Economic burden of HPV9-related diseases: a real-world cost analysis from Italy

Abstract

Introduction The objectives of this study were to estimate the economic burden of HPV in Italy, accounting for total direct medical costs associated with nine major HPV-related diseases, and to provide a measure of the burden attributable to HPV 6, 11, 16, 18, 31, 33, 45, 52, 58 infections. Methods A cost-of-illness incidence-based model was developed to estimate the incidences and costs of invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, oropharyngeal, anogenital warts, and recurrent respiratory papillomatosis (RRP) in the context of the Italian National Health System (NHS). We used data from hospital discharge records (HDRs) of an Italian region and conducted a systematic literature review to estimate the lifetime cost per case, the number of incident cases, the prevalence of HPV9 types. Costs of therapeutic options not included in the diagnosis-related group (DRG) tariffs were estimated through a scenario analysis. Results In 2018, the total annual direct costs were €542.7 million, with a range of €346.7-€782.0 million. These costs could increase considering innovative therapies for cancer treatment (range €16.2-€37.5 million). The fraction attributable to the HPV9 genotypes without innovative cancers treatment was €329.5 million, accounting for 61% of the total annual burden of HPV-related diseases in Italy. Of this amount, €135.9 million (41%) was related to men, accounting for 64% of the costs associated with non-cervical conditions. Conclusions The infections by HPV9 strains and the economic burden of non-cervical HPV-related diseases in men were found to be the main drivers of direct costs.

Human papillomavirus in Italy: retrospective cohort analysis and preliminary vaccination effect from real-world data

“…According to the results of this study, the hospitalization risk profile by age demonstrates the high impact of cancer condition for adult patients (two-thirds of the overall hospitalization occurs after 50 years), while GW and CIN hospitalization occurs for young adults (half of the total hospitalization before 38 years of the observed women). Furthermore, the economic burden among men represented more than one-third (34%) of the total hospitalization cost associated with the HPV-related diseases analyzed, which is consistent with previously published data [ 8 , 17 , 27 ] and with the effort to extend the anti-HPV immunization programme to include boys in the National Immunization Plan 2017–19.…”

“…Information related to the hospital discharges of all accredited public and private hospitals, both for ordinary and day care regimes, was taken into account. We included hospitalisations related to resident patients presenting one of the ICD-9-CM codes as primary or secondary diagnosis: genital warts (GW): ‘condyloma acuminatum’ (078.11); ‘cervical intraepithelial neoplasia (CIN)’ (067.32–067.33); ‘anal cancers’ (AC) (154.2–154.8); ‘oropharyngeal cancers (OC): ‘oropharyngeal cancer’ (146.0–146.9) and ‘head, face and neck cancers’ (171.0); and genital cancers (GC): ‘penis cancer’ (187.1–187.9) and ‘cervical cancer’ (180.0–180.9) [ 16 , 17 ]. A sensitivity analysis was applied considering only the primary diagnosis.…”

“…Information related to the hospital discharges (HDRs) of all accredited public and private hospitals in Italy, both for ordinary and day care regimens, was included to estimate the costs of cervical, vulvar, vaginal, penile, head, and neck cancer. Hospitalization and lifetime costs for these HPV-related conditions were investigated in-depth in previous work [ 17 ].…”

“…Moreover, in 2017, the Italian Ministry of Health extended the immunization programme to 12-year-old boys, even though some regions had already started in 2014 [12]. Although different studies were conducted in Italy to evaluate the epidemiological impact [13,14], economic burden [15][16][17], and vaccination cost-effectiveness [11,[18][19][20][21][22] of HPV-related diseases, no specific analyses were conducted from a cohort real-world data perspective.…”

HPV Vaccination during the COVID-19 Pandemic in Italy: Opportunity Loss or Incremental Cost

“… Target coverage rate: in this second scenario, the optimal vaccine target defined by the Italian NIP 2017–2019 was considered [ 8 ] ( Table 1 ). Model adaptation for gender, coverage rate and efficacy: the previously developed model, considered the starting point for this analysis [ 13 , 14 ], includes only bivalent and quadrivalent vaccination in their simulations. However, in Italy, in 2017, a nine-valent vaccination program was adopted.…”