Estimate of the economic burden of pre-neoplastic lesions and cervical cancer in Colombia. Implications for HPV vaccination
Keywords:
Uterine cervical cancer, Mass screening, Costs and cost analysis, Vaccine against human papillomavirusAbstract
Objective: To estimate the economic burden cervical neoplastic disease in Colombia and the effects of its prevention.
Methods: The incidence was calculated from a Markov model on the natural history of human papillomavirus (HPV) infection. Direct costs were estimated, in Colombian Pesos (COP), from cost-generating events identified in national and international guides. The monetary value of the procedures was based on current tariff manuals (ISS 2001 with a 30% adjustment and mandatory insurance (SOAT). The frequencies of use were defined by expert consensus. Screening program (cytology) and vaccination (HPV) costs were included.
Results: The expected cases per year for IFRS (NIC) 1 (International Financial Reporting Standards), IFRS 2-3 and cancer were 177,317, 46,911, and 5,110, respectively. The cost of cytology was COP$19,070 (D 9.80) and each vaccine dose cost COP$23,700 (D 10.00). Screening represented the highest cost in the control of the disease (COP$126.933 million; D 38.5 million). The vaccine generated an additional cost of COP$11.977 million (D 3.5 million) and a saving of COP$15.969 million (D 4.8 million). This latter started 20 years after introducing the strategy. To reduce the cost of the vaccination contributes to a saving and to decrease the cost of screening shortens its start-up time.
Conclusions: Vaccination against HPV reduces the costs of controlling uterine cervical cancer, but it requires a sustained investment for a long period of time. The reduction in the vaccine and screening costs would bring significant economic benefits, where the new, alternative technologies could play an important role.
Author Biographies
Oscar Gamboa, Instituto Nacional de Cancerología
Grupo Área Unidad de Análisis, Instituto Nacional de Cancerología de Colombia, Bogotá D. C., Colombia
Raúl Murillo, International Agency for Research on Cancer
Implementation Group, International Agency for Research on Cancer, Lyon, Francia
References
International Agency for Research on Cancer. GLOBOCAN 2012 Lyon: IARC; 2014 [consulta el 15 de abril de 2014]. Disponible en: http://globocan.iarc.fr/
Piñeros M, Pardo C, Gamboa O, Hernández G. Atlas de mortalidad por cáncer en Colombia. 3 ed. Bogotá: Imprenta Nacional de Colombia; 2010.
Parkin DM, Almonte M, Bruni L, Clifford G, Curado MP, Piñeros M. Burden and trends of type-specific human papillomavirus infections and related diseases in the latin america and Caribbean region. Vaccine. 2008;26 Suppl 11:L1-15.
https://doi.org/10.1016/j.vaccine.2008.05.043
Murillo R, Almonte M, Pereira A, Ferrer E, Gamboa OA, Jeronimo J, et al. Cervical cancer screening programs in Latin America and the Caribbean. Vaccine. 2008;26 Suppl 11:L37-48.
https://doi.org/10.1016/j.vaccine.2008.06.013
Grce M, Matovina M, Milutin-Gasperov N, Sabol I. Advances in cervical cancer control and future perspectives. Coll Antropol. 2010;34(2):731-6.
Ronco G, Giorgi Rossi P. New paradigms in cervical cancer prevention: opportunities and risks. BMC Womens Health. 2008;8:23.
https://doi.org/10.1186/1472-6874-8-23
Andrés-Gamboa O, Chicaíza L, García-Molina M, Díaz J, González M, Murillo R, et al. Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia. Salud Pública Mex. 2008;50(4):276-85.
https://doi.org/10.1590/S0036-36342008000400005
Muñoz N, Méndez F, Posso H, Molano M, van den Brule AJ, Ronderos M, et al. Incidence, duration, and determinants of cervical human papillomavirus infection in a cohort of Colombian women with normal cytological results. J Infect Dis. 2004;190(12):2077-87.
https://doi.org/10.1086/425907
Molano M, Van den Brule A, Plummer M, Weiderpass E, Posso H, Arslan A, et al. Determinants of clearance of human papillomavirus infections in Colombian women with normal cytology: a population-based, 5-year follow-up study. Am J Epidemiol. 2003;158(5):486-94.
https://doi.org/10.1093/aje/kwg171
Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000;151(12):1158-71.
https://doi.org/10.1093/oxfordjournals.aje.a010166
Sanders GD, Taira AV. Cost-effectiveness of a potential vaccine for human papillomavirus. Emerg Infect Dis. 2003;9(1):37-48.
https://doi.org/10.3201/eid0901.020168
Moscicki AB, Schiffman M, Kjaer S, Villa LL. Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine. 2006;24 Suppl 3. S3/42-51.
https://doi.org/10.1016/j.vaccine.2006.06.018
Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a metaanalysis. Obstet Gynecol. 1998;92 4 Pt 2, 727-735.
https://doi.org/10.1097/00006250-199810001-00046
Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsague X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348(6):518-27.
