medications, or procedures for the time period of 2006–2008. Prevalence, incidence and resource utilization were analysed. Findings were extrapolated to the whole Israeli population using age and gender incidence rates.


Incidence of CC was found to be 5 per 100000 females. Incidences of cervical intraepithelial neoplasia (CIN) grades 1, 2 and 3 were 74, 27 and 36 per 100 000 females, respectively. Incidence of genital warts was 239 and 185 per 100 000 for men and women, respectively. The overall annual economic burden was calculated to be $US48 838 058 (year 2010 values).


HPV poses a significant burden in terms of health (clinical and quality of life) and in monetary terms, even for conditions that are sometimes regarded as benign, such as CIN1 or genital warts. Current findings should be used for proper evaluation of measures to reduce HPV-related morbidity and mortality, such as regular screening and vaccination.