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Vaccines for the 21st Century: A Tool for Decisionmaking
For the purposes of the calculation in this report, the committee assumed that approximately half of women with HPV infection experience a 3-month episode of limited or severe genital warts and the other half experience recurrences of limited or severe genital warts. Health utility indices (HUI) associated with those episodes range from .85 to .95. It was assumed that 10% of women with HPV infections develop cervical dysplasia due to the infection. It was also assumed that cancers that develop secondary to HPV infection occur with an average lag of 25 years from time of infection. Cervical cancers were separately described as carcinoma in situ, locally invasive at diagnosis, and advanced at diagnosis. Treatment phases and follow-up phases are included, with HUI and duration of that state ranging from 4 months of treatment at an HUI of .8 to 16 years of life spent at an HUI of .9.
Sequelae of HPV infection of men was assumed to parallel to a great degree that in women: several scenarios of genital warts and penile cancers. HUI and duration of time in the specific disease states show the same ranges as for women. Table A11–1 shows the disease states for both men and women.
COST INCURRED BY DISEASE
Table A11–2 summarizes the health care costs incurred by HPV infections. For the purposes of the calculations in this report, it was assumed that women with genital warts incur costs associated with physician visits and diagnostics. More severe cases were assumed to involve more frequent physician visits. It was assumed that approximately half of women with mild recurrent warts and all of the women with extensive recurrent warts visit a physician four times per year. It was assumed that women with cervical dysplasia incur costs associated with specialist visits, diagnostics, and follow-up visits for 1.5 years.
It was assumed that cervical carcinoma in situ was associated with multiple visits, advanced diagnostics, and ambulatory surgery during the treatment phase. During the 2-year follow-up, it was assumed that all patients receive 3 follow-up visits; and diagnostics per year. Treatment for locally invasive cervical cancer was assumed to be associated with physician visits, diagnostics, hospitalization, including costs for surgeons/anesthesiologists; and radiation therapy. The 2-year follow-up phase was assumed to include quarterly physician and diagnostic evaluation. Advanced cervical cancer was associated with similar treatment costs as for locally invasive cancer, but with increased physician visits during both the treatment phase and the follow-up phase.
Treatment patterns for acute and chronic (recurring genital warts and penile cancers) sequelae of HPV infection in men were assumed to be similar to that of treatment patterns in women.