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So RJ, Hillel AT, Motz KM, Akst LM, Best SR. Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis. Otolaryngol Head Neck Surg 2024; 170:1091-1098. [PMID: 38123898 DOI: 10.1002/ohn.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To describe iatrogenic laryngeal injury and identify its risk factors in recurrent respiratory papillomatosis (RRP) patients receiving surgical care. STUDY DESIGN Case-control. SETTING Tertiary care academic hospital in a metropolitan area. METHODS Charts of patients with RRP seen at our institution from January 2002 to December 2022 were reviewed. Patients were separated into 2 cohorts based upon whether they experienced any form of iatrogenic laryngeal injury-including anterior commissure synechiae, vocal cord scar, reduced vocal fold pliability, vocal fold motion impairment, and glottic and/or subglottic stenosis. Adjusted logistic regressions were performed to identify factors associated with iatrogenic laryngeal injury. RESULTS Of 199 RRP patients, 133 (66.8%) had identifiable iatrogenic laryngeal injury. The most common injuries were anterior commissure synechiae (n = 67; 50.4%) and reduced vocal fold pliability (n = 54; 40.6%). On a multivariate logistic regression, patients with diabetes mellitus (adjusted odds ratio [aOR] [95% confidence interval [CI]]: 2.99 [1.02, 8.79]; P = .04) and who received at least 10 surgeries lifetime (aOR [95% CI]: 14.47 [1.70, 123.19]; P = .01) were at increased risk for iatrogenic laryngeal injury, whereas receiving less than 5 surgeries (aOR [95% CI]: 0.21 [0.09, 0.51]; P < .001) was found to be protective. When treating the lifetime number of surgeries as a continuous variable, a greater number of surgeries was a significant risk factor for iatrogenic laryngeal injury (aOR [95% CI]: 1.32 [1.14, 1.53]; P < .001). CONCLUSION These results suggest the importance of strict glucose control for diabetic patients receiving RRP surgical care, and emphasize the clinical need to identify medical therapies to decrease RRP surgical frequency for patients.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin M Motz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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So RJ, Rayle C, Joo HH, Huang EY, Seiwert TY, Raabe EH, Best SR. Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Single Institution's Experience. Laryngoscope 2024. [PMID: 38525973 DOI: 10.1002/lary.31387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/05/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Medical therapies to limit disease recurrence are critically needed for recurrent respiratory papillomatosis (RRP). Systemic bevacizumab is emerging as an exciting adjuvant therapy toward this end, but uptake has been poor due to the lack of experience and awareness of best prescribing practices. The objective of this study was to describe a single tertiary care academic medical center's experience using systemic bevacizumab for the treatment of RRP. METHODS A retrospective review was performed to identify patients with RRP on systemic bevacizumab. Demographic and clinical characteristics, findings on imaging reports, and disease response at all anatomic subsites involved in papilloma were documented. RESULTS Of the 17 RRP patients on systemic bevacizumab, 9 (52.9%) were male, and 12 (70.6%) were diagnosed with juvenile-onset RRP. The total lifetime number of surgeries was high, with more than half (n = 9; 52.9%) undergoing more than 50 surgeries. Following induction of systemic bevacizumab, a significant reduction in patients with laryngeal (n = 15; 94.1% vs. n = 7; 41.2%, p < 0.001) and tracheal (n = 11; 64.7% vs. n = 5; 29.4%, p = 0.04) RRP was noted. Surgical frequency was significantly lower following systemic bevacizumab (2.5 vs. 0.5 surgeries per year; p < 0.001). The most common complications were new-onset hypertension (n = 4; 23.5%) and proteinuria (n = 5; 29.4%). CONCLUSION Systemic bevacizumab is effective in reducing the number of surgeries needed for RRP while exhibiting a relatively safe complication profile. Papillomas in the larynx and trachea are most responsive to systemic bevacizumab, while pulmonary RRP is most likely to exhibit a partial-to-stable response. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Christopher Rayle
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Henry H Joo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Emily Y Huang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Tanguy Y Seiwert
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Eric H Raabe
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Schindele A, Al-Sabtti S, Olofsson K. Human papilloma virus (HPV) vaccination is associated with reduced number of surgical treatments, an observational study on recurrent respiratory papillomatosis in Northern Sweden. Acta Otolaryngol 2024; 144:71-75. [PMID: 38484282 DOI: 10.1080/00016489.2024.2316264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is a wart-like lesion mainly affecting the larynx, caused by human papillomavirus (HPV) genotypes 6 and 11. The disease affects both children and adults, and there is no cure. Surgery is the current symptom-relieving treatment; however, HPV vaccination is used as an adjuvant treatment. AIMS AND OBJECTIVES The aims were to study effects of HPV vaccination in RRP cases and to compare juvenile-onset to adult-onset disease and high treatment frequency (TF) to low TF cases. MATERIAL AND METHODS Medical records of RRP patients were studied from May 2006 to January 2023. Eighty-five RRP cases, tested for HPV genotypes with PapilloCheck®, were included. Vaccination- onset- and treatment analysis were performed. RESULTS Twelve percent of the cases were vaccinated. The number of surgeries decreased from 2.0 to 0.8/year after HPV vaccination. Most cases had an adult-onset and less than one treatment per year. Juvenile-onset cases had a higher vaccination treatment ratio compared to adult-onset. CONCLUSIONS HPV vaccination was associated with a lower number of treatments per year, supporting the use of vaccination as an adjuvant treatment. SIGNIFICANCE Vaccination as adjuvant treatment to surgery may lead to increased quality of life for RRP patients and saved healthcare resources.
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Affiliation(s)
- Alexandra Schindele
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Östersund, Sweden
| | - Semma Al-Sabtti
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Katarina Olofsson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
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Ponduri A, Azmy MC, Axler E, Lin J, Schwartz R, Chirilă M, Dikkers FG, Yang CJ, Mehta V, Gangar M. The Efficacy of Human Papillomavirus Vaccination as an Adjuvant Therapy in Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:2046-2054. [PMID: 36651338 PMCID: PMC10859188 DOI: 10.1002/lary.30560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To characterize the efficacy of human papillomavirus (HPV) vaccination as an adjuvant therapy in recurrent respiratory papillomatosis (RRP). DATA SOURCES PubMed, Embase, Cochrane, Google Scholar, ClinicalTrials.gov, and Web of Science databases were queried for articles published before April 2021. REVIEW METHODS All retrieved studies (n = 870) were independently analyzed by two reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement using predefined inclusion and exclusion criteria. 13 studies met inclusion criteria. A random-effects meta-analysis was performed to study intersurgical interval (ISI) and number of surgical procedures per year before and after vaccination. RESULTS The systematic review included 13 studies, comprising 243 patients. All studies utilized the Gardasil® quadrivalent vaccine, and one study (Yiu et al. 2019) utilized both the quadrivalent and Gardasil® 9-valent vaccines. Our meta-analysis included 62 patients with ISI data across 4 studies, and 111 patients with data on the number of surgical procedures per month across 7 studies. The mean number of surgical procedures decreased by 4.43 per year after vaccination (95% CI, -7.48 to -1.37). Mean ISI increased after vaccination, with a mean difference of 15.73 months (95% CI, 1.46-29.99). Two studies reported on HPV sero-conversion, with HPV seropositivity of 100% prior to vaccination and 25.93% after vaccination. CONCLUSION The addition of HPV vaccination was associated with an increase in time between surgeries and reduction in the number of surgical procedures required. HPV vaccination may be a beneficial adjuvant treatment for RRP. LEVEL OF EVIDENCE NA Laryngoscope, 133:2046-2054, 2023.
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Affiliation(s)
- Anusha Ponduri
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Monica C Azmy
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Eden Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Magdalena Chirilă
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Frederik G Dikkers
- Department of Otorhinolaryngology/Head and Neck Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Vikas Mehta
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Mona Gangar
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
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McGuire JK, Kabagenyi F, Peer S. Human papillomavirus vaccination in Africa: An airway perspective. Int J Pediatr Otorhinolaryngol 2023; 165:111423. [PMID: 36681046 DOI: 10.1016/j.ijporl.2022.111423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis (RRP) is a chronic condition caused by Human papillomavirus six (HPV-6) and HPV-11 that involves the respiratory tract. Disease severity ranges from mild (hoarseness), through to severe (stridor, respiratory distress and airway emergencies). Africa has the fastest growing and youngest population of all the continents. It also has the greatest burden of cervical cancer. There is an association with infection of the oncogenic HPV strains and the strains responsible for RRP. It is reasonable to conclude that although RRP may be underestimated in low-to-middle-income countries, it poses a considerable health risk to Africa. The primary aim of this project was to assess the suitability of HPV vaccination coverage on the African continent. METHODS A prospective study was designed to consist of an online survey. It was distributed to 135 African otolaryngologists. Questions focussed on HPV vaccination programmes; whether they were government directed; and their rollout. Information from countries that had multiple otolaryngologists respond to the survey were compared. Additionally, data review and corroboration were performed. RESULTS There were 58 (43%) participants from 19 countries. Nine countries reported a national vaccination programme (NVP), five used Cervarix; four used quadrivalent Gardasil. Collateral data revealed 18 of 54 countries had NVP in Africa and 26 countries had completed HPV vaccine pilot or demonstration projects. CONCLUSIONS HPV vaccination in Africa should be urgently re-evaluated to include the HPV-6 and HPV-11 strains that cause JORRP, which have not been recognised during national vaccination programme planning.
