The economic burden of HPV-related diseases: Poland
Key highlights
Key highlights
• Human Papillomavirus (HPV) infection remains one of the most prevalent sexually transmitted infections worldwide, affecting millions annually.
• In Poland, where the median age at first sexual intercourse is 17 years for men and between 18.0 and 18.7 for women, individuals aged 17 and older are typically at risk of HPV infection and, consequently, HPV-related diseases.
• Cervical cancer is the most prevalent HPV-related cancer in Poland, the third most common female cancer in women aged 15 to 44, and the sixth leading cause of female cancer overall.
• Poland’s crude mortality rate for cervical cancer is 6 93 deaths per 100,000 women per year, leading to about 1,361 death cases annually (data for 2021). Additionally, Poland had one of the lowest 5-year survival rates compared to the European average.
• Reported costs of the CC prevention program amount to PLN 20,241,823 per year and the total treatment costs for this cancer at PLN 91,970,076 for 2022. The healthcare burden is significant with an average treatment cost of PLN 28,000 per patient and an annual incidence of approximately 3,000 cases every year
• Data on other HPV-related diseases is scarce, leaving a substantial gap in understanding the broader economic implications of HPV infections.
• A rough estimate of the total HPV-related costs, based on available data from several sources, is that the total economic burden of the disease is around €135 million annually (approximately PLN 578.9 million in 2024).
• The economic burden of HPV-related diseases highlights the crucial role of effective prevention strategies, including vaccination and screening programs, in mitigating both health and financial consequences.
• Since 2016, Poland implemented a cervical cancer screening program aimed at preventing the disease by identifying risks and removing precancerous lesions available to individuals aged 25 to 59 years.
• Poland started a publicly funded gender-neutral HPV vaccination program in June 2023 for boys and girls aged 11 to 13. In September 2024, boys and girls aged 9 to 14 became eligible for the program.
• Despite the implementation of prevention strategies, both vaccination coverage and screening rates remain low. The changes implemented in the National Immunization Programme from September 2024 aim to address this issue.
• In the past 16 months, Poland’s HPV vaccination program has expanded significantly, including the extension of eligible age cohorts, involvement of GP practices in administering vaccines and scheduling, school-based vaccination to reach more children and adolescents, and digital reporting to simplify tracking and follow-up.
3.2.
3.2.1.
3.2.1.1.
3.2.1.2.
3.2.2.
Abbreviations
Abbreviation Definition
CC Cervical cancer
CIN Cervical intraepithelial neoplasia
HPV Human Papillomavirus
PVLFP Present value of future lost productivity
YPLL Years of productive life lost
1. Introduction
Human Papillomavirus (HPV) infection remains one of the most prevalent sexually transmitted infections worldwide, affecting millions of individuals annually. In Poland, as in many other countries, HPV poses a significant public health challenge due to its association with various cancers, including cervical, anal, and oropharyngeal cancers, among others. These diseases not only impact individual health but also impose substantial socioeconomic burdens on healthcare systems and society at large.
Understanding the socioeconomic impact of HPV-related diseases is crucial for several reasons. Firstly, the direct medical costs associated with treating HPV-induced cancers are substantial, encompassing diagnosis, treatment, and long-term care. Moreover, indirect costs such as productivity losses due to morbidity and premature mortality further exacerbate the economic burden. The economic impact of HPV-related diseases underscores the importance of effective prevention strategies, including vaccination and screening programs, in mitigating both health and financial consequences.
Investigating the socioeconomic aspects of preventive measures against HPV is also imperative for accurately allocating resources to mitigate the health burden caused by HPVrelated diseases. Vaccination against high-risk HPV types has demonstrated significant effectiveness in reducing infections and subsequently, preventing cancers. Early detection through screening programs allows for timely intervention, potentially preventing the progression of precancerous lesions to invasive cancer. By assessing the cost-effectiveness of these interventions, policymakers and healthcare providers can make informed decisions about resource allocation and public health policies.
