HPVrelated Disease Burden and Costs in Taiwan Dr

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HPV-related Disease Burden and Costs in Taiwan Dr. CJ Tseng CGMH, Taiwan 09/04/2006

HPV-related Disease Burden and Costs in Taiwan Dr. CJ Tseng CGMH, Taiwan 09/04/2006

Outline L 1 § § HPV epidemiology in Taiwan § Cost analysis for Cervical

Outline L 1 § § HPV epidemiology in Taiwan § Cost analysis for Cervical neoplasia in Taiwan § Cost-effectiveness analysis of HPV vaccine E 1 R** C L E 6 E 7 HPV 16 (7, 905 bp***) Cervical neoplasia disease burden in Taiwan § § Self-paid view Agency view 2 E 2 4 E E 5 L 2

HPV Epidemiology in Taiwan REFERENCES 1. Lin Hao, et al. Prevalence of cervical human

HPV Epidemiology in Taiwan REFERENCES 1. Lin Hao, et al. Prevalence of cervical human papillomavirus in Taiwanese women , Gynecol Oncol. 2006, 101: 40 -5. 2. Jeng CJ , et al. Prevalence of cervical human papillomavirus in Taiwanese women. Clin Invest Med. 2005 Oct; 28: 261 -6. 3. Tseng CJ: Prevalence of cervical human papillomavirus in Taiwanese women , 2005 year’s report of the Department of Health Taiwan. Am J OBGYN, 2006, in press 4. Prevalence of cervical human papillomavirus in Taiwanese women , 2006 year’s report of the Department of Health Taiwan. 5. Chu TU, et al. : From 3 studies (TSGH, T 1899, and CBCP), presented in TAGO, 2002 6. Huang LW, et al. : Type-specific distribution of human papillomavirus in relation to grades of cervical neoplasia. , Int J Gynaecol Obstet. 2006 ; 92: 143 -4. 7. Hung-Cheng Lai, et al. Favorable Clinical Outcome of Cervical Cancers Infected with Human Papilloma Virus Type 58 and Related Types, Int. J. Cancer 1999: 84, 553557. 3

HPV infection by Age, Taiwan 13. 73 % The 10 -county HPV screening study

HPV infection by Age, Taiwan 13. 73 % The 10 -county HPV screening study by the Department of Health, Taiwan, 2005. Total number = 10, 000

Prevalence of HPV in Taiwanese Women HPVs CJ Tseng Jeng CJ Lin Hao Case

Prevalence of HPV in Taiwanese Women HPVs CJ Tseng Jeng CJ Lin Hao Case No 6036 1320 4383 Age 18 - 50 21 - 65 16– 78 Method Gene. Chip MY 11/bio. GP 6+ Overall prevalence 25. 4% Multiple infection 31. 1 % 35. 84% 22. 1% HR-HPV 14. 3% 19. 85% 11. 1% HPV 16 2. 5% 4. 9 % 2. 5% HPV 18 2. 1% 4. 7 % 1. 1% HPV 52 2. 2% 3. 1 % 2. 4% HPV 58 1. 8% 3. 3 % 2. 1% HPV 51 1. 1% 2. 9 % 0. 9 % HPV 56 1. 7% 2. 8 % 0. 8 %(HPV 33) l l 19. 3% Prevalence of cervical human papillomavirus in Taiwanese women , Lin Hao, Gynecol Oncol. 2006, 101: 40 -5. Prevalence of cervical human papillomavirus in Taiwanese women. Jeng CJ , Clin Invest Med. 2005 Oct; 28: 261 -6. Prevalence of cervical human papillomavirus in Taiwanese women , 2006 year’s report of the Department of Health Taiwan. All were Cytology sample. 5

HPV Type-specific Prevalence, Taiwan HPV types % No 11, 739 Single infection Multiple infection

HPV Type-specific Prevalence, Taiwan HPV types % No 11, 739 Single infection Multiple infection l l l 28. 27 HPV prevalence HPV types % HPV 16 2. 77 HPV 18 2. 02 HPV 52 2. 38 HPV 58 2. 08 HPV 56 1. 49 HR-HPV 13. 73 LR-HPV 13. 6 16+18 4. 79 HPV 51 1. 23 16+18+52+58 9. 25 HPV 11 11% Prevalence of cervical human papillomavirus in Taiwanese women , Lin Hao, Gynecol Oncol. 2006, 101: 40 -5. Prevalence of cervical human papillomavirus in Taiwanese women. Jeng CJ , Clin Invest Med. 2005 Oct; 28: 261 -6. Prevalence of cervical human papillomavirus in Taiwanese women , 2006 year’s report of the Department of Health Taiwan 6

