All you need to read in the other general journalsBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d784 (Published 08 February 2011) Cite this as: BMJ 2011;342:d784
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The Cost of Genital Warts to the NHS in 2010
The short cut article on HPV vaccination for young men emphasised the
need for costs weighted against benefits (1). Whilst the cost-
effectiveness of vaccinating boys requires further analysis, the case for
a quadrivalent vaccine for girls is compelling particularly when updated
costs are applied.
The 2008 analysis of the cost effectiveness of HPV vaccination (2) by
Jit et al used a cost per female episode of genital warts (almost 100% of
which are caused by HPV types 6 and 11 (3)) of 134 GBP based on 2006
prices. Since then, the cost of managing genital warts has increased and
confers a growing disease and cost burden to the NHS. Minimum estimates
put the cost at 160 GBP per case (new and recurrent), as recently
presented in the QOLIGEN study (4), although a new analysis shows the cost
to be closer to 273 GBP when accounting for other important costs such as
GP consultations and prescription medicines, and persistent cases. This
is consistent with a recent study in Ireland that places the cost at 300
GBP (360 Euros) (5).
This new analysis, which utilised expert opinion from genitourinary
medicine (GUM) clinics to define real-life treatment pathways and number
of visits by type of genital warts patient, is based on official costs
from NHS payment by results (PBR) and Reference Cost schedules (6).
Genital wart episodes for 2009 were obtained from the Health Protection
Agency (HPA) surveillance system and extrapolated to population estimates
for 2010 (7). The numbers of patients seeking care from GPs were
determined using a sample from The Health Improvement Network (THIN)
database (8). GP visit cost was obtained from the Personal Social Services
Research Unit (PSSRU) (9) and drug costs from the British National
Formulary (BNF) (10). All costs used were at 2010 prices.
The analysis estimated that 173,077 genital warts patients were
treated in UK GUM clinics in 2010 of which 55.6% were first episodes,
33.6% were recurrent and 10.8% were persistent. There were a total of
49,504 patients with genital warts estimated to be diagnosed at a GP
surgery, of which 32,722 were referred to a GUM clinic, and so subtracting
referrals already captured in the 55.6% this results in a total of 189,859
individuals seeking care for genital warts in the UK in 2010. The cost of
care in GUM clinics and in the GP setting was therefore 49.9 GBP million
and 2.5 GBP million respectively - a total cost to the NHS of 52.4 GBP
million. This equates to an average of 276 GBP per treated genital warts
patient (273 GBP females, 278 GBP males).
This analysis, which is based on the HPA's own data, emphasises the
importance of updating existing analyses and assessment criteria to
accurately inform the Government's future choice between the two available
HPV vaccines, only one of which additionally protects against HPV types 6
and 11 (Gardasil).
Colm O'Mahony1, Stuart Carroll2, Ruth Brown3, Susanne Hartz4, Fiona
Charman5, Vanessa Griffiths6
1. Consultant GUM and HIV Physician, Countess of Chester Foundation
Trust Hospital, UK
2. Health Economist, Sanofi Pasteur MSD, Maidenhead, UK
3. Research Scientist, UBC, London, UK
4. Research Associate, Health Economics, UBC, London, UK
5. Market Access Department, Sanofi Pasteur MSD, Maidenhead, UK
6. Associate Director, NHS Leicestershire County and Rutland, UK
Declarations of interest: Analysis undertaken by UBC with financial
support from SPMSD.
(1) British Medical Journal, HPV vaccination for young men? N Engl J
Med2011;364:401-11, BMJ 2011; 342:d784
(2) Mark Jit, Yoon Hong Choi W, John Edmunds, Economic Evaluation of
Human Papillomavirus vaccination in the United Kingdom
doi:10.1136/bmj.a769, BMJ 2008;337;a769
(3) FUTURE Study Group. Four year efficacy of prophylactic human
papillomavirus quadrivalent vaccine against low grade cervical, vulvar,
and vaginal intraepithelial neoplasia and anogenital warts: randomised
controlled trial. BMJ2010;341:c3493. (20 July)
(4) Woodall SC, Jit M, Solden K, Lacey CJN. The QOLIGEN study:
investigation of quality of life loss, duration of episode and treatment
costs associated with genital warts in the UK. 26th International
Papillomavirus conference. Montreal, Canada, 3-8 July 2010.
(5) A Dee, F Howell, C O'Connor, et al. Determining the cost of
genital warts: a study from Ireland. Sex Transm Infect2009;85:402-3.
(6) National Schedule of reference costs: Year 2008-09, NHS Trusts
and PCTs combined day cases. HRG data; Outpatient attendance tariff,
Payments by results (PbR) arrangements for 2010-2011, Department of
Health, 22 February 2010; Admitted patient care and outpatient procedure
tariff, Payments by results (PbR) arrangements for 2010-2011, Department
of Health, 22 February 2010
(7) Total number of STI diagnoses and other episodes of care seen at
genitourinary medicine clinics, UK & England: 2000- 2009, Health
protection Agency, HPA center of infections and Number of selected STI
diagnoses made at genitourinary medicine clinics in the UK and England:
2000 - 2009, Health protection Agency, HPA center of infections.
(8) The Health Improvement Network (THIN), http://www.thin-uk.com/.
(9) Personal Social Services Research Unit (PSSRU), Unit Costs of
health and social care 2010. PSSRU P.167, The University of Kent.
(10) British National Formulary (BNF) 60, BMJ Group and
Pharmaceutical Press 2010.
Competing interests: Declarations of interest: Analysis undertaken by UBC with financial support from SPMSD.