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PLoS One. 2018 Sep 20;13(9):e0202564. doi: 10.1371/journal.pone.0202564. eCollection 2018.

Epidemiological and economic burden of potentially HPV-related cancers in France.

Author information

Service d'hépato-gastroentérologie et proctologie, Hôpital Bichat-Claude Bernard, Paris, France; Ramsay Général de Santé, Clinique Blomet, Paris, France.
Service d'ORL et Chirurgie Cervico-Faciale, Hôpital Tenon, Sorbonne Université, Paris, France.
Dermatologist, Paris, France.
Head of the Pathology Department Laboratoire-Cerba, Cergy-Pontoise, France.
Gynecologist, Paris, France.
MSD Vaccins, Lyon, France.
Health Economist, Lyon, France.
Stève Consultants, Oullins, France.


Human papillomaviruses (HPV) infection is now known to be responsible for almost all cervical cancers, and for a substantial fraction of Head and Neck cancers (HNCs). However, comprehensive epidemiological and economic data is lacking in France, especially for rarer potentially HPV-related cancers, which include anal, vulvar and vaginal cancers. Using the national comprehensive database of French public and private hospital information (PMSI), we assessed prevalence and incidence of patients with in-hospital diagnosis for potentially HPV-related cancers in 2013, and estimated costs related to their management over a 3-year period after diagnosis in France. Concerning female genital cancers, 7,597, 1,491 and 748 women were hospitalized for cervical, vulvar and vaginal cancer in 2013, respectively, with 3,120, 522 and 323 of them being new cases. A total of 4,153 patients were hospitalized for anal cancer in 2013, including 1,661 new cases. For HNCs, 8,794 and 14,730 patients were hospitalized for oral and oropharyngeal cancer in 2013, respectively; 3,619 and 6,808 were new cases. Within the 3 years after cancer diagnosis, the average cost of hospital care per patient varied from €28 K for anal cancer to €41 K for oral cancer. Most expenditures were related to hospital care, before outpatient care and disability allowance; they were concentrated in the first year of care. The total economic burden associated with HPV-potentially related cancers was about €511 M for the French National Health Insurance over a 3 years period (2011 to 2013), ranging from €8 M for vaginal cancer to €222 M for oropharyngeal cancer. This study reported the most up-to-date epidemiological and economic data on potentially HPV-related cancers in France. These results may be used to evaluate the potential impact of new preventive strategies, namely the generalized organized screening of cervical cancer and the nine-valent HPV vaccine, indicated in the prevention of cervical, vaginal, vulvar and anal cancers.

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Conflict of interest statement

The study was supported and funded by MSD Vaccins. André Dahlab, Xavier Bresse and Mathieu Uhart are former employees of MSD Vaccins. MSD Vaccins is the market authorization holder of Gardasil®, Human papillomavirus 9-valent vaccine, recombinant. Charlotte Cancalon, Laura Catella and Stève Bénard are employees of stève consultants. As a private pharmaceutical industry, MSD Vaccins is not allowed to access French hospital information from the PMSI database; it has to contract with consultant firms such as stève consultants that comply with the criteria of confidentiality, expertise and independence defined by ministerial order (July 17, 2017). A service agreement (commercial contract of consultancy for designing and implementing the study) was then arranged between MSD Vaccins and stève consultants; stève consultants committed to perform analysis meeting MSD Vaccins’ needs, a priori defined in a protocol, and to transmit only aggregated statistics to MSD Vaccins. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. Lastly, Laurent Abramowitz, Jean Lacau Saint Guily, Micheline Moyal-Barracco, Christine Bergeron and Hélène Borne, the 5 members of the study Independent Scientific Committee, do not have competing interest in the context of this study.

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