Type-Specific Prevalence of HPV in Precancer and Carcinomas of the Cervix in Taiwan LSIL

Type-Specific Prevalence of HPV in Precancer and Carcinomas of the Cervix in Taiwan LSIL % HSIL Cancer Tseng Liaw Chu Lai n=168 n=78 N=589 n=379 n=101 N=711 n=255 n=167 N=263 n=94 HRHPVs 45 7 85 91 98 99 90 86 HPV 16 19. 3 37. 18 5. 6 28. 6 50. 50 23. 2 46. 2 65. 9 43. 7 47. 9 HPV 18 17. 2 28. 21 3. 0 14. 3 32. 67 1. 8 15. 5 22. 8 10. 3 8. 5 HPV 58 7. 2 19. 23 3. 6 28. 6 18. 81 11. 7 17. 2 9. 0 8. 7 18. 1 HPV 52 13. 4 21. 79 9. 0 25. 0 18. 81 12. 1 10. 9 3. 0 2. 7 2. 1 l l Sample : Liaw: cytology sample; Tseng: biopsy; Chu : biopsy; Lai : biopsy. HPV assay: Liaw: PCR ; Tseng: Genechip ; Chu : PCR ; Lai : PCR l l Chu TU, et al. : From 3 studies (TSGH, T 1899, and CBCP), presented in TAGO, 2002 Huang LW, et al. : Type-specific distribution of human papillomavirus in relation to grades of cervical neoplasia. , Int J Gynaecol Obstet. 2006 ; 92: 143 -4. Tseng CJ: Prevalence of cervical human papillomavirus in Taiwanese women , 2005 year’s report of the Department of Health Taiwan. Am J OBGYN, 2006, in press Favorable Clinical Outcome of Cervical Cancers Infected with Human Papilloma Virus Type 58 and Related Types, Hung-Cheng Lai Int. J. Cancer 1999: 84, 553 -557 l l 7

Type-Specific Prevalence of HPV in Precancer and Carcinomas of the Cervix in Taiwan HPV

Type-Specific Prevalence of HPV in Precancer and Carcinomas of the Cervix in Taiwan HPV types LSIL HSIL ICC Total 835 1191 779 HPV 16 11. 37% 27. 23% 49. 78% HPV 18 8. 21% 8. 40% 14. 46% HPV 58 5. 78% 17. 68% 12. 68% HPV 52 11. 08% 16. 77% 5. 38% HPV 31 2. 45% 6. 54% 4. 23% HPV 33 2. 47% 7. 48% 3. 25% 16 +18 19. 58% 35. 63% 64. 25% 16+18+52+58 30. 66% 70. 05% 82. 31% 8

Theoretical Rate Reduction of HPV Vaccination, in Taiwan 9

Theoretical Rate Reduction of HPV Vaccination, in Taiwan 9

Disease Burden Of Cervical Cancer and Precancer, in Taiwan REFERENCES 1. Data from the

Disease Burden Of Cervical Cancer and Precancer, in Taiwan REFERENCES 1. Data from the “Year-report of cancer” of National Cancer Registration System, Department of National Health, Taiwan, 2003 2. Chien-Jen Chen , et al. Cancer Epidemiology and Control in Taiwan. Chien-Jen Chen, et al. Japanese Journal of Clinical Oncology 32: S 66 -S 81, 2003. YY Chen et al. National Cervical Neoplasia Screening Program in Taiwan: 10 -year Experiences on Six Million Women. 2005. Presented in the 2006 year-meeting of the Association of Taiwan OBGYN. 10

Mortality of female cancer, in Taiwan,2003 Total no of women : 11, 062, 426,

Mortality of female cancer, in Taiwan,2003 Total no of women : 11, 062, 426, Taiwan, 2003 Sites Mortality (%) 1 Lung 2219 19. 85 2 Liver 1887 16. 88 3 Colon 1686 15. 08 4 Breast 1439 12. 87 5 Cervix 874 7. 82 6 Stomach 819 7. 33 7 Pancreases 517 4. 63 8 Gall bladder 458 9 Lymphoma 451 4. 10 10 Ovary 357 4. 03 13278 118. 8 Total l No Data from the “Year-report of cancer” of National Cancer Registration System, Department of National Health, Taiwan, 2003 11

Incidence of female cancer, in Taiwan,2003 Sites 1 No Incidence Cervix 5, 725 46.