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Affiliation(s)
- J K McGuire
- Division of Otolaryngology, Department of Surgery, University of Cape Town, South Africa.
| | - F Kabagenyi
- Division of Otolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - S Peer
- Division of Otolaryngology, Department of Surgery, University of Cape Town, South Africa
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Wu X, Xiao Y, Guo D, Zhang Z, Liu M. Reduced NK Cell Cytotoxicity by Papillomatosis-Derived TGF-β Contributing to Low-Risk HPV Persistence in JORRP Patients. Front Immunol 2022; 13:849493. [PMID: 35350785 PMCID: PMC8957810 DOI: 10.3389/fimmu.2022.849493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/19/2022] Open
Abstract
The role of natural killer (NK) cells in juvenile-onset recurrent respiratory papillomatosis (JORRP) patients remains elusive. In this study, we find increased NK cell percentage, particularly CD11b-CD27- (DN) subsets in peripheral blood of JORRP patients and associated with disease activity. RNA sequencing shows a downregulated "natural killer cell-mediated cytotoxicity" feature in JORRP tumors. We also find impaired cytotoxic capacity and lower expression of NK cell-activating receptors including NKp30 and NKp46. Higher transforming growth factor-beta 1 (TGF-β1) is found both in plasma and tumor tissues of JORRP, and anti-TGF-β1 antibody could restore NK cell cytolytic activity and upregulate NKp30 and NKG2D expression. Also, we find a significantly higher Chemokine receptor type 6 (CXCR6) on NK cells in tumors compared with that in peripheral blood. Finally, RT-PCR analysis show that both HPV6-E6-E7 and HPV11-E6-E7 overexpression leads to higher TGFB1 expression compared with control SNU-1076 cell line, and higher CXCR6 expression is detected on NK coculture with HPV11-E6-E7-overexpressing cells. In conclusion, we demonstrate that TGF-β1 by papillomatosis leads to decreased NK cell cytotoxicity through downregulating NK cell-activating receptors in JORRP patients.
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Affiliation(s)
- Xunyao Wu
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Guo
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zixin Zhang
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meiyu Liu
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Sichero L, Ferreira S, López RVM, Mello BP, Costa V, El-Achkar VNR, Carlos R, Ribeiro-Silva A, Pignatari S, Kaminagakura E, Villa LL. Prevalence of human papillomavirus 6 and 11 variants in recurrent respiratory papillomatosis. J Med Virol 2021; 93:3835-3840. [PMID: 32910471 DOI: 10.1002/jmv.26503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022]
Abstract
Human papillomavirus (HPV) types 6 and 11 are the etiological agents of recurrent respiratory papillomatosis (RRP). We examined the prevalence and distribution of HPVs 6 and 11 genetic variants in juvenile onset (JORRP) and adult onset (AORRP) laryngeal papillomas. Cases of JORRP and AORRP were collected, retrospectively. HPV detection and genotyping were accessed by polymerase chain reaction-sequencing in 67 RRP samples. Overall, the most prevalent HPV-6 variants were from B1 (55.8%) and B3 (27.9%) sublineages, whereas among HPV-11 positive samples A2 (62.5%) variants were predominant. A higher prevalence of HPV-6 B1 was observed in JORRP (83.3% B1 and 16.7% B3), compared with AORRP cases (58.3% B1 and 41.7% B3). HPV-11 A2 variants were more prevalent both in JORRP (57.2%) and in AORRP cases (70.0%). Nevertheless, with the exception that HPV-6 B1 were significantly less likely to recur, there was a lack of association between any particular HPVs 6 or 11 variant and clinicopathological features. Our data do not support an association between HPVs 6 and 11 variability and RRP.
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Affiliation(s)
- Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Silvaneide Ferreira
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rossana V M López
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Barbara P Mello
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Victor Costa
- Department of Bioscience and Oral Diagnosis, São Paulo State University (UNESP), São Paulo, Brazil
| | - Vivian N R El-Achkar
- Department of Bioscience and Oral Diagnosis, São Paulo State University (UNESP), São Paulo, Brazil
| | - Román Carlos
- Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala
| | - Alfredo Ribeiro-Silva
- Department of Pathology and Forensic Medicine, Ribeirao Preto Medical School, Universidade de São Paulo, Ribeirao, Preto, Brazil
| | - Shirley Pignatari
- Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Estela Kaminagakura
- Department of Bioscience and Oral Diagnosis, São Paulo State University (UNESP), São Paulo, Brazil
| | - Luisa L Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo Federal University, Sao Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Marcus K, Lee DJ, Wilson JS, Smith RJH, Puricelli M. Pembrolizumab Induced Acute Persistent Airway Disease in a Patient with Recurrent Respiratory Papillomatosis (RRP). Ann Otol Rhinol Laryngol 2021; 131:331-336. [PMID: 34056952 DOI: 10.1177/00034894211021276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present an uncommon but serious, recently identified complication of checkpoint inhibitor therapy in a patient treated with pembrolizumab infusion for disseminated recurrent respiratory papillomatosis (RRP). METHODS Case report. RESULTS A 43-year-old woman with underlying asthma developed acute hypoxic respiratory failure within 24 hours of her third infusion of pembrolizumab for treatment of intractable, disseminated recurrent respiratory papillomatosis. Pulmonary function testing revealed a severe intra-thoracic obstructive ventilatory defect. Discontinuation of pembrolizumab, ventilatory support, and treatment with systemic and inhaled corticosteroids resulted in resolution of respiratory failure; however, her underlying asthma remains poorly controlled. CONCLUSION To our knowledge, this case is the first report of pembrolizumab-induced obstructive respiratory failure in a patient being treated for RRP.
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Affiliation(s)
- Kathryn Marcus
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jeffrey S Wilson
- Department of Internal Medicine-Pulmonology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael Puricelli
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madision, Madison, WI, USA
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9
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Benedict JJ, Derkay CS. Recurrent respiratory papillomatosis: A 2020 perspective. Laryngoscope Investig Otolaryngol 2021; 6:340-345. [PMID: 33869767 PMCID: PMC8035938 DOI: 10.1002/lio2.545] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Despite recent advancement recurrent respiratory papillomatosis (RRP) remains a rare but challenging benign airway neoplasm. In recent years there has been significant shifts in incidence of this disease due to changes in vaccination and prevention for human papilloma virus (HPV) and its related pathology. This review will highlight the epidemiology, prevention and treatment of RRP. METHODS The PubMed database was searched using relevant MeSH terms including "recurrent respiratory papillomatosis." The titles and abstracts were reviewed to assess relevance and unrelated articles were excluded. A full-text review for select articles was performed, the data and discussions were interpreted and synthesized to create a concise update on the management of RRP. RESULTS With the increasing utilization of the 9-valent and quadrivalent HPV vaccine in Australia, we have seen a significant decrease in the incidence of RRP. Preliminary data in the US shows a similar trend of decreased incidence after implementation of vaccination. Single dose Gardasil in developing countries has shown sustained immunization for at least 7 years. Preliminary clinical trials and retrospective studies have shown the HPV vaccine may have benefit as a treatment method in addition to prevention for HPV related diseases. Bevacizumab (Avastin), a VEGF monoclonal antibody, has shown promise as a systemic treatment for RRP. The Corona Virus Disease 2019 (COVID-19) pandemic has affected perioperative management of RRP. CONCLUSION RRP continues to decline in incidence since the implementation of HPV vaccination. Advancement in the medical management including Bevacizumab show promise as an additional option for the management of RRP.
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Affiliation(s)
- Jacob J. Benedict
- Department of Otolaryngology – Head and Neck Surgery, Eastern Virginia Medical SchoolSentara Norfolk General HospitalNorfolkVirginiaUSA
| | - Craig S. Derkay
- Department of Otolaryngology – Head and Neck Surgery, Eastern Virginia Medical SchoolChildren's Hospital of the King's DaughtersNorfolkVirginiaUSA
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10
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Sidell DR, Balakrishnan K, Best SR, Zur K, Buckingham J, De Alarcon A, Baroody FM, Bock JM, Boss EF, Bower CM, Campisi P, Chen SF, Clarke JM, Clarke KD, Cocciaglia A, Cotton RT, Cuestas G, Davis KL, DeFago VH, Dikkers FG, Dossans I, Florez W, Fox E, Friedman AD, Grant N, Hamdi O, Hogikyan ND, Johnson K, Johnson LB, Johnson RF, Kelly P, Klein AM, Lawlor CM, Leboulanger N, Levy AG, Lam D, Licameli GR, Long S, Lott DG, Manrique D, McMurray JS, Meister KD, Messner AH, Mohr M, Mudd P, Mortelliti AJ, Novakovic D, Ongkasuwan J, Peer S, Piersiala K, Prager JD, Pransky SM, Preciado D, Raynor T, Rinkel RNPM, Rodriguez H, Rodríguez VP, Russell J, Scatolini ML, Scheffler P, Smith DF, Smith LP, Smith ME, Smith RJH, Sorom A, Steinberg A, Stith JA, Thompson D, Thompson JW, Varela P, White DR, Wineland AM, Yang CJ, Zdanski CJ, Derkay CS. Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement. Laryngoscope 2021; 131:E1941-E1949. [PMID: 33405268 DOI: 10.1002/lary.29343] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality. STUDY DESIGN Delphi method-based survey series. METHODS A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up. RESULTS The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18). CONCLUSION This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E1941-E1949, 2021.
