**7. Economic and health care system burden of HPV infections**

Clinical HPV infections are responsible for substantial morbidity and invoke high costs associated with the treatment of clinically relevant lesions[66]. Currently, two vaccines are available: a bivalent HPV 16/18 AS04-adjuvanted vaccine (GlaxoSmithKline Biologicals, Rixensart, Belgium) and a quadrivalent HPV 6/11/16/18 aluminum-adjuvanted vaccine (Merck and Co., West Point, PA, USA). Both vaccines are designed to protect against the two more prevalent HPV genotypes, HPV-16 and 18, that are responsible together for about 70% of all cervical cancer cases worldwide. The quadrivalent vaccine also offers a protection against 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 impact on the direct and indirect costs related to HPV infections[68].

HPV vaccination, which is currently implanted all over the world, is expected to prevent a

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http://dx.doi.org/10.5772/55825

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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

Department of Social and Preventive Medicine, University of Montreal, Montreal, Sainte-

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substantial proportion of cervical and other HPV-related cancers in the future.

**Acknowledgements**

**Author details**

Claudie Laprise\*

**References**

the Fonds de la recherche en santé du Québec.

and Helen Trottier

Justine Hospital Research Center, Montreal, Canada

humans ; v. 100B. 2009: Lyon, France.

Epub 2009/04/08.

2006/09/05.

\*Address all correspondence to: claudielaprise@videotron.ca

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

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

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 millions of annual costs respectively.

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

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