Abstract
Background
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.
Objective
To evaluate the burden of HPV-related conditions in Israel, including CC, cervical precancerous lesions and genital warts.
Methods
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.
Results
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).
Conclusions
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.
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References
Garland SM, Smith JS. Human papillomavirus vaccines: current status and future prospects. Drugs 2010; 70(9): 1079–98
de Villiers EM, Fauquet C, Broker TR, et al. Classification of papillomaviruses. Virology 2004; 324(1): 17–27
Wiley D, Masongsong E. Human papillomavirus: the burden of infection. Obstet Gynecol Surv 2006; 61(6 Suppl. 1): S3–14
Parkin DM, Bray F. Chapter 2: the burden of HPV-related cancers. Vaccine 2006; 24Suppl. 3: S3/11–25
Lacey CJ, Lowndes CM, Shah KV. Chapter 4: burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine 2006; 24Suppl. 3: S3/35–41
Gross G, Pfister H. Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Med Microbiol Immunol 2004; 193(1): 35–44
Bosch FX, Burchell AN, Schiffman M, et al. Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine 2008; 26Suppl. 10: K1–16
Wright Jr TC, Massad LS, Dunton CJ, et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis 2007; 11(4): 223–39
Wright Jr TC, Massad LS, Dunton CJ, et al. 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007; 11(4): 201–22
Mortensen GL, Larsen HK. The quality of life of patients with genital warts: a qualitative study. BMC Public Health 2010; 10: 113
Woodhall S, Ramsey T, Cai C, et al. Estimation of the impact of genital warts on health-related quality of life. Sex Transm Infect 2008; 84(3): 161–6
Mortensen GL. Long-term quality of life effects of genital warts: a follow-up study. Dan Med Bull 2010; 57(4): A4140
Insinga RP, Glass AG, Myers ER, et al. Abnormal outcomes following cervical cancer screening: event duration and health utility loss. Med Decis Making 2007; 27(4): 414–22
Annemans L, Remy V, Oyee J, et al. Cost-effectiveness evaluation of a quadrivalent human papillomavirus vaccine in Belgium. Pharmacoeconomics 2009; 27(3): 231–45
Woodhall SC, Jit M, Cai C, et al. Cost of treatment and QALYs lost due to genital warts: data for the economic evaluation of HPV vaccines in the United Kingdom. Sex Transm Dis 2009; 36(8): 515–21
Szarewski A. HPV vaccine: Cervarix. Expert Opin Biol Ther 2010; 10(3): 477–87
Siddiqui MA, Perry CM. Human papillomavirus quadrivalent (types 6, 11, 16, 18) recombinant vaccine (Gardasil). Drugs 2006; 66(9): 1263–71
Ginsberg GM, Fisher M, Ben-Shahar I, et al. Cost-utility analysis of vaccination against HPV in Israel. Vaccine 2007; 25(37-38): 6677–91
Israel National Cancer Registry. Cancer incidence tables — Cervix Uteri, 2007 [online]. Available from URL: http://www.health.gov.il/download/sartan/2007/cer_ut2007.pdf [Accessed 2010 Sep 1]
Menczer J. The low incidence of cervical cancer in Jewish women: has the puzzle finally been solved? Isr Med Assoc J 2003; 5(2): 120–3
Sadan O, Schejter E, Ginath S, et al. Premalignant lesions of the uterine cervix in a large cohort of Israeli Jewish women. Arch Gynecol Obstet 2004; 269(3): 188–91
Menczer J. The human papillomavirus vaccine and its relevance in Israel. Isr Med Assoc J 2007; 9(7): 546–9
Israel National Cancer Registry. Cancer in Israel: trends in incidence and mortality 1982-2002 and selected updated data, 2004 [online]. Available from URL: http://www.health.gov.il/Download/pages/cancer290109.pdf [Accessed 2010 Sep 1]
Israel Central Bureau of Statistics. Statistical abstract of Israel 2005 [online]. Available from URL: http://www.cbs.gov.il/reader/shnaton/templ_shnaton.html?num_tab=st02_10x&CYear=2005 [Accessed 2010 Sep 1]