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Affiliation(s)
- Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, and, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Karen Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Julia Buckingham
- Maternal and Child Health Research Institute, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Alessandro De Alarcon
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery and Department of Pediatrics, University of Chicago Medicine and The Comer Children's Hospital, Chicago, Illinois, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Division of Laryngology and Professional Voice, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Charles M Bower
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences (UAMS), Arkansas Children's Hospital, Little Rock, Alaska, U.S.A
| | - Paolo Campisi
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sharon F Chen
- Department of Pediatrics, Division of Infectious Diseases, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Jeffrey M Clarke
- Department of Medicine, Division of Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Kevin D Clarke
- Pediatric Otolaryngology, Division of Otolaryngology Head and Neck Surgery, University of British Columbia (UBC, UVIc), Victoria General Hospital, Victoria, British Columbia, Canada
| | - Alejandro Cocciaglia
- ENT-Respiratory Endoscopy Department, Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Robin T Cotton
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Giselle Cuestas
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - Kara L Davis
- Department of Pediatrics, Division of Pediatric Oncology, Bass Center for Childhood Cancer and Blood Disorders, Stanford University, Stanford, California, U.S.A
| | - Victor H DeFago
- Pediatric Surgery, Sanatorio del Salvador Privado SA, Cordoba, Argentina
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ines Dossans
- Otolaryngology-Head and Neck Surgery, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Walter Florez
- Department of Otolaryngology, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | - Elizabeth Fox
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, Tennessee, U.S.A
| | - Aaron D Friedman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, U.S.A
| | - Nazaneen Grant
- Department of Otolaryngology, Division of Laryngology, Medstar Georgetown University Hospital, Georgetown, Washington, District of Columbia, U.S.A
| | - Osama Hamdi
- Howard University College of Medicine, Washington, District of Columbia, U.S.A
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Kaalan Johnson
- University of Washington School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, Seattle, Washington, District of Columbia, U.S.A
| | - Liane B Johnson
- Department of Surgery, Dalhousie University, Division of Paediatric Otolaryngology-Head and Neck Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Peggy Kelly
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Claire M Lawlor
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Nicolas Leboulanger
- Head and Neck Surgery, Pediatric Otolaryngology, Necker Enfants Malades Hospital, Paris University, Paris, France
| | - Alejandro G Levy
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Arnold Palmer Hospital Center for Children's Cancer and Blood Disorders, Orlando Health, Orlando, Florida, U.S.A
| | - Derek Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Greg R Licameli
- Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Steve Long
- Department of Head and Neck Surgery, Kaiser Permanente, Hillsboro, Oregon, U.S.A
| | - David G Lott
- Department of Otorhinolaryngology, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Dayse Manrique
- Department of Otorhinolaryngology, Universidad Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - James Scott McMurray
- Pediatric Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Anna H Messner
- Department of Otolaryngology/Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Michael Mohr
- Department of Hematology, Oncology and Respiratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Pamela Mudd
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Anthony J Mortelliti
- Department of Otolaryngology-Head and Neck Surgery, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, U.S.A
| | - Daniel Novakovic
- Department of Otolaryngology, Head and Neck Surgery, Central Clinical School, Faculty of Medicine and Health, University of Sydney, The Canterbury Hospital, Sydney, New South Wales, Australia
| | - Julian Ongkasuwan
- Department of Otolaryngology, Division of Adult and Pediatric Laryngology, Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Shazia Peer
- Division of Otorhinolaryngology, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Krysztof Piersiala
- Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinksa University Hospital, Stockholm, Sweden
| | - Jeremy D Prager
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | | | - Diego Preciado
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Tiffany Raynor
- Department of Otolaryngology, Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Rico N P M Rinkel
- Department of Otolaryngology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hugo Rodriguez
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Verónica P Rodríguez
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - John Russell
- Department of Paediatric Otolaryngology, Children's Health Ireland, Dublin, Ireland
| | - María Laura Scatolini
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Patrick Scheffler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - David F Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Lee P Smith
- Division of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York, U.S.A
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Abraham Sorom
- Otolaryngology, Head and Neck Surgery, Confluence Health, Wenatchee, Washington, District of Columbia, U.S.A
| | - Amalia Steinberg
- Otolaryngology, Head and Neck Surgery, Alaska Native Medical center, Anchorage, Alaska, U.S.A
| | - John A Stith
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, SSM Cardinal Glennon Children's Hospital Medical Center, St. Louis, Missouri, U.S.A
| | - Dana Thompson
- Division of Pediatric Otolaryngology Head and Neck Surgery Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jerome W Thompson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric ENT, LeBonheur Children's Hospital, College of Medicine, University of Tennnessee, Memphis, Tennessee, U.S.A
| | - Patricio Varela
- Pediatric Surgery Department, Universidad de Chile, Mackenna Children Hospital, Clinica Las Condes Medical center, Santiago, Chile
| | - David R White
- Division of Pediatric Otolaryngology, Medical University of South Carolina (MUSC) Shawn Jenkins Children's Hospital, Charleston, South Carolina, U.S.A
| | - Andre M Wineland
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Christina J Yang
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, New York, New York, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, Division of Pediatric Otolaryngology/Head and Neck Surgery, North Carolina Children's Hospital, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A
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11
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Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis. Biosci Rep 2020; 40:224730. [PMID: 32426815 PMCID: PMC7251323 DOI: 10.1042/bsr20192005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Laryngeal papillomatosis is a benign disease in the larynx but with the potential to develop into significant complications as a result of its high recurrence rate. CO2 laser and radiofrequency controlled ablation (coblation) have been used to treat recurrent respiratory papillomatosis, but detailed comparisons of their respective treatment outcomes are not fully investigated. This retrospective study examines the procedure time, time interval between interventions, blood loss during operation, post-operative complications and pain scores among patients who received either CO2 laser or radiofrequency coblation interventions for laryngotracheal recurrent respiratory papillomatosis. Compared with CO2 laser intervention, radiofrequency coblation significantly reduced operation time, time interval between interventions, blood loss during operation and number of times bipolar electrocoagulation needed in each procedure. Post-operatively, pain scores after radiofrequency coblation were significantly lower than those after CO2 laser intervention. Incidence rates of post-operative complications, in terms of palate pharyngeal mucosa damage, bleeding and subcutaneous emphysema, were also significantly reduced after radiofrequency coblation. Low-temperature radiofrequency coblation is a superior intervention compared with CO2 laser against laryngotracheal recurrent respiratory papillomatosis.
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12
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Mennini FS, Fabiano G, Favato G, Sciattella P, Bonanni P, Pinto C, Marcellusi A. Economic burden of HPV9-related diseases: a real-world cost analysis from Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:829-840. [PMID: 30900047 DOI: 10.1007/s10198-019-01044-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 03/14/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The objectives of this study were to estimate the economic burden of HPV in Italy, accounting for total direct medical costs associated with nine major HPV-related diseases, and to provide a measure of the burden attributable to HPV 6, 11, 16, 18, 31, 33, 45, 52, 58 infections. METHODS A cost-of-illness incidence-based model was developed to estimate the incidences and costs of invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, oropharyngeal, anogenital warts, and recurrent respiratory papillomatosis (RRP) in the context of the Italian National Health System (NHS). We used data from hospital discharge records (HDRs) of an Italian region and conducted a systematic literature review to estimate the lifetime cost per case, the number of incident cases, the prevalence of HPV9 types. Costs of therapeutic options not included in the diagnosis-related group (DRG) tariffs were estimated through a scenario analysis. RESULTS In 2018, the total annual direct costs were €542.7 million, with a range of €346.7-€782.0 million. These costs could increase considering innovative therapies for cancer treatment (range €16.2-€37.5 million). The fraction attributable to the HPV9 genotypes without innovative cancers treatment was €329.5 million, accounting for 61% of the total annual burden of HPV-related diseases in Italy. Of this amount, €135.9 million (41%) was related to men, accounting for 64% of the costs associated with non-cervical conditions. CONCLUSIONS The infections by HPV9 strains and the economic burden of non-cervical HPV-related diseases in men were found to be the main drivers of direct costs.
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Affiliation(s)
- F S Mennini
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - Gianluca Fabiano
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.
- Institute for Leadership and Management in Health, Kingston University, London, UK.
| | - G Favato
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - P Sciattella
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - P Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - C Pinto
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - A Marcellusi
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University, London, UK
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13
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Datta S, Pink J, Medley GF, Petrou S, Staniszewska S, Underwood M, Sonnenberg P, Keeling MJ. Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK. BMC Infect Dis 2019; 19:552. [PMID: 31234784 PMCID: PMC6591963 DOI: 10.1186/s12879-019-4108-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection. METHODS We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection. RESULTS At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective. CONCLUSIONS Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective.
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Affiliation(s)
- Samik Datta
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK. .,National Institute of Water and Atmospheric Research, Wellington, 6021, New Zealand.
| | - Joshua Pink
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Graham F Medley
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Sophie Staniszewska
- Royal College of Nursing Research Institute, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK
| | - Matt J Keeling
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK
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14
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Tam S, Wu CF, Peng HL, Dahlstrom KR, Sturgis EM, Lairson DR. Cost of treating recurrent respiratory papillomavirus in commercially insured and medicaid patients. Laryngoscope 2019; 130:1186-1194. [PMID: 31194270 DOI: 10.1002/lary.28139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The study objective was to estimate the first 2 years' direct costs of treating new cases of juvenile-onset and adult-onset recurrent respiratory papillomatosis (RRP) and determine the predictors of treatment costs. METHODS Cases were patients diagnosed with RRP in commercial insurance claims in 2011-2014 and Texas Medicaid in 2008-2012 for treatment of RRP. Controls were patients without a diagnosis of HPV-related cancer or RRP, matched with cases by age, sex, geographic area, date of diagnosis of RRP, and propensity score. Total health care costs in the first 2 years after diagnosis were obtained from cases and matched controls. A generalized linear model was created to identify predictors of monthly costs. RESULTS In commercially insured patients, a total of 122 cases of juvenile-onset (<18 years old) and 1824 cases of adult-onset (≥18 years old) RRP were identified. The mean first 2 years' cost difference between cases and controls was $58,733 for juvenile-onset disease and $11,185 for adult-onset disease after model adjustments. In the Texas Medicaid population, 73 cases of juvenile-onset and 96 cases of adult-onset RRP were identified. The mean first 2 years' cost difference between cases and controls was $76,115 for juvenile-onset disease and $4,633 for adult-onset disease after model adjustments. CONCLUSION The first 2 years' medical costs difference of juvenile-onset and adult-onset RRP among commercially insured and Medicaid population were approximately $60,000 to $70,000 and $5,000 to $11,000, respectively, and should be considered in HPV vaccination promotion investment decisions. LEVEL OF EVIDENCE N/A Laryngoscope, 130:1186-1194, 2020.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Ho-Lan Peng
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erich M Sturgis
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - David R Lairson
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
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15
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Abstract
Recurrent respiratory papillomatosis (RRP) remains a challenging disease afflicting children and adults, resulting in an estimated $120 million per year in United States healthcare-related costs, with annual costs per patient approaching $60,000. Although the prevalence of RRP has declined, RRP remains the most common benign laryngeal neoplasm in children. RRP is unique in its high rate of multisite recurrence, its high burden on patient quality of life, and its high associated healthcare costs. This article summarizes current understanding of the natural history and quality of life burden of RRP, and basic science advancements in prevention and treatment.
