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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
UNITED KINGDOM: The Impact of Genital Warts: Loss of Quality of Life and Cost of Treatment in Eight Sexual Health Clinics in the UK
S.C. Woodhall; and others on behalf of the QOLIGEN study group
November 16, 2011
Sexually Transmitted Infections Vol. 87: P. 458-463 (10..11) -

Approximately 125,000 episodes of genital warts were diagnosed in sexual health clinics in England in 2009, resulting in a "substantial" impact on the health service, according to the study authors. Repeated treatment, which consists of clinic- based ablation, pharmaceutical therapies or a combination of the two, may be necessary, and recurrence rates following care of between 10 percent and 40 percent have been reported in clinical trials.

England offers free school-based vaccination against human papillomavirus, and both the Cervarix and Gardasil vaccines are licensed for use. However, only the quadrivalent vaccine (Gardasil) protects against the HPV strains linked to most genital wart cases, in addition to the strains that cause the majority of cervical cancer cases.

To estimate the loss of quality of life and cost of treatment associated with genital warts seen in sexual health clinics, a cross-sectional questionnaire study and case note review of patients with genital warts was carried out in seven clinics in England and one in Northern Ireland.

From the participating clinics, 895 patients were recruited to take part in the questionnaire study. The case note review involved a separate sample of 370 participants who had attended one of the clinics with a first visit for a first or recurrent episode of genital warts between April and June 2007. Quality of life was measured using the EQ-5D questionnaire, and the cost of an episode of care was gleaned from the case note review.

The weighted mean EQ-5D index score was 0.87 (95 percent confidence interval 0.85 to 0.89). The weighted mean disutility, mostly registered in the anxiety/depression scale and pain/discomfort scale, was 0.056 (95 percent CI 0.038 to 0.074). The estimated mean loss of quality-adjusted life-years associated with an episode of genital warts was 0.018 (95 percent CI 0.0079 to 0.031), totaling 6.6 days of healthy life lost per episode. The weighted mean cost per episode of care was 94 GBP (US $149) (95 percent CI 84 GBP [US $134] to 104 GBP [US $165]), not including the cost of STD screening.

"Genital warts have a substantial impact on the health service and the individual. This information can be utilized for economic evaluation of [HPV] vaccination," the authors concluded.