In Poland, as elsewhere, the socioeconomic impact of HPV-related diseases and the effectiveness of preventive measures has not been thoroughly researched yet. This report aims to explore these facets, providing insights into the current landscape, identifying gaps in knowledge, and recommending strategies to enhance public health outcomes and economic efficiency in managing HPV infections and associated diseases.
2. Methodology
To this aim, we performed a literature and information search in PubMed to identify indexed literature as well as grey literature sources to identify additional and complementary sources of information. For the PubMed search, articles were screened and identified using key terms such as "economic," "costs," "cost-effectiveness," and "cost of illness," along with HPVrelated terms. Our review included studies focusing on the economic impact of HPV-related
diseases and studies reporting the economic effects of preventive measures. Furthermore, a targeted Google search was conducted to identify any additional relevant information. Only credible sources, such as governmental websites (e.g., Serwis Rzeczypospolitej Polskiej, Narodowy Instytut Zdrowia Publiczego, Narodowy Fundusz Zdrowia, Ministerstwo Zdrowia), were considered. The identified articles and documents were then reviewed to extract relevant data on the costs associated with HPV-related diseases, including direct medical costs, indirect costs, and broader economic impacts. This methodology ensures a comprehensive overview of the economic burden, incorporating both peer-reviewed studies and authoritative grey literature sources.
3. The Polish Landscape
Statistics for Poland
• Population (2024)(1)
37.58 million
• GDP per capita (2024)(2)
$23,010.00
• Currency Polish zloty (PLN)
• National HPV prevention programs Vaccination (2023) (3) –Cervical cancer screening (2016)(4)
• Vaccine coverage – (aged 12-13)
18.3% (63% and 37% ) (2023) (5)
3.1. HPV transmission and HPV-related diseases in Poland
Since sexual intercourse is the primary route of transmission, all sexually active individuals are at risk of genital HPV infection In Poland, the median age at first sexual intercourse is 17 years for men and between 18.0 and 18.7 for women (4) Given that 85.85% of the population is aged 17 and older (6), a substantial portion of the Polish population is at risk of HPV infection and, consequently, HPV-related diseases.
Cervical cancer (CC) is the most prevalent HPV-related cancer in Poland and the third most common female cancer in women aged 15 to 44 in the country Based on 2022 data, the incidence rate is 17.28 cases per 100,000 women per year, with 2,952 new CC cases diagnosed that year alone in the country (7) The crude mortality rate is 6.93 cases per 100,000 women
Figure 1. Map of Poland and key statistical information for the country
annually, as reported by the Polish National Cancer Registry for 2021 (8) Poland is considered to have a moderate incidence of CC; however, it has one of the highest mortality rates in Europe. Additionally, based on the data from 2017, Poland had one of the lowest 5-year survival rates compared to the European average (9)
Other HPV-related cancers in Poland include cancers of the oral cavity, vulva, vagina, anus, penis, and oropharynx, which are also often consequences of HPV infection After CC, the second most frequent HPV-related cancer is laryngeal cancer, with a crude incidence rate of 16.3 per 100,000 individuals for males and 6 68 for females (4). However, it is important to note that, unlike CC, only a small proportion of laryngeal cancer cases is directly associated with HPV infection (2.4%) That way, other HPV-related cancers with a lower number of annual cases, but higher HPV attribution, like oropharyngeal cancer, could contribute significantly to the burden of HPV-related cancers too A summary of the annual number of cases and deaths for cervical and other HPV-related diseases is presented in Table 1
Table 1. Annual number of new cases and deaths per cancer type in Poland in 2021 (8, 10) Cancer type
(2021)
(C10)
Cavity Cancer (C06, C14)
Abbreviations: M: men; W: women
3.2. Socioeconomic burden of HPV-related diseases in Poland
HPV-related diseases are not only associated with increased mortality but also impose significant costs on individuals and society. The socioeconomic burden of these diseases was estimated using available data obtained from the literature. This involved extracting reported healthcare costs incurred by both the healthcare system and patients for each HPV-related disease. Whenever possible, we also extracted societal costs, including productivity losses due to absenteeism or mortality, informal care costs, and productivity losses related to caregiving
3.2.1. Healthcare costs
3.2.1.1. Cervical intraepithelial neoplasia and cervical cancer
Data on the economic burden of HPV-related diseases in Poland is, in general, somewhat limited. The costs of population CC screening for 2017 were identified. The price per cytology and the total costs for these years are presented in Table 2.