https://doi.org/10.1056/NEJMoa021641
Ault KA. Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet. 2007;369(9576):1861-8.
https://doi.org/10.1016/S0140-6736(07)60852-6
FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. J Infect Dis. 2007;196(10):1438-46.
https://doi.org/10.1086/522864
Lehtinen M, Paavonen J, Wheeler CM, Jaisamrarn U, Garland SM, Castellsague X, et al. Overall efficacy of HPV- 16/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol. 2012;13(1):89-99.
https://doi.org/10.1016/S1470-2045(11)70286-8
Murillo R, Molano M, Martinez G, Mejia JC, Gamboa O. HPV prevalence in Colombian women with cervical cancer: implications for vaccination in a developing country. Infect Dis Obstet Gynecol. 2009;2009:653598.
https://doi.org/10.1155/2009/653598
Wheeler CM, Castellsague X, Garland SM, Szarewski A, Paavonen J, Naud P, et al. Cross-protective efficacy of HPV-16/18 AS04- adjuvanted vaccine against cervical infection and precancer caused by non-vaccine oncogenic HPV types: 4-year end-ofstudy analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol. 2012;13(1):100-10.
https://doi.org/10.1016/S1470-2045(11)70287-X
Instituto Nacional de Cancerología. Protocolos de manejo del paciente con cáncer. Bogotá: Legis S.A; 2010.
National Comprehensive Cancer Network. NCCN Guideline Washington2011 [consulta el 21 de junio de 2011]. Disponible en: www.nccn.org.
Fonseca AJ, de Lima Ferreira LC. Systematic review of the costeffectiveness of the vaccination against HPV in Brazil. Hum Vaccin Immunother. 2014;10(12):3484-90.
https://doi.org/10.4161/hv.34410
Giraldi G, Martinoli L, De Luca d'Alessandro E. The human papillomavirus vaccination: a review of the cost-effectiveness studies. Clin Ter. 2014;165(6):e426-32.
Aljunid S, Zafar A, Saperi S, Amrizal M. Burden of disease associated with cervical cancer in malaysia and potential costs and consequences of HPV vaccination. Asian Pac J Cancer Prev. 2010;11(6):1551-9.
Baio G, Capone A, Marcellusi A, Mennini FS, Favato G. Economic burden of human papillomavirus-related diseases in Italy. PLoS One. 2012;7(11):e49699.
https://doi.org/10.1371/journal.pone.0049699
Bergeron C, Breugelmans JG, Bouee S, Lorans C, Benard S, Remy V. Cervical cancer screening and associated treatment costs in France. Gynecol Obstet Fertil. 2006;34(11): 1036-42.
https://doi.org/10.1016/j.gyobfe.2006.09.005
Borget I, Abramowitz L, Mathevet P. Economic burden of HPVrelated cancers in France. Vaccine. 2011;29(32):5245-9.
https://doi.org/10.1016/j.vaccine.2011.05.018
Brown RE, Breugelmans JG, Theodoratou D, Benard S. Costs of detection and treatment of cervical cancer, cervical dysplasia and genital warts in the UK. Curr Med Res Opin. 2006;22(4):663-70.
https://doi.org/10.1185/030079906X99972
Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine. 2012;30(42):6016-9.
https://doi.org/10.1016/j.vaccine.2012.07.056
de la Hoz-Restrepo F, Alvis-Guzman N, Narvaez J, Choconta- Piraquive LA. Evaluating the burden of disease caused by human papillomavirus in Bogota. Rev Salud Pública (Bogotá). 2009;11(3):454-67.
https://doi.org/10.1590/S0124-00642009000300014
Insinga RP, Dasbach EJ, Elbasha EH. Assessing the annual economic burden of preventing and treating anogenital human papillomavirus-related disease in the US: analytic framework and review of the literature. Pharmacoeconomics. 2005;23(11):1107-22.
https://doi.org/10.2165/00019053-200523110-00004
Low JJ, Ko Y, Ilancheran A, Zhang XH, Singhal PK, Tay SK. Health and economic burden of HPV-related diseases in Singapore. Asian Pac J Cancer Prev. 2012;13(1): 305-8.
https://doi.org/10.7314/APJCP.2012.13.1.305
Lee J, Seow A, Ling SL, Peng LH. Improving adherence to regular pap smear screening among Asian women: a populationbased study in Singapore. Health Educ Behav. 2002;29(2): 207-18.
https://doi.org/10.1177/1090198102029002006
Othman NH, Rebolj M. Challenges to cervical screening in a developing country: The case of Malaysia. Asian Pac J Cancer Prev. 2009;10(5):747-52.
Murillo R, Wiesner C, Cendales R, Pineros M, Tovar S. Comprehensive evaluation of cervical cancer screening programs: the case of Colombia. Salud Publica Mex. 2011;53(6):469-77.
Bray F, Moller B. Predicting the future burden of cancer. Nature reviews Cancer. 2006;6(1):63-74.
https://doi.org/10.1038/nrc1781
International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007;120(4): 885-91.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Todos los derechos reservados.