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Affiliation(s)
- Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, 601 Children's Lane, 2nd Floor, Norfolk, VA 23507, USA.
| | - Andrew E Bluher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Sentara Norfolk General Hospital, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
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16
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Dareng EO, Adebamowo SN, Famooto A, Olawande O, Odutola MK, Olaniyan Y, Offiong RA, Pharoah PP, Adebamowo CA. Prevalence and incidence of genital warts and cervical Human Papillomavirus infections in Nigerian women. BMC Infect Dis 2019; 19:27. [PMID: 30616634 PMCID: PMC6323853 DOI: 10.1186/s12879-018-3582-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Genital warts are important causes of morbidity and their prevalence and incidence can be used to evaluate the impact of HPV vaccination in a population. METHODS We enrolled 1020 women in a prospective cohort study in Nigeria and followed them for a mean (SD) of 9 (4) months. Nurses conducted pelvic examinations and collected ectocervical samples for HPV testing. We used exact logistic regression models to identify risk factors for genital warts. RESULTS The mean age of study participants was 38 years, 56% (535/962) were HIV-negative and 44% (427/962) were HIV-positive. Prevalence of genital warts at enrolment was 1% (4/535) among HIV-negative women, and 5% (23/427) among HIV-positive women. Of 614 women (307 HIV negative and 307 HIV positive women) for whom we could compute genital wart incidence, it was 515 (95% CI:13-2872) per 100,000 person-years in HIV-negative and 1370 (95% CI:283-4033) per 100,000 person-years in HIV-positive women. HIV was associated with higher risk of prevalent genital warts (OR:7.14, 95% CI:2.41-28.7, p < 0.001) while higher number of sex partners in the past year was associated with increased risk of incident genital warts (OR:2.86, 95% CI:1.04-6.47. p = 0.04). HPV11 was the only HPV associated with prevalent genital warts in this population (OR:8.21, 95% CI:2.47-27.3, p = 0.001). CONCLUSION Genital warts are common in Nigeria and our results provide important parameters for monitoring the impact of future HPV vaccination programs in the country. HIV infection and number of sexual partners in past year were important risk factors for prevalent and incident genital warts respectively.
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Affiliation(s)
- Eileen O Dareng
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Sally N Adebamowo
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 725 W. Lombard St. Suite 445, Baltimore, MD, 21201, USA
| | | | | | | | - Yinka Olaniyan
- Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria
| | - Richard A Offiong
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Paul P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clement A Adebamowo
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 725 W. Lombard St. Suite 445, Baltimore, MD, 21201, USA.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
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17
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18
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Attra J, Hsieh LE, Luo L, Mo JQ, Brigger M, Liu YT, Pransky S. Development of Human-Derived Cell Culture Lines for Recurrent Respiratory Papillomatosis. Otolaryngol Head Neck Surg 2018; 159:638-642. [PMID: 29759030 DOI: 10.1177/0194599818774754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is mainly caused by human papillomavirus (HPV) 6 and 11. While various adjuvant therapies have been reported, no effective therapy has been documented to universally "cure" this disease. In the era of precision medicine, it would be valuable to identify effective intervention based on drug sensitivity testing and/or molecular analysis. It is essential to be able to successfully carry out in vitro culture and expand tumor cells directly from patients to accomplish this goal. Here we report the result of successful culture of HPV-infected cell lines (success rate 70%, 9/13) that express the E6/E7 RNA transcript, using pathologic tissue biopsies from patients treated at our institution. The availability of such a system would enable ex vivo therapeutic testing and disease modeling.
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Affiliation(s)
- James Attra
- 1 Pediatric Otolaryngology, Rady Children's Specialist Medical Foundation, San Diego, California, USA
| | - Li-En Hsieh
- 2 Moores Cancer Center, University of California San Diego, San Diego, California, USA
| | - Linda Luo
- 3 UCSD-RCHSD Biorepository, San Diego, California, USA
| | - Jun Qin Mo
- 6 Pathology, Rady Children's Hospital, San Diego, California, USA.,7 Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Matthew Brigger
- 1 Pediatric Otolaryngology, Rady Children's Specialist Medical Foundation, San Diego, California, USA.,4 Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Yu-Tsueng Liu
- 2 Moores Cancer Center, University of California San Diego, San Diego, California, USA.,5 Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Seth Pransky
- 1 Pediatric Otolaryngology, Rady Children's Specialist Medical Foundation, San Diego, California, USA.,4 Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA
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Reyes LM, Aguilar JL, Villamor P, De La Torre C, Álvarez A, Mantilla E, Álvarez-Neri H. Clinical and sociodemographic characteristics associated with disease severity in juvenile recurrent respiratory papillomatosis: A study of 104 patients in a tertiary care pediatric hospital. Int J Pediatr Otorhinolaryngol 2018; 108:63-66. [PMID: 29605367 DOI: 10.1016/j.ijporl.2018.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Juvenile recurrent respiratory papillomatosis (JRRP) is generally aggressive and with a high recurrence rate. Currently, there is no definite curative treatment for JRRP. Therefore, a greater understanding of the aspects that influence the severity and prognosis of the disease is required. OBJECTIVE The aim of this study was to establish the clinical and socioeconomic characteristics of pediatric patients with JRRP and its relationship with the severity of the disease in a tertiary care pediatric hospital. RESULTS A strong relationship was observed between the severity of the disease and the age at the time of diagnosis, and having a tracheostomy. A moderate association was found between the severity of the disease and the age at the time of the study, the area of origin and the recurrence rate. None of the socioeconomic statuses had a correlation with the severity of the JRRP. CONCLUSIONS JRRP is associated with multiple surgeries due to the recurrence and aggressiveness of the disease. The socioeconomic status does not seem to influence the severity of the disease, whereas younger patients and users of tracheostomy should receive a more strict follow-up given the increased risk of severe disease.
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Affiliation(s)
- Lee Marvin Reyes
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Juan León Aguilar
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Perla Villamor
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico.
| | - Carlos De La Torre
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Alicia Álvarez
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Edgar Mantilla
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Hiram Álvarez-Neri
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
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Lindman JP, Lewis LS, Accortt N, Wiatrak BJ. Use of the Pediatric Quality of Life Inventory to Assess the Health-Related Quality of Life in Children with Recurrent Respiratory Papillomatosis. Ann Otol Rhinol Laryngol 2016; 114:499-503. [PMID: 16134343 DOI: 10.1177/000348940511400701] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The objective of this study was to use the Pediatric Quality of Life Inventory (PedsQL), a 23-question modular instrument designed to measure the health-related quality of life (HRQOL) in children and adolescents, to compare the HRQOL in children with recurrent respiratory papillomatosis (RRP) with the HRQOLs reported for healthy children and children with other chronic medical conditions. Methods: The PedsQL version 4.0 Generic Core Scales consist of 23 questions in 4 subscales (Physical, Emotional, Social, and School Functioning) for parent-proxy reporting on the HRQOL in children ages 2 to 4 years, parent reporting for children 5 to 18 years, and child self-reporting for ages 5 to 7 years (age-adjusted questions and rating scales) and 8 to 18 years. The questionnaires were administered in person or by telephone to 22 children with RRP and (or, for children 2 to 4 years of age) one parent recruited from a tertiary pediatric otolaryngology practice. The results were compared with validated norms for healthy children and scores for children whose parents reported a chronic medical condition. Results: Compared with healthy controls, the children 5 to 18 years of age with RRP self-reported a significantly (p < .05) worse HRQOL as measured by the PedsQL Total Score, Psychosocial Health score (a combination of Emotional, Social, and School Functioning Scores), and Social Functioning and School Functioning scores. Self-reported scores for the children 5 to 18 years of age with RRP compared with children with other chronic illnesses followed the same trend, and the difference approached statistical significance (p = .05) for the School Functioning Subscale scores. The parent-proxy report (for children 2 to 18 years of age) scores for children with RRP were significantly lower (p < .0001) on every scale and in total compared with scores for healthy children. Compared with scores of children with other chronic medical conditions, the parent-proxy report scores were significantly lower for psychosocial health (p = .005) and school functioning (p<.0001). Conclusions: Children with RRP report a lower quality of life than do those who are healthy, and a quality of life similar to that of those who have other chronic medical problems. The parent reports also reflect a lower quality of life for children affected by this disease, as compared with healthy children. The PedsQL demonstrated a statistically significant low HRQOL in children with RRP; however, the clinical implications of this finding appear trivial. A distinct, disease-specific survey for RRP, if developed, would have enhanced responsiveness and sensitivity to change (due to the natural course of the disease and/or surgical treatments).