For 2017, the total costs for screening procedures alone amounted to PLN 8.29 million for cytology tests and PLN 11.43 million for the diagnostic stages. Translating this to 2024, this would amount to PLN 12.7 million for testing and PLN 17.5 million for diagnosing. This indicates that a large portion of the healthcare expenditure is focused on early detection through screening and diagnostics.
Cervical intraepithelial neoplasia (CIN), usually detected during cervical screenings, is classified as precancerous change. One of the critical areas requiring improvement in the Polish screening program is the absence of a CIN register in the country. This lack of a registry makes it challenging to estimate the incidence and prevalence of the condition in the country accurately (12). Nonetheless, the literature yielded some results on costs associated with CIN and its detection. The average price of unit cost in the screening program, which includes both the collection of cervical material for screening as well as diagnostic stage and direct medical expenses, is PLN 42.73 (PLN 64.41, or approximately €15, inflated to 2024) (11). Due to the demands of the screening program, assuming the unit cost of the screening program, the cost of detecting one precancerous lesion is estimated at PLN 4,273 (PLN 6,440, or approximately €1,508, inflated to 2024). Again, this suggests that while screening is essential for prevention, it is relatively costly, especially when considering the need for ongoing diagnostics.
Table 2. Costs of cervical cancer prevention program – year 2017 (11)
Similarly, reported costs related to CC were limited in the literature In 2022, the costs of treating CC totalled PLN 91,970,076 (PLN 109,123,184, or €25,431,155 inflated to 2024) (7).
Table 3 shows the breakdown of the costs of basic therapeutic procedures used to treat CC that were used to calculate the sum. Teletherapy was found to be the most expensive procedure for treating CC, with a cost of PLN 26,218,123 In 2022, the average cost of treating a patient with CC amounted to PLN 28,000 (PLN 33,222, or €7,742 inflated to 2024), underlining the high financial burden of cancer care, particularly for advanced stages of the disease (7).
Table 3. Top seven expenditures for basic cervical cancer therapeutic procedures reimbursed by the National Health Fund (Narodowy Fundusz Zdrowia) in 2022 (13)
Procedure
Total costs (PLN)
Teletherapy 26,218,123
Brachytherapy 19,144,132
Hospitalization clinical oncology 6,149,582
Hospitalisation gynecologic oncology 4,519,861
Teleradiotherapy 3,576,050
Hospitalization level III referral 3,323,899
Chemotherapy hospitalization with combination therapy 2,238,255
A rough estimation of the total annual HPV-related costs in Poland can be derived from another study, conducted by Patel et al., in 2018 (14). The annual direct costs reported by the authors were:
• €11.2 million (around €13.7 million, or PLN 53.4 million, in 2024) for CC screening in 2018,
• €16.8 million (around €20.6 million, or PLN 80.3 million, in 2024) for diagnosis and treatment of cervical lesions, and
• €12.8 million (around €15.7 million, or around PLN 61.2 million, in 2024) for diagnosis and treatment of CC.
Roughly, these costs combined amounted to a total of €40.8 million annual HPV-related costs in Poland (around €50.7 million, or PLN 197.7 million, in 2024). Most of the costs related to CC detection and treatment in developed countries are due to CC screening; however, following up on abnormal cytology results to prevent disease progression also consumes significant healthcare resources. The combined cost of screening, diagnostic follow-ups, and cancer treatment presents a substantial burden on the healthcare system, which may require improvements in efficiency and cost-effectiveness to reduce overall expenditure. The economic burden of HPV-related diseases in Poland is considerable, with a substantial portion of healthcare costs directed towards prevention and screening, but the costs of diagnosis and treatment of cervical lesions and cervical cancer are even higher.
