title: Cost of Preventing, Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination.
abstract: OBJECTIVE
  Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented.
  
  
  METHODS
  Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts.
  
  
  RESULTS
  From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million.
  
  
  CONCLUSIONS
  Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden.
authors.affiliation: Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ellinor
authors.initials: E
authors.lastname: Östensson
authors.affiliation: Department of Neurobiology, Care Science and Society, Centre for Family Medicine and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Fröberg
authors.affiliation: Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden; Department of Communicable Disease Control and Prevention for Stockholm County, Stockholm, Sweden.
authors.forename: Amy
authors.initials: A
authors.lastname: Leval
authors.affiliation: Department of Oncology-Pathology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann-Cathrin
authors.initials: AC
authors.lastname: Hellström
authors.affiliation: Department of Medicine, Solna (MedS), K2, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Bäcklund
authors.affiliation: Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Zethraeus
authors.affiliation: Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sonia
authors.initials: S
authors.lastname: Andersson
mesh_terms: D000328:Adult; D003218:Condylomata Acuminata / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D013548:Sweden / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D055815:Young Adult
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18