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Affiliation(s)
- Jonathan P Lindman
- Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Janda P, Leunig A, Sroka R, Betz CS, Rasp G. Preliminary Report Of Endolaryngeal And Endotracheal Laser Surgery Of Juvenile-Onset Recurrent Respiratory Papillomatosis By Nd:Yag Laser and a New Fiber Guidance Instrument. Otolaryngol Head Neck Surg 2016; 131:44-9. [PMID: 15243556 DOI: 10.1016/j.otohns.2003.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES: Recurrent respiratory papillomatosis (RRP) caused by human papilloma virus (type 6 and 11) is the most common benign neoplasm of the larynx in children. Despite being a benign disease, treatment is very difficult and is characterized by frequent recurrence, spread throughout the respiratory tract, and malignant degeneration. Besides surgical resection and the established CO2 laser treatment, laser surgery by fiber-guided Nd:YAG laser light promises to be a bloodless and effective treatment procedure. To improve this new method, a novel fiber guidance instrument has been developed to aid in endolaryneal laser surgery of RRP. STUDY DESIGN AND SETTING: The method described uses a specially designed instrument for fiber guidance that is equipped with a bendable distal tip to move the fiber end precisely. Moreover, the instrument includes an additional channel for the suction of smoke and pyrolysis products. Up to now, 5 patients (aged 4 to 8 years) with RRP were treated by Nd:YAG laser light (λ = 1064 nm; power, 10W; irradiance, 3.5 kW/cm 2 , continuous wave) with a prototype version of the new instrument and were followed up for 12 months each. RESULTS: Because of the adequate length and the bendable distal tip with a range of −5° up to 45° to the optical axis of the fiber and less than 10% light loss at maximal deflection, RRP can be treated by Nd:YAG laser light easily and precisely. The continuous suctioning ensured an optimum view of the operating field and a minimal load of potential infectious laser plume and toxic pyrolysis products for the patient as well as for the physician. The laser treatment of RRP with the new fiber guidance instrument was only minimally traumatic. During 1-year follow-up visits, all Nd:YAG laser light-treated patients, showed a regression of the disease. CONCLUSIONS: The new fiber guidance instrument enables a precise and easy treatment of the RRP with fiber-guided laser systems (eg, Nd:YAG-, diode-, and KTP-lasers) and an effective removal of infectious laser plume as well as toxic pyrolysis products. A follow-up period of 1 year revealed that Nd:YAG laser surgery seems to prevent a rapid recurrence of juvenile respiratory papillomatosis in the treated patients.
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Affiliation(s)
- Philip Janda
- Department of Otorhinolaryngology, Ludwig-Maximilians University, Munich, Germany.
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Motz KM, Hillel AT. Office-based Management of Recurrent Respiratory Papilloma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016; 4:90-98. [PMID: 27242951 DOI: 10.1007/s40136-016-0118-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review will highlight the indications and benefits of office-based therapy for recurrent respiratory papillomatosis (RRP) and discuss the utilization of photo-dynamic lasers and adjuvant medical therapy in office-based settings. Office-based management of RRP allows for more timely interventions, is preferred by the majority of patients, and negates the risk of general anesthesia. Current literature argues for the utilization of KTP laser over CO2 laser for office-based treatment of RRP. Medical therapies for RRP are limited, but agents such as bevacizumab are promising and have been shown to reduce disease burden. Medical therapies that can induce disease remission are still needed. Office-based procedures save time and healthcare expenses compared to like procedures in the operating room. However, the increased frequency for office-based procedures predicts similar overall healthcare costs for office-based and OR laser excision of RRP. Office-based management of RRP is a feasible and well-tolerated strategy in appropriately selected patients with adequate local anesthesia.
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Affiliation(s)
- Kevin M Motz
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N. Caroline Street, JHOC 6th Floor, Baltimore, MD 21287, USA
| | - Alexander T Hillel
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N. Caroline Street, JHOC 6th Floor, Baltimore, MD 21287, USA
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Measso do Bonfim C, Simão Sobrinho J, Lacerda Nogueira R, Salgado Kupper D, Cardoso Pereira Valera F, Lacerda Nogueira M, Villa LL, Rahal P, Sichero L. Differences in Transcriptional Activity of Human Papillomavirus Type 6 Molecular Variants in Recurrent Respiratory Papillomatosis. PLoS One 2015; 10:e0132325. [PMID: 26151558 PMCID: PMC4494706 DOI: 10.1371/journal.pone.0132325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/14/2015] [Indexed: 11/19/2022] Open
Abstract
A significant proportion of recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus type 6 (HPV-6). The long control region (LCR) contains cis-elements for regulation of transcription. Our aim was to characterize LCR HPV-6 variants in RRP cases, compare promoter activity of these isolates and search for cellular transcription factors (TFs) that could explain the differences observed. The complete LCR from 13 RRP was analyzed. Transcriptional activity of 5 variants was compared using luciferase assays. Differences in putative TFs binding sites among variants were revealed using the TRANSFAC database. Chromatin immunoprecipation (CHIP) and luciferase assays were used to evaluate TF binding and impact upon transcription, respectively. Juvenile-onset RRP cases harbored exclusively HPV-6vc related variants, whereas among adult-onset cases HPV-6a variants were more prevalent. The HPV-6vc reference was more transcriptionally active than the HPV-6a reference. Active FOXA1, ELF1 and GATA1 binding sites overlap variable nucleotide positions among isolates and influenced LCR activity. Furthermore, our results support a crucial role for ELF1 on transcriptional downregulation. We identified TFs implicated in the regulation of HPV-6 early gene expression. Many of these factors are mutated in cancer or are putative cancer biomarkers, and must be further studied.
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Affiliation(s)
- Caroline Measso do Bonfim
- Laboratory of Genomic Studies, Universidade do Estado de São Paulo, UNESP, São José do Rio Preto, SP, Brazil
| | - João Simão Sobrinho
- Molecular Biology Laboratory, Center of Translational Oncology, Instituto do Câncer do Estado de São Paulo, ICESP, São Paulo, Brazil
| | - Rodrigo Lacerda Nogueira
- Department of Ophthalmology/Otorhinolaryngology and Head/Neck Surgery, Discipline Otorhinolaryngology, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, USP, São Paulo, Brazil
| | - Daniel Salgado Kupper
- Department of Ophthalmology/Otorhinolaryngology and Head/Neck Surgery, Discipline Otorhinolaryngology, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, USP, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology/Otorhinolaryngology and Head/Neck Surgery, Discipline Otorhinolaryngology, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, USP, São Paulo, Brazil
| | - Maurício Lacerda Nogueira
- Laboratory of Research in Virology, Faculty of Medicine of São José do Rio Preto, FAMERP, São José do Rio Preto, Brazil
| | - Luisa Lina Villa
- Molecular Biology Laboratory, Center of Translational Oncology, Instituto do Câncer do Estado de São Paulo, ICESP, São Paulo, Brazil
- Department of Radiology and Oncology, School of Medicine, Universidade de São Paulo, USP, São Paulo, Brazil
- School of Medicine, Santa Casa de São Paulo and HPV Institute, São Paulo, Brazil
| | - Paula Rahal
- Laboratory of Genomic Studies, Universidade do Estado de São Paulo, UNESP, São José do Rio Preto, SP, Brazil
| | - Laura Sichero
- Molecular Biology Laboratory, Center of Translational Oncology, Instituto do Câncer do Estado de São Paulo, ICESP, São Paulo, Brazil
- * E-mail:
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Estimating the incidence and prevalence of juvenile-onset recurrent respiratory papillomatosis in publicly and privately insured claims databases in the United States. Sex Transm Dis 2014; 41:300-5. [PMID: 24722383 DOI: 10.1097/olq.0000000000000115] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a chronic disease caused by human papillomavirus types 6 and 11. It is associated with significant morbidity that places intense physical, psychological, and financial strain on patients and their families. Few studies have assessed the incidence and prevalence of JORRP in the United States. METHODS This retrospective, longitudinal cohort study was performed using data from a pair of large insurance claims databases in the United States. The Optum Clinformatics and Truven MarketScan Medicaid databases represent a sample of privately and publicly insured children, respectively. Cohorts of children aged 0 to 17 years were created within each database to estimate the incidence and prevalence of JORRP in 2006. Claims-based algorithms were designed to capture as many potential cases as possible. To improve the accuracy of the incidence and prevalence estimates, chart validation was performed to estimate the positive predictive value (PPV) of the claims-based algorithms. RESULTS The overall PPV-adjusted incidence of JORRP in 2006 was 0.51 per 100,000 in Optum and 1.03 per 100,000 in the MarketScan Medicaid population. Peak incidence was observed among 0- to 4-year-olds in both databases. The PPV-adjusted prevalence of JORRP in 2006 was 1.45 and 2.93 per 100,000 in the Optum and MarketScan Medicaid cohorts, respectively. CONCLUSIONS Although relatively uncommon, JORRP represents a disease with significant morbidity. The incidence and prevalence of JORRP in publicly insured children were consistently higher than those covered by private insurance plans, suggesting an increased burden of illness among those with lower socioeconomic status.
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Ilmarinen T, Hagström J, Haglund C, Auvinen E, Leivo I, Pitkäranta A, Aaltonen LM. Low expression of nuclear Toll-like receptor 4 in laryngeal papillomas transforming into squamous cell carcinoma. Otolaryngol Head Neck Surg 2014; 151:785-90. [PMID: 25205638 DOI: 10.1177/0194599814549730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The malignant transformation rate of recurrent respiratory papillomatosis (RRP), a disease caused by human papillomavirus (HPV), has varied significantly. Cells of the human immune system express toll-like receptors (TLRs) that recognize particles from viruses and bacteria; TLRs are also present on tumor cells, and down-regulation of TLRs has been shown during the progression of HPV-associated neoplasia. The aim of this study was to determine the malignant transformation rate of laryngeal papillomas (LPs) and analyze the potential of TLR2, TLR4, and TLR9 immunoexpression as indicators of the increased cancer risk. STUDY DESIGN Retrospective case-control study. SETTING Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. SUBJECTS AND METHODS We reviewed all patients with RRP treated for LPs between 1975 and 2011. Data from the Finnish Cancer Registry confirmed the number of patients diagnosed with laryngeal squamous cell carcinoma (LSCC). Laryngeal tissue specimens from patients developing LSCC were subjected to TLR2, TLR4, and TLR9 immunohistochemistry. Nine patients with RRP without malignant transformation and 19 patients with LSCC without a pre-existing LP served as controls. RESULTS Nine of 324 patients (2.8%) with RRP developed LSCC. The intensity of nuclear staining of TLR4 was significantly lower in LPs transforming into LSCC than in LPs without malignant transformation. The expression of cytoplasmic TLR4 in LSCC correlated with tumor grade and T stage. Cytoplasmic TLR9 expression was significantly lower in LPs than in LSCC. CONCLUSION The expression of TLR4 may serve as a predictive marker of malignant transformation in LPs. High immunoexpression of cytoplasmic TLR4 in LSCC was associated with a more aggressive disease.
