Evaluating the epidemiology and morbidity burden associated with human papillomavirus in Israel: accounting for CIN1 and genital warts in addition to CIN2/3 and cervical cancer.
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 100,000 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.
The School of Pharmacy, The Hebrew University of Jerusalem, Israel. orens@ekmd.huji.ac.il
Oren
O
Shavit
Raanan
R
Raz
Michal
M
Stein
Gabriel
G
Chodick
Eduardo
E
Schejter
Yehuda
Y
Ben-David
Raanan
R
Cohen
Daphna
D
Arbel
Varda
V
Shalev
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003218:Condylomata Acuminata / Q000453:epidemiology* / Q000503:physiopathology*; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology* / Q000821:virology