Effective prevention, early detection, and efficient management of CIN could potentially reduce these costs in the long term.
It is important to emphasize that these total costs did not account for indirect societal costs such as productivity losses due to absenteeism and premature mortality, as well as intangible costs, such as psychological distress and reduced quality of life, which further compound the economic impact. Incorporating indirect costs into this calculation, the total annual cost attributed to HPV in Poland would be even higher, showcasing the financial impact of the disease in the country.
3.2.1.2. Other HPV-related cancers
The economic burden of HPV-related diseases in Poland extends far beyond CC, encompassing a variety of other cancers and conditions that significantly impact both healthcare costs and patient quality of life. However, the evidence on the costs associated with these other HPV-related diseases is quite limited. Most analyses tend to focus on cancers of the female reproductive organs, leaving a substantial gap in our understanding of the broader economic implications of HPV infections. The table below, adapted from the study by Holecki et al., illustrates the hospital services provided to female patients for treating malignant vulvar and vaginal cancers in the Silesian Voivodeship from 2011 to 2012 (15). This regional data highlights the substantial costs associated with treating these HPV-related cancers.
This data underscores the significant financial burden posed by HPV-related cancers of the vulva and vagina. However, it is crucial to note that these figures represent only a fraction of the total economic burden, as they do not account for other HPV-related cancers and conditions. This deficiency in data is a significant barrier to developing effective healthcare policies and interventions. It underscores the urgent need for comprehensive studies that capture the costs associated with all HPV-related diseases. The focus on cancers of the female reproductive organs in the existing literature may be due to the relatively higher incidence rates and the well-established connection between HPV and these cancers. However, this narrow focus overlooks the broader spectrum of HPV-related diseases, leading to an underestimation of the true economic burden.
Table 4 Hospital Services and Costs for HPV-Related Cancers in Silesian Voivodeship (2011–2012) (15)
3.2.2. Indirect costs
Indirect costs associated with HPV-related diseases can be substantial, particularly in the case of cancer, and consist primarily of productivity losses. The productivity losses arise from absenteeism due to cancer treatment, premature death, and the caregiving responsibilities shouldered by family members or other caregivers. Additionally, the emotional and psychological impact on patients and their families may lead to further mental health care costs
Indirect costs associated with HPV-related diseases were scarce in the literature in Poland We identified only one poster on productivity loss due to CC mortality in the country in 2019 and one article identifying the indirect costs due to premature death for 11 HPV-related cancers (oropharynx, oral cavity, nasopharynx, hypopharynx, pharynx, anal, larynx, vulval, vaginal, cervical, and penile) in Central and Eastern European countries, including Poland, also for 2019. In that year, the years of productive life lost (YPLL) due to mortality from CC totalled 4,933 for cases related to any HPV type. Notably, the present value of future lost productivity (PVLFP) tends to increase, despite the decrease in the number of YPLL, reaching PLN 308,1 million in 2019 (16) The future lost productivity due to HPV-related diseases, which was calculated based on the expected productive life years remaining of a person and the agespecific mortality rate, was estimated to be €37 million in Poland in that year (€44,8 million, or around PLN 191 million, inflated to 2024), being the second highest amount in Central Eastern Europe, only behind Romania with €46 millions of indirect costs (17) The average lost productivity in all nine countries was €22,086 (€26,768, or around PLN 114,077, inflated to 2024), with the lowest value being for vulva cancer (€2,933) and the highest for nasopharynx (€33,634) The total costs and the average lost productivity per cancer type for Central and Eastern European countries can be found in Table 5.