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Affiliation(s)
- Taru Ilmarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, Haartman Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland Helsinki University Hospital Laboratory, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Caj Haglund
- Department of Pathology, Haartman Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Eeva Auvinen
- Helsinki University Hospital Laboratory, Helsinki University Hospital, University of Helsinki, Helsinki, Finland Department of Virology, Haartman Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ilmo Leivo
- Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys. PLoS One 2014; 9:e89974. [PMID: 24651645 PMCID: PMC3961226 DOI: 10.1371/journal.pone.0089974] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/25/2014] [Indexed: 01/27/2023] Open
Abstract
Background Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. Methods A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Results Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered ‘good value for money.’ For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. Conclusions At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.
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Rodier C, Lapointe A, Coutlée F, Mayrand MH, Dal Soglio D, Roger M, Trottier H. Juvenile respiratory papillomatosis: risk factors for severity. J Med Virol 2013; 85:1447-58. [PMID: 23765781 DOI: 10.1002/jmv.23615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/10/2022]
Abstract
Juvenile recurrent respiratory papillomatosis is caused mainly by human papillomavirus genotypes 6 or 11, acquired at birth or during pregnancy from an infected mother. Recurrent respiratory papillomatosis is characterized by recurring warts growing most commonly in the larynx. Multiple surgical procedures and the risk of airway obstruction contribute to the devastating impact of this disease. Some children will go into remission after a few surgeries whereas others will require repeated interventions over several years. Further understanding of the risk factors associated with severity may contribute to tailored treatments. A retrospective study of cases diagnosed between January 1995 and December 2008 was conducted to study determinants of severe forms of juvenile recurrent respiratory papillomatosis. Demographic and clinical variables were abstracted from children's medical charts and mothers' delivery charts. Viral factors (HPV genotyping and viral load) were studied from archived biopsies. Specific HLA class II alleles and killer-cell immunoglobulin-like receptors genes were tested from saliva samples. Logistic regression was performed to identify risk factors for severity. Overall, 31 pediatric cases of recurrent respiratory papillomatosis were identified. The only significant factor associated with severe forms of recurrent respiratory papillomatosis was the maternal history of condylomas during pregnancy (OR: 12.05 [P=0.05]). The analysis failed to identify risk factors that could be used clinically to identify recurrent respiratory papillomatosis cases likely to take a severe course. Although too early to determine, vaccination against the HPV types involved most commonly in recurrent respiratory papillomatosis may provide the best hope to prevent severe forms of this disease.
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Affiliation(s)
- Caroline Rodier
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
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Management of complex glottic stenosis in children with recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2013; 77:1729-33. [PMID: 23972336 DOI: 10.1016/j.ijporl.2013.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe our management of complex glottic stenosis in tracheotomy dependent children with severe recurrent respiratory papillomatosis. METHODS Retrospective chart review at a tertiary care children's hospital. RESULTS Three children with complex glottic stenosis secondary to severe recurrent respiratory papillomatosis were treated at our institution since 2011. Two patients had complete stenosis, and the third had near-complete stenosis. Two patients were managed using balloon dilation alone, and the third also underwent laryngotracheal reconstruction with posterior costal cartilage grafting. Two patients have been successfully decannulated and the third has been tolerating continuous tracheotomy capping for greater than twelve months. All three patients underwent aggressive debridement of papillomatosis and balloon dilation every 4-6 weeks until their burden of disease was controlled. In two patients, the glottic airway was patent, and the third continued to have complete restenosis between procedures and required laryngotracheoplasty with multiple post-operative dilation procedures to establish an adequate glottic airway. CONCLUSIONS Severe laryngeal stenosis is a well-described complication of recurrent respiratory papillomatosis, but its management is not well-defined. Aggressive management of papillomatosis with frequent debridement is critical in successfully managing laryngeal stenosis. Balloon dilation alone may be surprisingly effective in these patients, and laryngotracheoplasty can be used as an adjunct procedure in those patients who fail balloon dilation. Given the quality of life issues and concerns regarding distal spread of disease with tracheotomies in these patients, we feel that aggressive management and early decannulation is in the patient's best interest.
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Hao Z, Dillard T, Biddinger P, Patel V. Suppression of respiratory papillomatosis with malignant transformation by erlotinib in a kidney transplant recipient. BMJ Case Rep 2013; 2013:bcr-2013-008757. [PMID: 23986124 DOI: 10.1136/bcr-2013-008757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old non-smoker and renal transplant recipient developed an incessant cough. A CT scan of the thorax revealed ill-defined hazy opacities in the right upper lung. He was diagnosed with non-tuberculosis Mycobacterium chelonae/abscessus infection based on sputum culture results. A trial of antibiotics initially resulted in some clinical improvement. A subsequent CT of the thorax documented worsening of the lesions in the right lung and new lesions on the left. An intratracheal growth was noted. Bronchoscopy with biopsy of the tracheal lesions documented respiratory papillomatosis with transformation to squamous cell cancer. Test for high-risk human papilloma virus was positive. Video-assisted thoracoscopic surgery biopsy with wedge resection of the left lower lobe revealed metastatic squamous cell lung cancer. He was treated with one ablation followed by four cycles of chemotherapy. He has been maintained on erlotinib ever since. There has been no recurrence of the cough or papillomas.
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Affiliation(s)
- Zhonglin Hao
- Cancer Center, Georgia Regents University, Augusta, Georgia, USA.
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Moldan MM, Bostrom BC, Tibesar RJ, Lander TA, Sidman JD. Epidermal growth factor receptor inhibitor therapy for recurrent respiratory papillomatosis. F1000Res 2013; 2:202. [PMID: 24795806 PMCID: PMC3999927 DOI: 10.12688/f1000research.2-202.v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/20/2022] Open
Abstract
The epidermal growth factor pathway has been implicated in various tumors, including human papillomavirus (HPV) lesions such as recurrent respiratory papillomatosis (RRP). Due to the presence of epidermal growth factor receptors in RRP, epidermal growth factor receptor (EGFR) inhibitors have been utilized as adjuvant therapy. This case series examines the response to EGFR inhibitors in RRP. Four patients with life-threatening RRP were treated with EGFR inhibitors. Operative frequency and anatomical Derkay scores were calculated prior to, and following EGFR inhibitor treatment via retrospective chart review. The anatomical Derkay score decreased for all four patients after initiation of EGFR inhibitor therapy. In one patient, the operative frequency increased after switching to an intravenous inhibitor after loss of control with an oral inhibitor. In the other patients there was a greater than 20% decrease in operative frequency in one and a more than doubling in the time between procedures in two. This study suggests that EGFR inhibitors are a potential adjuvant therapy in RRP and deserve further study in a larger number of patients.
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Affiliation(s)
- Matthew M Moldan
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bruce C Bostrom
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA
| | - Robert J Tibesar
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA ; Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Timothy A Lander
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA ; Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA
| | - James D Sidman
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA ; Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA
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Baio G, Capone A, Marcellusi A, Mennini FS, Favato G. Economic burden of human papillomavirus-related diseases in Italy. PLoS One 2012; 7:e49699. [PMID: 23185412 PMCID: PMC3504125 DOI: 10.1371/journal.pone.0049699] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 10/11/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Human papilloma virus (HPV) genotypes 6, 11, 16, and 18 impose a substantial burden of direct costs on the Italian National Health Service that has never been quantified fully. The main objective of the present study was to address this gap: (1) by estimating the total direct medical costs associated with nine major HPV-related diseases, namely invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, and head and neck, anogenital warts, and recurrent respiratory papillomatosis, and (2) by providing an aggregate measure of the total economic burden attributable to HPV 6, 11, 16, and 18 infection. METHODS For each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, and 18, in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection. RESULTS The total direct costs (expressed in 2011 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be €528.6 million, with a plausible range of €480.1-686.2 million. The fraction attributable to HPV 6, 11, 16, and 18 was €291.0 (range €274.5-315.7 million), accounting for approximately 55% of the total annual burden of HPV-related disease in Italy. CONCLUSIONS The results provided a plausible estimate of the significant economic burden imposed by the most prevalent HPV-related diseases on the Italian welfare system. The fraction of the total direct lifetime costs attributable to HPV 6, 11, 16, and 18 infections, and the economic burden of noncervical HPV-related diseases carried by men, were found to be cost drivers relevant to the making of informed decisions about future investments in programmes of HPV prevention.
