DÄ internationalArchive1-2/2008Human Papillomavirus and Cervical Cancer - Current Status of Vaccination Against Human Pathogenic Papillomavirus: The Cost Debate

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Human Papillomavirus and Cervical Cancer - Current Status of Vaccination Against Human Pathogenic Papillomavirus: The Cost Debate

Dtsch Arztebl Int 2008; 105(1-2): 23. DOI: 10.3238/arztebl.2008.0023a

Wenderlein, J M

LNSLNS The causal link between HPV infection and cervical carcinoma was established 15 years ago. A safe vaccine against the four highest risk viruses achieved in three IM doses over 6 months is undoubtedly a huge success.

HPV negative girls or young women enjoy 100% protection for 5 (possibly 10) years. In those already infected with HPV or with an associated cervical lesion, fewer than half benefit. The population of 12- to 17-year-old females in Germany is 2.5 million. The vaccine costs would initially amount to 1.25 billion euros (currently 500 euros per vaccine, excluding the costs associated with administration) for this group. To this must be added the cost of repeat vaccination after 5 years (possibly after 10 years). An additional 380 000 girls who reach the age of 12, are added to this population annually, at a vaccination cost of 200 million euros assuming the desired 100% uptake rate.

These must be set against 6500 new cervical carcinomas. Assuming a total population of 82 million Germans with around half female, cervical carcinoma will affect 1 in 13 000. This risk is by no means equally distributed among women. Heavy smokers, for example, have a significantly higher risk. This is reflected in clinics where cytological abnormalities are discussed.

In conclusion: timely vaccination certainly protects against HPV infection and its associated anogenital lesions. Treatment costs must be set against vaccination costs, which are in the billions of euros. The incidence of breast cancer is seven times that of cervical carcinoma. Health economists must clarify the respective contributions of screening and vaccination for these diseases to rationing of health care resources. This would lead to a discussion of individual participation in cost, as against increasing statutory health insurance premiums. DOI: 10.3238/arztebl.2008.0023a

Prof. Dr. med. J. Matthias Wenderlein
Universitätsfrauenklinik Ulm
Prittwitzstr. 41
89075 Ulm, Germany
wenderlein@gmx.de

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

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