The economic burden of human papillomavirus-related precancers and cancers in Sweden

Abstract

Background: High-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country.

Materials and methods: This prevalence-based cost-of-illness study used diagnosis-specific data from national registries to determine the number of HR HPV-related precancers and cancers. The HR HPV-attributable fractions of these diseases were derived from a literature review and applied to the total burden to estimate HR HPV-attributable costs. Direct costs were based on health care utilization and indirect costs on loss of productivity due to morbidity (i.e., sick leave and early retirement) and premature mortality.

Results: The total annual cost of all HR HPV-attributable precancers and cancers was €94 million (€10.3/inhabitant). Direct costs accounted for €31.3 million (€3.4/inhabitant) of the total annual cost, and inpatient care amounted to €20.7 million of direct costs. Indirect costs made up €62.6 million (€6.9/inhabitant) of the total annual cost, and premature mortality amounted to €36 million of indirect costs. Cervical precancer and cancer was most costly (total annual cost €58.4 million). Among cancers affecting both genders, anal precancer and cancer, and oropharyngeal cancer were the most costly (€11.2 million and €11.9 million, respectively). For oropharyngeal cancer, males had the highest health care utilization and represented 71% of the total annual cost. Penile precancer and cancer was least costly (€2.6 million).

Conclusion: The economic burden of HR HPV-related precancers and cancers is substantial. The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden.

Fig 1. HR HPV-attributable fraction of outpatient and inpatient health care events by high-risk human papillomavirus-related disease and gender.

(a) Outpatient and inpatient health care events for both genders. (b). Outpatient and inpatient health care events by gender. (c). Outpatient and inpatient health care events by disease among males (d) Outpatient and inpatient health care events by disease among females.

Fig 2. HR HPV-attributable fraction of morbidity (i.e., sick leave and early retirement days) by HPV-related disease and gender.

(a) Morbidity by gender. (b) Sick leave days for both genders. (c) Early retirement days for both genders. (d) Morbidity (sick leave and early retirement days) for both genders. (e) Sick leave days among males. (f) Early retirement days by disease among males. (g) Sick leave and early retirement days among males. (h) Sick leave days by disease among females. (i) Early retirement days by disease among females. (j) Morbidity by disease among females.

Fig 3. Attributable fraction of total costs including both direct costs (i.e., inpatient care and outpatient care) and indirect costs (i.e., mortality, sick leave, and early retirement days) presented per HPV-related disease and gender.

(a) Attributable fraction of total cost per HPV related precancer and cancer type. (b) Attributable fraction of total cost of HPV related precancers and cancers per cost type; direct costs and indirect costs. (c) Attributable fraction of total cost of HPV related precancers and cancers per gender. (d) Attributable fraction of total cost per HPV related precancers and cancers for females. (e) Attributable fraction of total cost per HPV related precancers and cancers for males.