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Affiliation(s)
- Gianluca Baio
- Department of Statistical Science, University College London, London, United Kingdom
- Biostatistics Unit, Department of Statistics, University of Milano–Bicocca, Milan, Italy
| | - Alessandro Capone
- Institute of Leadership and Management in Health (ILMH), Kingston University London, London, United Kingdom
| | - Andrea Marcellusi
- CEIS Sanità (CHEM – Centre for Health Economics and Management), Faculty of Economics, University of Tor Vergata, Rome, Italy
| | - Francesco Saverio Mennini
- Institute of Leadership and Management in Health (ILMH), Kingston University London, London, United Kingdom
- CEIS Sanità (CHEM – Centre for Health Economics and Management), Faculty of Economics, University of Tor Vergata, Rome, Italy
| | - Giampiero Favato
- Institute of Leadership and Management in Health (ILMH), Kingston University London, London, United Kingdom
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Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine 2012; 30:6016-9. [PMID: 22867718 DOI: 10.1016/j.vaccine.2012.07.056] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 07/18/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
Abstract
Estimates of the direct medical costs attributable to human papillomavirus (HPV) can help to quantify the economic burden of HPV and to illustrate the potential benefits of HPV vaccination. The purpose of this report was to update the estimated annual direct medical costs of the prevention and treatment of HPV-associated disease in the United States, for all HPV types. We included the costs of cervical cancer screening and follow-up and the treatment costs of the following HPV-associated health outcomes: cervical cancer, other anogenital cancers (anal, vaginal, vulvar and penile), oropharyngeal cancer, genital warts, and recurrent respiratory papillomatosis (RRP). We obtained updated incidence and cost estimates from the literature. The overall annual direct medical cost burden of preventing and treating HPV-associated disease was estimated to be $8.0 billion (2010 U.S. dollars). Of this total cost, about $6.6 billion (82.3%) was for routine cervical cancer screening and follow-up, $1.0 billion (12.0%) was for cancer (including $0.4 billion for cervical cancer and $0.3 billion for oropharyngeal cancer), $0.3 billion (3.6%) was for genital warts, and $0.2 billion (2.1%) was for RRP.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Ongkasuwan J, Friedman EM. Juvenile recurrent respiratory papilloma: Variable intersurgical intervals. Laryngoscope 2012; 122:2844-9. [PMID: 22847877 DOI: 10.1002/lary.23534] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/02/2012] [Accepted: 05/30/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
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Jit M, Chapman R, Hughes O, Choi YH. Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model. BMJ 2011; 343:d5775. [PMID: 21951758 PMCID: PMC3181234 DOI: 10.1136/bmj.d5775] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare the effect and cost effectiveness of bivalent and quadrivalent human papillomavirus (HPV) vaccination, taking into account differences in licensure indications, protection against non-vaccine type disease, protection against disease related to HPV types 6 and 11, and reported long term immunogenicity. DESIGN A model of HPV transmission and disease previously used to inform UK vaccination policy, updated with recent evidence and expanded to include scenarios where the two vaccines differ in duration of protection, cross protection, and end points prevented. SETTING United Kingdom. Population Males and females aged 12-75 years. MAIN OUTCOME MEASURE Incremental cost effectiveness ratios for both vaccines and additional cost per dose for the quadrivalent vaccine to be equally cost effective as the bivalent vaccine. RESULTS The bivalent vaccine needs to be cheaper than the quadrivalent vaccine to be equally cost effective, mainly because of its lack of protection against anogenital warts. The price difference per dose ranges from a median of £19 (interquartile range £12-£27) to £35 (£27-£44) across scenarios about vaccine duration, cross protection, and end points prevented (assuming one quality adjusted life year (QALY) is valued at £30,000 and both vaccines can prevent all types of HPV related cancers). CONCLUSIONS The quadrivalent vaccine may have an advantage over the bivalent vaccine in reducing healthcare costs and QALYs lost. The bivalent vaccine may have an advantage in preventing death due to cancer. However, considerable uncertainty remains about the differential benefit of the two vaccines.
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Affiliation(s)
- Mark Jit
- Health Protection Agency, London NW9 6BT, UK.
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Katsenos S, Becker HD. Recurrent respiratory papillomatosis: a rare chronic disease, difficult to treat, with potential to lung cancer transformation: apropos of two cases and a brief literature review. Case Rep Oncol 2011; 4:162-71. [PMID: 21526134 PMCID: PMC3081647 DOI: 10.1159/000327094] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP), which is caused exclusively by human papilloma virus (HPV), is a rare condition characterized by recurrent growth of benign papillomata in the respiratory tract. The papillomata can occur anywhere in the aerodigestive tract but most frequently in the larynx, affecting both children and adults. The management of this entity remains still challenging since no specific definitive treatment exists. Nevertheless, novel surgical interventions as well as several adjuvant therapies have shown promising results in the long-term palliative management of this debilitating disease. Despite its mostly benign nature, RRP may cause significant morbidity and mortality because of its unpredictable clinical course and especially its tendency, albeit infrequent, for malignant transformation. In this article, we present two patients with RRP; one underwent bronchoscopic laser ablation in combination with inhaled interferon-alpha administration that led to a long-term regression of the disease while the other patient was diagnosed with transformation to squamous cell lung carcinoma with fatal outcome. We include a review of the current literature with special emphasis on RRP management and the potential role of HPV in the development of lung cancer.
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Affiliation(s)
- Stamatis Katsenos
- Department of Interdisciplinary Endoscopy, Thoraxklinik at Heidelberg University, Heidelberg, Germany
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Ksiazek J, Prager JD, Sun GH, Wood RE, Arjmand EM. Inhaled cidofovir as an adjuvant therapy for recurrent respiratory papillomatosis. Otolaryngol Head Neck Surg 2011; 144:639-41. [PMID: 21493248 DOI: 10.1177/0194599810395353] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A previously healthy, full-term, 4-month-old boy presented with progressively weakening cry, hoarseness, and increased work of breathing. Flexible fiberoptic laryngoscopy revealed glottic papillomas, which were endoscopically removed with a microdebrider in the operating room (Derkay score 23). The patient was diagnosed with recurrent respiratory papillomatosis that disseminated throughout his airway. Despite biweekly serial microdebridements, intralesional cidofovir, and systemic interferon-α, the patient's health declined substantially (Derkay score 40), culminating in a 47-day hospitalization due to complications of his disease. Inhaled cidofovir was initiated after all conventional treatments had failed. Within 6 weeks of therapy (40 mg daily per treatment, 12 days on and 2 days off), the papillomatous disease improved substantially (Derkay score 23). While inhaled cidofovir appeared to significantly reduce papillomatous disease burden in this patient, further investigation into its long-term effectiveness and safety profile is necessary.
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Affiliation(s)
- Jeffrey Ksiazek
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Xue Q, Wang H, Wang J. Recurrent respiratory papillomatosis: an overview. Eur J Clin Microbiol Infect Dis 2010; 29:1051-4. [DOI: 10.1007/s10096-010-0963-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 05/06/2010] [Indexed: 11/28/2022]
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Abstract
Recurrent respiratory papillomatosis (RRP) is an infrequent benign neoplasm commonly involving the upper respiratory tract with laryngeal predilection. The diagnosis and treatment of this disease are challenging due to its nonspecific clinical presentations and recurrent nature. We report here a rare juvenile case of RRP arising in the trachea without laryngeal lesions. Our experiences indicate that a high awareness of RRP and proper consideration in the right clinical context are prerequisites for early diagnosis, and a combination of multiple treatment modalities should be considered as a feasible treatment regimen.
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Affiliation(s)
- Qingliang Xue
- Respiratory Diseases Department of the Chinese PLA General Hospital
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van Nieuwenhuizen AJ, Rinkel RNPM, de Bree R, Leemans CR, Verdonck-de Leeuw IM. Patient reported voice outcome in recurrent respiratory papillomatosis. Laryngoscope 2010; 120:188-92. [PMID: 19877192 DOI: 10.1002/lary.20662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS To assess the impact of patient reported voice outcome on quality of life and emotional functioning in patients treated for recurrent respiratory papillomatosis (RRP). STUDY DESIGN Cross-sectional. METHODS All adult patients treated for RRP between 1984 and 2008 were asked to participate. Outcome measures were obtained from questionnaires including VHI (Voice Handicap Index), HADS (Hospital Anxiety and Depression Scale), 36-Item Short Form Health Survey (SF-36), and Utrechtse Coping List. RESULTS Out of 45 included patients, 34 (22 males,12 females) participated (76%). Mean age was 52 years (range, 25-85 years). RRP was located only in the larynx in 90% of the cases. Adult onset RRP was diagnosed in 29 cases, juvenile onset RRP in 5. Median number of surgical procedures was five (range, 1-17). In this study cohort, 68% scored above the VHI cutoff point, and 18% had an increased risk for depression or anxiety disorders (HADS). VHI scores were related to age, time between consecutive surgeries, time since last surgery, and passive coping. They were not related to gender, onset of RRP, or location. VHI scores were related to the SF-36 subscales social functioning (r = -0.43) and mental health (r = -0.43). CONCLUSIONS Patients with RRP often report voice problems in daily life, and this is related to (a passive) coping style, social functioning, and mental health. Psychosocial intervention targeting an adaptive coping style may be beneficial in selected cases.
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Affiliation(s)
- Annette J van Nieuwenhuizen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis. The Journal of Laryngology & Otology 2009; 124:510-4. [DOI: 10.1017/s0022215109992398] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractBackground:A variety of treatment modalities are currently used to treat recurrent respiratory papillomatosis. We aimed to study the efficacy of radiofrequency cold ablation (coblation) for the treatment of laryngotracheal recurrent respiratory papillomatosis, by comparing treatment intervals for coblation and CO2 laser vaporisation.Method:Retrospective case series of adult patients with advanced laryngotracheal recurrent respiratory papillomatosis.Results:Six patients were treated for at least two years by CO2 laser vaporisation with or without intralesional cidofovir. All six subsequently underwent treatment with radiofrequency coblation with or without intralesional cidofovir. Coblation resulted in longer periods between interventions, compared with CO2 laser (p = 0.03).Conclusion:Radiofrequency coblation appears to be an attractive alternative technique to CO2 laser for the surgical treatment of advanced laryngotracheal papillomata.
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Kim JJ, Goldie SJ. Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States. BMJ 2009; 339:b3884. [PMID: 19815582 PMCID: PMC2759438 DOI: 10.1136/bmj.b3884] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the cost effectiveness of including preadolescent boys in a routine human papillomavirus (HPV) vaccination programme for preadolescent girls. DESIGN Cost effectiveness analysis from the societal perspective. SETTING United States. POPULATION Girls and boys aged 12 years. INTERVENTIONS HPV vaccination of girls alone and of girls and boys in the context of screening for cervical cancer. Main outcome measure Incremental cost effectiveness ratios, expressed as cost per quality adjusted life year (QALY) gained. RESULTS With 75% vaccination coverage and an assumption of complete, lifelong vaccine efficacy, routine HPV vaccination of 12 year old girls was consistently less than $50,000 per QALY gained compared with screening alone. Including preadolescent boys in a routine vaccination programme for preadolescent girls resulted in higher costs and benefits and generally had cost effectiveness ratios that exceeded $100,000 per QALY across a range of HPV related outcomes, scenarios for cervical cancer screening, and assumptions of vaccine efficacy and duration. Vaccinating both girls and boys fell below a willingness to pay threshold of $100,000 per QALY only under scenarios of high, lifelong vaccine efficacy against all HPV related diseases (including other non-cervical cancers and genital warts), or scenarios of lower efficacy with lower coverage or lower vaccine costs. CONCLUSIONS Given currently available information, including boys in an HPV vaccination programme generally exceeds conventional thresholds of good value for money, even under favourable conditions of vaccine protection and health benefits. Uncertainty still exists in many areas that can either strengthen or attenuate our findings. As new information emerges, assumptions and analyses will need to be iteratively revised to continue to inform policies for HPV vaccination.