Table 5. Value of lost productivity stratified by cancer in nine Central and Eastern European countries including Poland in 2019
However, in addition to productivity losses due to premature death, HPV-related diseases are also associated with productivity losses due to absenteeism. No study estimated these costs could be identified in the literature. Nevertheless, a rough estimation of the productivity losses arising from absenteeism due to cancer treatment can be calculated by considering the average hourly rate for men and women, the length of the absence, and the assumption that a working day consists of eight hours per day (Table 6) To do so, we extracted the data from a study that estimated productivity losses from short-term work absence due to neoplasms in Poland (18)
Table 6. Estimated average productivity losses due to short-term work absence due to cervical cancer
The average value of a working hour €12.0 (2024); 51,1 PLN (2024)
Cervical cancer average length of an absence episode 22.9 days
Average productivity losses per case due to short-term work absence due to cervical cancer €2,198 (2024), 9367,2 PLN (2024)
Taking the annual number of cases of CC into account, this would lead to a rough annual productivity loss from short-term work absence of €8.4 million/PLN 35.7 million (PLN 74.4 million, inflated to 2024) for CC alone. The total productivity losses are even higher when considering also long-term work absence, and caregiver absenteeism. Moreover, similar estimates can also be attributed to other HPV-related cancers.
The paucity of reported indirect costs means that the true socioeconomic burden of HPVrelated diseases in Poland might be underestimated. This is especially true since the national immunization program was only recently implemented (2023), which could lead to high HPVrelated costs up to 2024. As the HPV vaccination coverage is still low in Poland (lower than 30%), it is a challenge to achieve WHO’s recommendation of 90% coverage of girls by the age of 15 and to decrease the overall clinical and economic burden caused by HPV-related cancers. Recognizing and addressing these hidden costs is crucial for a comprehensive understanding of the impact of HPV-related diseases on individuals and society, ultimately guiding more effective public health policies and interventions.
3.2.3. Total costs
An estimation of the total annual economic burden of HPV-related diseases in Poland, combining both direct and indirect costs, was based on the most recent data reported in the previous sections. Table 7. shows a breakdown of all the costs considered in the calculation inflated to 2024.
(14)
(around €135 million)
aCalculation based on number of cases (vulvar: 272 and vaginal: 54) multiplied by the cost per patient (vulvar: PLN 6,616 and vaginal: PLN 3,253) for both vulvar and vaginal cancer
The total estimated economic burden of HPV-related diseases in Poland in 2024 amounts to approximately PLN 578.9 million (€135 million), incorporating both direct healthcare costs and indirect productivity losses from the most recent data available. The estimation highlights the burden of indirect costs as they exceed direct healthcare costs. The total burden is even higher when considering additional indirect costs, such as caregiver absenteeism and psychological distress. The scarcity of studies investigating the total economic burden of HPV in Poland highlights the necessity for further research to capture the full economic burden of HPV-related diseases, enabling more informed decision-making and resource allocation for prevention and treatment programs.
3.3. Economic benefits of HPV-related preventive measures
To fight the occurrence of HPV-related diseases and reduce the socioeconomic burden associated with the virus, several preventive measures have been put in place Since 2016, Poland implemented a CC screening program aimed at preventing the disease by identifying risks and removing precancerous lesions. The program is available to individuals aged 25 to 59 years However, individuals do not receive an active invitation to screening, meaning that they need to seek the information and services themselves, which potentially results in a lower number of individuals using the available program. The coverage of CC screening in Poland is shown in Figure 2
Table 7 Estimated economic burden of HPV-related diseases in Poland in 2024 based on available data
Despite campaigns and the policy of sending out invitations for screening, participation in the program remains low, with the percentage varying from 21,19% and 26,77% in the years 2007–2013. Notably, among EU/EEA countries, Poland was the last to introduce a national HPV vaccination program. In 2009, the Polish Agency for Health Technology Assessment and Tariff System issued a negative opinion on financing HPV vaccination through public funding. Thus until recently, HPV vaccination has been conducted individually by local governments as part of their own preventive programs, alongside the option of privately purchasing the vaccine (11, 14). Under the national program, two HPV vaccines, the 2-valent and the 9-valent became freely available. The country transitioned to a publicly funded approach only in June 2023, with a universal program providing free HPV vaccination for girls and boys aged 12 to 13 (3, 19, 20). More recently, in September 2024, this was extended to the age range of 9 to 14 (21). The relative novelty of the universal free vaccination program, combined with the decentralization of primary preventive measures against HPV across the country, poses challenges in data collection as not much literature is available about the economic benefits after the program’s launch.
Recently, Jakubczyk et al. assessed the cost-effectiveness of the 9-valent vaccine compared to the 2-valent vaccine in both girls and boys aged 12-13 years in Poland, before the extension to boys and girls aged 9 to 14 in 2024 (22). The 9-valent vaccine provides broader protection, covering nine HPV types (HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58), whereas the 2-valent vaccine mainly targets HPV 16 and 18. The results incicated that the total cost savings (excluding vaccine costs) associated with the 9-valent vaccine were estimated at €66 million
Figure 2. Estimated coverage of cervical cancer screening in Poland (4)
over the study period due to reduced treatment costs for HPV-related diseases. The costeffectiveness of this intervention, which was measured using the incremental costeffectiveness ratio (ICER), compared the additional cost of this intervention to the additional health benefits it provides In this study, the ICER measured the additional cost of using the 9-valent HPV vaccine instead of the 2-valent vaccine per quality-adjusted life year (QALY, a year of life in good health) gained. The study reported that every QALY gained by switching to the 9-valent vaccine costs an additional €8,094. This value is well below Poland’s costeffectiveness threshold (three times the GDP, around €18,000-€20,000), a value used to determine whether the cost of a healthcare intervention is justified by the health benefits it provides Therefore, the 9-valent vaccine offers better health outcomes at a justifiable cost and is considered a cost-effective choice.
Besides being cost-effective, an HPV vaccination program targeting both genders would also guarantee equal access and promote gender equality in Poland (3) This approach would help to remove the sexual aspect from vaccination, thus decreasing any stigma linked to a program that vaccinates only girls. This way, HPV vaccination might become more acceptable to a wider range of individuals, likely boosting vaccination uptake rates and enhancing the overall effectiveness of the program. This is of particular significance since the vaccination coverage since the implementation of the program was overall low (9.8% up to August 2023 and 18.3% up to December 2023) and more girls are vaccinated when compared to boys (65% girls and 35% boys in August 2023 and 63% girls and 37% boys in December 2023) (3) (5) The reported coverage during the initial months is notably low, suggesting potential barriers related not only to individual costs but also to a lack of awareness about the importance of HPV vaccination before the program’s start. To improve HPV vaccination coverage, strategies might include targeted public awareness campaigns that highlight the significance of the vaccine. Additionally, implementing a school-based program could be an effective approach, though it is important to carefully address potential challenges such as logistical issues, consent procedures, and parental concerns.
In summary, Poland's efforts to combat HPV-related diseases include a CC screening program (implemented in 2016) and a recently introduced national HPV vaccination program (implemented in 2023 and extended in 2024). Though, despite the introduction of a publicly funded HPV vaccination program in Poland in June 2023, several gaps remain in research and policy implementation. The long-term impact of the program on vaccination uptake, effect of extending to an age cohort of boys and girls aged 9 to 14, and HPV-related disease prevention have yet to be thoroughly studied. Given that Poland was the last EU/EEA country to introduce a national HPV vaccination program, there is a lack of literature assessing the program’s success, barriers to uptake, and public health benefits. To improve uptake, public
awareness campaigns and school-based programs are recommended to address potential logistical and consent-related challenges. Additionally, further research is needed to understand the factors contributing to low screening adherence and to evaluate how HPV vaccination might influence participation in screening. Studies should also explore whether vaccination leads to improved screening rates or, conversely, creates a false sense of security that reduces participation. Another key concern is the gender disparity in HPV vaccination coverage. Future studies should examine the reasons behind this discrepancy and identify strategies to promote equal access and acceptance of HPV vaccination among both genders. Addressing this issue is crucial for ensuring gender equity in HPV-related cancer prevention and reducing any stigma associated with the vaccine. Finally, no studies reporting costs related to other HPV-related cancers were found in the literature, overshadowing the economic burden from the other diseases. All these limitations hinder a more complete analysis of the costs of HPV in Poland, especially HPV-related cancers other than cervical, and the economic benefits of HPV-related measures, like screening and vaccination programmes
4. References
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