**Acknowledgements**

HPV-6 and 11, which cause over 90% of genital warts. These vaccines are likely to have a major impact on the incidence and mortality of cervical cancer in the future as well on the burden of other HPV related diseases. Most of developed countries have national recommendations for the use of HPV vaccines in women and many have implemented publicly funded or copayment routine vaccination programs[67]. These vaccination programs will have a significant

278 Human Papillomavirus and Related Diseases – From Bench to Bedside A Diagnostic and Preventive Perspective

Direct and indirect costs related to screening and treatment of HPV-related cancer is substan‐ tial. Direct costs include usually costs related to medical services such as appointments with physicians and/or gynaecologists, hospital (including inpatient services), nursing and home care and drug prescriptions and time lost for patients or caregivers. However, indirect costs might also be considered in the evaluation of the burden associated to HPV (loss of produc‐

A recent study in United States evaluated direct medical cost of the prevention and treatment of pathologies associated with HPV[69]. Most of the annual direct medical costs are attributed to cervical screening and follow-up are estimated at 6.6 billions of U.S. dollars: \$5.4 billion for cervical screening routine and \$1.2 billion for follow-up costs. Cervical cancer costs \$441 millions annually, vulvar and vaginal cancer costing for \$37 and \$12 millions respectively. Anal cancer and penile cancer treatment costs has been estimated at \$155 millions and \$7

Direct and indirect costs related to genital warts are also important. Genital warts are known to be resistant to treatment and having high recurrence rates even if the appropriate treatment has been done[62]. This involves repeated physicians visits for treatment and high direct costs. The indirect costs include lower productivity for the patient due to illness as well as psycho‐ logical and emotional burden such as anger, stress, anxiety, depression, shame, guilt and isolation which are also realities for patients [70, 71]. Chesson et al. evaluated at \$288 millions

Anogenital HPV infections are very common and transmitted principally via sexual contacts. High prevalence has been found in both female and male adults. Even if the majority of anogenital infections will clear spontaneously, a small proportion of infection will progress and cause different anogenital cancers. HPV is a necessary cause of cervical cancer and plays a role in other anogenital cancers in men and women. Some subgroups such as MSM, sex workers and HIV individuals are particularly at risk of HPV infections. Clinical HPV infections are responsible for substantial morbidity and invoke high costs associated with the treatment of clinically relevant lesions. Prevention is always preferable to treatment and in this optic,

impact on the direct and indirect costs related to HPV infections[68].

**7.1. Example of economic burden of HPV-related cancers in U.S.A**

**7.2. Genital warts are also an important economic and health care burden**

the direct medical costs related to genital warts in United States [69].

tivity, psychological, emotional burden on patient)[68].

millions of annual costs respectively.

**8. Conclusion**

Claudie Laprise received a doctoral research award from the Canadian Institutes of Health Research (FRN: 96236) and Helen Trottier received a salary award (chercheur-boursier) from the Fonds de la recherche en santé du Québec.
