Economic burden of human papillomavirus-related diseases in Italy

Abstract

Introduction: Human papilloma virus (HPV) genotypes 6, 11, 16, and 18 impose a substantial burden of direct costs on the Italian National Health Service that has never been quantified fully. The main objective of the present study was to address this gap: (1) by estimating the total direct medical costs associated with nine major HPV-related diseases, namely invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, and head and neck, anogenital warts, and recurrent respiratory papillomatosis, and (2) by providing an aggregate measure of the total economic burden attributable to HPV 6, 11, 16, and 18 infection.

Methods: For each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, and 18, in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection.

Results: The total direct costs (expressed in 2011 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be €528.6 million, with a plausible range of €480.1-686.2 million. The fraction attributable to HPV 6, 11, 16, and 18 was €291.0 (range €274.5-315.7 million), accounting for approximately 55% of the total annual burden of HPV-related disease in Italy.

Conclusions: The results provided a plausible estimate of the significant economic burden imposed by the most prevalent HPV-related diseases on the Italian welfare system. The fraction of the total direct lifetime costs attributable to HPV 6, 11, 16, and 18 infections, and the economic burden of noncervical HPV-related diseases carried by men, were found to be cost drivers relevant to the making of informed decisions about future investments in programmes of HPV prevention.

Figure 1. Economic burden of human papillomavirus-related diseases in Italy.

Flow of information through the different phases of the systematic review.

Figure 2. Burden of noncervical HPV 6, 11, 16, and 18-related diseases.

The dominant prevalence of HPV 6 and 11 in anogenital warts and RRP, which were associated cumulatively with 56.9% of the total costs of noncervical HPV 6, 11, 16, and 18-related diseases, meant that the fraction of total costs for noncervical diseases attributable to HPV 6 and 11 was at least as large as the fraction of direct costs attributable to HPV 16 and 18.

Figure 3. Sensitivity analysis.

The Tornado chart reported in Figure 3 shows the changes in our valuation of the economic burden of HPV 6,11,16 and 18-related disease associated with ranges of values for each input variable. Uncertainty is mostly is associated with the widest swing in the incidence rate of RRP patients per year.