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Affiliation(s)
- Jane J Kim
- Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision Science, 718 Huntington Avenue, Boston, MA 02115, USA.
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Johnson K, Derkay C. Palliative Aspects of Recurrent Respiratory Papillomatosis. Otolaryngol Clin North Am 2009; 42:57-70, viii. [DOI: 10.1016/j.otc.2008.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Insinga RP, Dasbach EJ, Elbasha EH. Structural differences among cost-effectiveness models of human papillomavirus vaccines. Expert Rev Vaccines 2008; 7:895-913. [PMID: 18767941 DOI: 10.1586/14760584.7.7.895] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this article we compare previously published cost-effectiveness studies of human papillomavirus (HPV) vaccines along a defined subset of key model structural assumptions relating to HPV infection and disease, cervical cancer screening and HPV vaccination. For each structural aspect examined, we summarize assumptions from each study, provide a critical review and discuss the impact upon results. Considerable variation was observed across HPV vaccine cost-effectiveness models in a number of influential assumptions. Holding constant factors for which current data are lacking, the combined impact of assumptions made for the remaining parameters examined would appear to tend toward underestimation of the cost-effectiveness of HPV vaccination within existing studies. However, uncertainty concerning parameters, such as the duration of vaccine protection and acquired immunity following HPV infection, and the relationship between age and HPV virulence, complicates precise estimation of the cost-effectiveness of HPV vaccination and rigorous evaluation of the validity of existing modeling results.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA 19454-1099, USA.
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Poetker DM, Patel NJ, Kerschner JE. Cidofovir modulated gene expression in recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2008; 72:1385-92. [PMID: 18620760 DOI: 10.1016/j.ijporl.2008.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 05/27/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) is a benign aerodigestive tract neoplasm. Cidofovir, an antiviral drug, has demonstrated efficacy in slowing and/or reducing RRP recurrence. This investigation examined the differential gene expression of RPP before and after cidofovir use in vivo. METHODS Papillomas were harvested from two patients pre- and post-cidofovir treatment. RNA was extracted from the tissues and separate Serial Analysis of Gene Expression (SAGE) libraries created. Overall gene expression as well as relative gene expression in the four libraries was compared. RESULTS Over 19,000 tags were found in each of the libraries, with over 6000 unique transcripts identified in the pre-treatment and over 6000 identified in the post-cidofovir libraries of both patient 1 and 2. Following cidofovir treatment, the greatest up-regulation was in gene families associated with cell proliferation, metabolism, transport and response to biotic stimuli. Post-treatment up-regulation was seen in numerous specific genes, such as Interferon Regulatory Factor 7 (P=0.000014), which has been associated with virus-host interactions, passive viral induction of host immune response, and response to DNA damage stimulus. Down-regulation was demonstrated in gene families associated with transcription, regulation of nucleic acid metabolism, and signal transduction. DISCUSSION Creation of RRP SAGE libraries demonstrates a broad list of genes expressed in RRP, as well as significant differences in gene expression after exposure to cidofovir, potentially allowing for a more thorough understanding of important genetic pathways in RRP treatment. In addition, over 1400 unique transcripts were identified, which will facilitate new gene discovery in RRP research.
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Affiliation(s)
- David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Abstract
BACKGROUND The cost-effectiveness of prophylactic vaccination against human papillomavirus types 16 (HPV-16) and 18 (HPV-18) is an important consideration for guidelines for immunization in the United States. METHODS We synthesized epidemiologic and demographic data using models of HPV-16 and HPV-18 transmission and cervical carcinogenesis to compare the health and economic outcomes of vaccinating preadolescent girls (at 12 years of age) and vaccinating older girls and women in catch-up programs (to 18, 21, or 26 years of age). We examined the health benefits of averting other HPV-16-related and HPV-18-related cancers, the prevention of HPV-6-related and HPV-11-related genital warts and juvenile-onset recurrent respiratory papillomatosis by means of the quadrivalent vaccine, the duration of immunity, and future screening practices. RESULTS On the assumption that the vaccine provided lifelong immunity, the cost-effectiveness ratio of vaccination of 12-year-old girls was $43,600 per quality-adjusted life-year (QALY) gained, as compared with the current screening practice. Under baseline assumptions, the cost-effectiveness ratio for extending a temporary catch-up program for girls to 18 years of age was $97,300 per QALY; the cost of extending vaccination of girls and women to the age of 21 years was $120,400 per QALY, and the cost for extension to the age of 26 years was $152,700 per QALY. The results were sensitive to the duration of vaccine-induced immunity; if immunity waned after 10 years, the cost of vaccination of preadolescent girls exceeded $140,000 per QALY, and catch-up strategies were less cost-effective than screening alone. The cost-effectiveness ratios for vaccination strategies were more favorable if the benefits of averting other health conditions were included or if screening was delayed and performed at less frequent intervals and with more sensitive tests; they were less favorable if vaccinated girls were preferentially screened more frequently in adulthood. CONCLUSIONS The cost-effectiveness of HPV vaccination will depend on the duration of vaccine immunity and will be optimized by achieving high coverage in preadolescent girls, targeting initial catch-up efforts to women up to 18 or 21 years of age, and revising screening policies.
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Affiliation(s)
- Jane J Kim
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
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Chesson HW, Forhan SE, Gottlieb SL, Markowitz LE. The potential health and economic benefits of preventing recurrent respiratory papillomatosis through quadrivalent human papillomavirus vaccination. Vaccine 2008; 26:4513-8. [DOI: 10.1016/j.vaccine.2008.06.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 06/10/2008] [Accepted: 06/12/2008] [Indexed: 10/21/2022]
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Abstract
PURPOSE OF REVIEW The human papillomavirus vaccine is now Food and Drug Administration-approved for girls and young women ages 9-26 years and Advisory Committee on Immunization Practices-recommended for girls ages 11-12 years of age. Several issues have shrouded its debut and continue to provide controversy that may hinder effective delivery of this vaccine to young people in industrialized as well as third world countries. RECENT FINDINGS The quadrivalent and divalent vaccines are compared, particularly with respect to juvenile recurrent respiratory papillomatosis. Recommendations for administration are summarized. Immunization of men and cost effectiveness are discussed. Issues regarding compulsory vaccination and attitudes of parents about human papillomavirus vaccination are reviewed. SUMMARY Studies of the human papillomavirus vaccine are very promising, showing excellent efficacy and very few adverse events. It remains to be determined if it will be licensed in the United States for use in boys and men. Some stumbling blocks to implementing the vaccine in the United States need to be addressed in order to gain widespread acceptance.
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Abstract
Recurrent respiratory papillomatosis (RRP), which is caused by human papillomavirus types 6 and 11, is the most common benign neoplasm of the larynx among children and the second most frequent cause of childhood hoarseness. After changes in voice, stridor is the second most common symptom, first inspiratory and then biphasic. Less common presenting symptoms include chronic cough, recurrent pneumonia, failure to thrive, dyspnea, dysphagia, or acute respiratory distress, especially in infants with an upper respiratory tract infection. Differential diagnoses include asthma, croup, allergies, vocal nodules, or bronchitis. Reports estimate the incidence of RRP in the United States at 4.3 per 100,000 children and 1.8 per 100,000 adults. Infection in children has been associated with vertical transmission during vaginal delivery from an infected mother. Younger age at diagnosis is associated with more aggressive disease and the need for more frequent surgical procedures to decrease the airway burden. When surgical therapy is needed more frequently than four times in 12 months or there is evidence of RRP outside the larynx, adjuvant medical therapy should be considered. Adjuvant therapies that have been investigated include dietary supplements, control of extra-esophageal reflux disease, potent antiviral and chemotherapeutic agents, and photodynamic therapies; although several have shown promise, none to date has "cured" RRP, and some may have serious side effects. Because RRP, although histologically benign, is so difficult to control and can cause severe morbidity and death, better therapies are needed. The potential for a quadrivalent human papilloma vaccine is being explored to reduce the incidence of this disease.
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Hu D, Goldie S. The economic burden of noncervical human papillomavirus disease in the United States. Am J Obstet Gynecol 2008; 198:500.e1-7. [PMID: 18455524 DOI: 10.1016/j.ajog.2008.03.064] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 12/31/2007] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was (1) to estimate the direct medical costs of 7 major noncervical human papillomavirus (HPV)-related conditions that include genital cancers, mouth and oropharyngeal cancers, anogenital warts, and juvenile-onset recurrent respiratory papillomatosis, and (2) to approximate the economic burden of noncervical HPV disease. STUDY DESIGN For each condition, we synthesized the best available secondary data to produce lifetime cost per case estimates, which were expressed in present value. Using an incidence-based approach, we then applied these costs to develop an aggregate measure of economic burden. RESULTS The economic burden that was associated with noncervical HPV-6-, -11-, -16-, and -18-related conditions in the US population in the year 2003 approximates $418 million (range, $160 million to $1.6 billion). CONCLUSION The economic burden of noncervical HPV disease is substantial. Analyses that assess the value of investments in HPV prevention and control programs should take into account the costs and morbidity and mortality rates that are associated with these conditions.
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Hoory T, Monie A, Gravitt P, Wu TC. Molecular Epidemiology of Human Papillomavirus. J Formos Med Assoc 2008; 107:198-217. [PMID: 18400605 DOI: 10.1016/s0929-6646(08)60138-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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