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Measuring the Benefits of HPV Vaccination

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Science Translational Medicine  22 Aug 2012:
Vol. 4, Issue 148, pp. 148ec149
DOI: 10.1126/scitranslmed.3004768

On the face of it, human papillomavirus (HPV) vaccination seems expensive: The cost is $130 per dose ($390 for the full series) compared with $23.20 per dose for the Hepatitis B vaccine ($69.69 for the series). But in balancing the costs and benefits of HPV vaccination, a first step is to assess the annual costs of HPV disease in the United States. Now, Chesson and colleagues perform this cost estimation from the perspective of the health service.

HPV infection is the precursor for many cancers of the anal and genital tracts—cervical cancer among women and anal cancer among men and women—and some head and neck cancers. In addition, HPV causes genital warts, a common reason for patients to seek care from primary care providers, and recurrent respiratory papillomatosis (RRP)—growths that can block the airways or change one’s voice. Efforts to prevent cervical cancer include widespread screening (Pap smear) and treatment of cancer precursor lesions to prevent cancer development. Among men who have sex with men, the field is moving forward to define the role of anal Paps to identify cancer early.

In their analysis, Chesson and colleagues included the costs of cervical cancer screening and follow-up and treatment of HPV-related health states. Using the number of cases of each health state per year and cost estimates from the literature and health insurance companies, the authors estimated the total direct medical costs of HPV disease per year and found that the overall annual direct medical cost of preventing and treating HPV-associated disease is about $8.0 billion, of which 82% is for cervical cancer screening. About 12% of the costs are for cancer treatment, and therapies for genital warts and RRP account for 3.6%. Vaccine costs were excluded from the analysis.

This full picture of the costs permits one to estimate the potential benefits of HPV vaccination. In addition to averting many of the costs of cancer treatment, HPV vaccination—through prevention of HPV infection—will likely reduce cervical cancer screening intensity and follow-up, resulting in further savings. Published at the same time, a paper by Houlihan and colleagues estimated that HPV infection may increase the risk of HIV infection twofold. If this finding is confirmed by further studies, then the benefits of HPV prevention through vaccination could extend beyond HPV disease to averting HIV infection and its associated costs. Understanding the costs and benefits will help inform decisions about health-care spending.

H. W. Chesson et al., Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine 4 August 2012 (10.1097/QAD.0b013e328358d908). [PubMed]

C. F. Houlihan et al., HPV infection and increased risk of HIV acquisition. A systematic review and meta-analysis. AIDS 7 August 2012 (10.1097/QAD.0b013e328358d908). [PubMed]

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