title: Burden of disease associated with cervical cancer in malaysia and potential costs and consequences of HPV vaccination.
abstract: BACKGROUND
  An estimated 70% of cervical cancers worldwide are attributable to persistent infection with human papillomaviruses (HPV) 16 and 18. Vaccination against HPV 16/18 has been shown to dramatically reduce the incidence of associated precancerous and cancerous lesions. The aims of the present analyses were, firstly, to estimate the clinical and economic burden of disease attributable to HPV in Malaysia and secondly, to estimate long-term outcomes associated with HPV vaccination using a prevalence-based modeling approach.
  
  
  METHODS
  In the first part of the analysis costs attributable to cervical cancer and precancerous lesions were estimated; epidemiologic data were sourced from the WHO GLOBOCAN database and Malaysian national data sources. In the second part, a prevalence-based model was used to estimate the potential annual number of cases of cervical cancer and precancerous lesions that could be prevented and subsequent HPV-related treatment costs averted with the bivalent (HPV 16/18) and the quadrivalent (HPV 16/18/6/11) vaccines, at the population level, at steady state. A vaccine efficacy of 98% was assumed against HPV types included in both vaccines. Effectiveness against other oncogenic HPV types was based on the latest results from each vaccine's respective clinical trials.
  
  
  RESULTS
  In Malaysia there are an estimated 4,696 prevalent cases of cervical cancer annually and 1,372 prevalent cases of precancerous lesions, which are associated with a total direct cost of RM 39.2 million with a further RM 12.4 million in indirect costs owing to lost productivity. At steady state, vaccination with the bivalent vaccine was estimated to prevent 4,199 cervical cancer cases per year versus 3,804 cases for the quadrivalent vaccine. Vaccination with the quadrivalent vaccine was projected to prevent 1,721 cases of genital warts annually, whereas the annual number of cases remained unchanged with the bivalent vaccine. Furthermore, vaccination with the bivalent vaccine was estimated to avert RM 45.4 million in annual HPV-related treatment costs (direct+indirect) compared with RM 42.9 million for the quadrivalent vaccine.
  
  
  CONCLUSIONS
  This analysis showed that vaccination against HPV 16/18 can reduce the clinical and economic burden of cervical cancer and precancerous lesions in Malaysia. The greatest potential economic benefit was observed using the bivalent vaccine in preference to the quadrivalent vaccine.
authors.affiliation: United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia. saljunid@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Aljunid
authors.forename: A
authors.initials: A
authors.lastname: Zafar
authors.forename: S
authors.initials: S
authors.lastname: Saperi
authors.forename: M
authors.initials: M
authors.lastname: Amrizal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D052162:Human papillomavirus 16 / Q000276:immunology*; D052161:Human papillomavirus 18 / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008296:Malaysia / Q000453:epidemiology; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines