Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France.

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d'information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

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

Health problems most commonly diagnosed among young female patients during visits to general practitioners and gynecologists in France before the initiation of the human papillomavirus vaccination program.

PURPOSE: Background rates for common health problems have seldom been estimated to facilitate interpretation of signals that may occur after a new public health intervention. Background rates of diagnoses from general practitioners (GPs) and gynecologists (GYNs) were assessed before the implementation of human papillomavirus (HPV) immunization program. METHODS: This cross-sectional study used data collected in 2006 in France. All visits of women (aged 11-23 years) to a GP or a GYN participating in the longitudinal patient data (LPD) network were considered. Diagnoses and symptoms were retrieved and classified according to the International Classification of Primary Care. Only diagnoses made in ≥ 1% of visits were reported in primary analyses. Independent analyses were performed for visits to GPs and GYNs and for adolescents and young adults. Finally, the rates of pre-specified health problems of interest (e.g., because of their potential identification as signals after HPV immunization) were computed from processed diagnostic data, using time windows consistent with HPV vaccination scheme. RESULTS: About 380,813 GP and 36,329 GYN visits were analyzed. Acute upper respiratory infections were the most frequently recorded diagnoses by GPs, accounting for 11,783 per 100,000 visits per year. Visits related to the respiratory system accounted for 10 of the 23 most frequent diagnoses by GPs. Genital candidiasis was the most frequent GYN diagnosis, accounting for 4746 per 100,000 visits per year. Most GYN visits were for pregnancy-related issues or menstrual problems. The main diagnoses were similar in adolescents compared with young adults in both GP and GYN settings. Pre-specified health problems occurred at high rates, as exemplified by acne that was diagnosed in 0.8% of patients during time windows consistent with HPV immunization. CONCLUSION: Diagnostic data processed from electronic health records identified the rates of common health events experienced by young female patients routinely visiting their GP or GYN before HPV immunization. Such rates may prove useful in interpreting adverse events reported after the launch of new medical interventions.