Incidence of female cancer, in Taiwan,2003 Sites 1 No Incidence Cervix 5, 725 46. 22 CIS 3, 618 29. 01 Invasive cancer 2, 107 17. 21 2 Breast 5, 339 43. 27 3 Colon 3, 370 28. 22 4 Liver 2, 455 21. 00 5 Lung 2, 339 19. 62 6 Prostate 1, 250 10. 43 7 Skin 995 8. 33 8 Thyroid 989 8. 11 9 Uterus 733 6. 06 10 Ovary 729 6. 04 29, 140 241. 69 Total l Data from “Year report of cancer” of National cancer registration system, Department of National Health, Taiwan, 2003 12

National Cervical Neoplasia Screening Program in Taiwan 10 -year Experiences on Six Million Women

National Cervical Neoplasia Screening Program in Taiwan 10 -year Experiences on Six Million Women Cervix Cancer Screening Registration System Department of National Health , Taiwan PI: Dr. Chien-Jen Chen , et al Minister of National Health , Taiwan Cancer Epidemiology and Control in Taiwan. Chien-Jen Chen, et al. Japanese Journal of Clinical Oncology 32: S 66 -S 81, 2003

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Reduction of mortality (1988 -1992) Cancer incidence per 100, 000 Impact of Screening on

Reduction of mortality (1988 -1992) Cancer incidence per 100, 000 Impact of Screening on Cervical Cancer Incidence Category Reduction rate Cancer Reduction with Screening Age Denmark Finland Sweden Iceland Norway Taiwan 59% 76% 66% 39% 32. 9% 15

Cervical cancer and precancer, in Taiwan Total no of women : 11, 062, 426,

Cervical cancer and precancer, in Taiwan Total no of women : 11, 062, 426, Taiwan, 2003 Incidence Case No Incidence / per 100, 000 l ASCUS CIN I/II CIN III Invasive 15, 674 6, 697 3, 618 2, 107 125. 68 53. 7 29. 01 17. 21 Data from “Year report of cancer” of National cancer registration system, Department of National Health, Taiwan, 2003 l Diagnosis based on pathology 16

Current Facts of Cervical Cancer Screening Annual Screening Program: in Taiwan l. YY Chen

Current Facts of Cervical Cancer Screening Annual Screening Program: in Taiwan l. YY Chen et al, 2005. National Cervical Neoplasia Screening Program in Taiwan: 10 -year Experiences on Six Million Women. 17

Cervical Cancer Women in Taiwan (2002) Cervical Cancer Women , 1/6 screened in 3

Cervical Cancer Women in Taiwan (2002) Cervical Cancer Women , 1/6 screened in 3 -years Ø 1/6 screened sporadically, >3 years Ø 1/6 screened rarely, (>5 years) Ø 1/2 never screened l l l over screening for some under screening for some poor follow up for some 18

Cost Analysis for Cervical Cancer and Precancer in Taiwan REFERENCES 1. Data from the

Cost Analysis for Cervical Cancer and Precancer in Taiwan REFERENCES 1. Data from the “Year-report of cancer” of National Cancer Registration System, Department of National Health, Taiwan, 2003 2. CJ Tseng, et al. The 2003 -2005 quality review for Cervical Cancer. Presented in the Department of National Insurance. Chang Gung Memorial Hospital, Chia-Yi , and, Taiwan. 3. YY Chen et al. National Cervical Neoplasia Screening Program in Taiwan: 10 -year Experiences on Six Million Women. 2005. Presented in the 2006 year-meeting of the Association of Taiwan OBGYN. 19

Quality Control Study for Cervical Cancer Studied subject: medical database from Taiwan National Insurance

Quality Control Study for Cervical Cancer Studied subject: medical database from Taiwan National Insurance Studied Aims: to evaluate the cost effective and quality Studied data were linked between the database from the National Insurance (south Taiwan) and the database from the National Cervical Cancer Registration System. This study was supported by : Department of National Insurance, Taiwan Department of National Health , Taiwan PI: Dr. Chih-Jen Tseng CJ Tseng, et al. The 2003 -2005 quality review for Cervical Cancer. Presented in the Department of National Insurance. Chang Gung Memorial Hospital, Chia-Yi , and, Taiwan.

Quality Control Study for Cervical Cancer Total no of women : 11, 062, 426,

Quality Control Study for Cervical Cancer Total no of women : 11, 062, 426, in Taiwan, 2003 Pap smear total no : 1, 934, 931 - National Cervical Cancer Registration System - Department of National Health , Taiwan Quality control sample: 1, 400, 545 women (age > 30) Pap smear no : 714, 278 From Jan. 2003 to Dec. 2005 - database from the Taiwan National Insurance. - Department of National Insurance, south Taiwan