World Health Organisation. Cervical cancer, human papillomavirus (HPV), and HPV vaccines. Key points for policymakers and health professionals [online]. Available from URL: http://www.rho.org/files/WHO_PATH_UNFPA_cxca_key_points.pdf [Accessed 2010 Sep 1]
Arbyn M, Autier P, Ferlay J. Burden of cervical cancer in the 27 member states of the European Union: estimates for 2004. Ann Oncol 2007; 18(8): 1423–5
Chodick G, Heymann AD, Wood F, et al. The direct medical cost of diabetes in Israel. Eur J Health Econ 2005; 6(2): 166–71
Shalev V, Chodick G, Heymann AD. Format change of a laboratory test order form affects physician behavior. Int J Med Inform 2009; 78(10): 639–44
Menczer J, Kogan L, Schejter E, et al. A population-based study of selected demographic characteristics of Israeli-Jewish women with cervical squamous cell carcinoma. Arch Gynecol Obstet 2011; 283(3): 629–33
Israel Ministry of Health. Health Services tariff, 2010 [online]. Available from URL: http://www.health.gov.il/pages/default.asp?maincat=1&catId=111&PageId=827 [Accessed 2010 Jun 1]
Israel Ministry of Health. Israeli Health Insurance Law, 1994 [online]. Available from URL: http://www.health.gov.il/forms/forms.asp?category_id=36&Element_Type_id=6 [Accessed 2010 May 31]
National Insurance Institute of Israel. Sick Funds Membership, April 2010 [online]. Available from URL: http://www.btl.gov.il/Mediniyut/Situation/haveruth/Documents/capitatia042010.pdf [Accessed 2010 May 31]
Israel Central Bureau of Statistics. Statistical abstract of Israel, 2009 [online]. Available from URL: http://www.cbs.gov.il/shnaton60/st02_19.pdf [Accessed 2010 Jun 1]
Israel Ministry of Health. Guidelines for the submission of a request to include a pharmaceutical product in the national list of health services, 2011 [online]. Available from URL: http://www.health.gov.il/pages/default.asp?maincat=11&catid=291&pageid=2133 [Accessed 2011 Jul 1]
Kim JJ, Goldie SJ. Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States. Br Med J 2009; 339: b3884
Israel Central Bureau of Statistics. National expenditure on Health, 2011 [online]. Available from URL: http://www.cbs.gov.il/hodaot2010n/08_10_201e.pdf [Accessed 2011 Apr 1]
Henk HJ, Insinga RP, Singhal PK, et al. Incidence and costs of cervical intraepithelial neoplasia in a US commercially insured population. J Low Genit Tract Dis 2010; 14(1): 29–36
Israel Ministry of Health. Israel national cancer registry, 2002 [online]. Available from URL: http://www.health.gov.il/pages/default.asp?PageId=688&catId=56&maincat=22 [Accessed 2008 Sep 1]
Kim JJ, Goldie SJ. Health and economic implications of HPV vaccination in the United States. N Engl J Med 2008; 359(8): 821–32
Center for the Evaluation of Value and Risk in Health. CEA Registry, 2010 [online]. Available from URL: https://research.tufts-nemc.org/cear/Default.aspx 2010; [Accessed 2010 Aug 1]
Acknowledgements
This study was supported by an unrestricted grant from MSD Israel. Dr Stein, Dr Cohen and Ms Arbel are employees of MSD Israel; Dr Shavit received consultancy fees from MSD Israel; Dr Shalev, Dr Chodik and Dr Raz are employees of Maccabi Healthcare Services sick fund, which owns the database that was used, and do not have any financial ties with MSD Israel.
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Shavit, O., Raz, R., Stein, M. et al. Evaluating the epidemiology and morbidity burden associated with human papillomavirus in Israel. Appl Health Econ Health Policy 10, 87–97 (2012). https://doi.org/10.2165/11594780-000000000-00000
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DOI: https://doi.org/10.2165/11594780-000000000-00000