Quality Control Study for Cervical Cancer 22

Quality Control Study for Cervical Cancer 22

Total Cost of Cervical Cancer and Precancer Total no of women : 1, 400,

Total Cost of Cervical Cancer and Precancer Total no of women : 1, 400, 545, South Taiwan, 2005 Follow up for 3 years. Enrolled: New cases. Exclusion: Dropped out or transferred cases Pap Abnormal ASCUS CIN I CINII CIS 714, 278 9305 3055 2818 3028 Rate 1. 30% 0. 43% 0. 39% 0. 42% Cost 277, 537, 732 8, 712, 860 35, 963, 316 CANCER 147, 621, 056 Early Adv Rec 168 135 102 0. 06% 24, 990, 000 30, 415, 500 29, 835, 000 23

Cost (mean) of Cervical Cancer and Precancer Estimated average costs per case $ 2,

Cost (mean) of Cervical Cancer and Precancer Estimated average costs per case $ 2, 852 for ASCUS / CIN I II $ 12, 762 for CIN II $ 48, 752 for CIS $ 148, 750 for Stage I (localized) disease $ 225, 300 for Stage II–III (regional) disease $ 292, 500 for recurrence and terminal care 24

Cervical cancer and precancer, Taiwan Total no of women : 11, 062, 426, Taiwan

Cervical cancer and precancer, Taiwan Total no of women : 11, 062, 426, Taiwan Women (age > 30) : 6, 128, 085, Women (age > 21): 8, 019, 171. Pap smear total no : 1, 934, 931 Pap smear total cost : NT$: 791, 554, 701 CX CA ASCUS/CIN I No l l l 27028 CINII 4667 CIS 3618 Early Adv Rec 512 1595 884 Data from the database of the National cervical cancer registration system, Department of National Health, Taiwan Studied data were linked to the database of the National Insurance, south Taiwan. Data from the “Year-report of cancer” of National Cancer Registration System, Department of National Health, Taiwan, 2003 25

Cervical Cancer and Precancer Cost (mean) and Case Number 26

Cervical Cancer and Precancer Cost (mean) and Case Number 26

Cost Analysis for Cervical Cancer CX CA ASCUS/CIN I CINII CIS Early Adv Rec

Cost Analysis for Cervical Cancer CX CA ASCUS/CIN I CINII CIS Early Adv Rec No 27028 4667 3618 512 1595 884 Cost / per case 2, 852 12, 762 48, 752 148, 750 225, 300 292, 500 Cost (NT$) 77, 083, 856 59, 560, 254 176, 384, 736 694, 083, 500 Cost (US$) 2, 408, 871 1, 861, 258 5, 512, 023 21, 690, 109 Total cost NT$: 1, 007, 112, 346 ( US$: 31, 472, 261 ) 27

Model 1 Estimated Cost for Cervical Cancer and Precancer Total no of women :

Model 1 Estimated Cost for Cervical Cancer and Precancer Total no of women : 11, 062, 426, , Taiwan, 2003 Women (age > 30) : 6, 128, 085 Pap smear total no : 1, 934, 931 Pap smear total cost : NT$: 791, 554, 701 28

The Estimated Cost for Cervical Cancer Treatment item (no=2, 107) % Cost (mean) (Radical)

The Estimated Cost for Cervical Cancer Treatment item (no=2, 107) % Cost (mean) (Radical) Hysterectomy 25. 20% 145, 101 77, 043, 407 Chemotherapy 7. 93% 125, 300 20, 935, 763 Radiation 7. 72% 185, 000 30, 092, 174 Operation and chemotherapy 17. 89% 270, 401 101, 925, 574 Operation and RT 4. 27% 330, 101 29, 698, 823 Operation and CCRT 15. 65% 455, 401 150, 166, 430 CCRT 21. 34% 310, 300 139, 521, 368 Supported care 17% 179, 000 64, 116, 010 Total NT$ 613, 499, 552 l Data from the quality report of the management of cervical cancer, the Department of National Health insurance, Taiwan, 2003. 29

The Estimated Cost for Cervical precancer CIS (no=3, 618) % Cost (mean) NT$ OPD

The Estimated Cost for Cervical precancer CIS (no=3, 618) % Cost (mean) NT$ OPD 443% 350 5, 609, 709 Pap 237% 450 3, 858, 597 Colposcopy 76. 5% 960 2, 657, 059 Biopsy + Pathology 96. 5% 3150 10, 997, 816 Laser / Cryo 26. 6% 3447 3, 317, 351 LEEP / Cone 87. 2% 11, 458 36, 148, 798 ATH 38. 1% 49, 185 67, 799, 457 RAH 0. 88% 145, 101 4, 619, 784 Total l Data 135, 008, 571 from the quality report of the management of cervical cancer, the Department of National Health insurance, Taiwan, 2002. 30

The Estimated Cost for Cervical precancer CIN II (no=4667) % Cost (mean) NT$ OPD

The Estimated Cost for Cervical precancer CIN II (no=4667) % Cost (mean) NT$ OPD 353% 350 5, 766, 079 Pap 261% 450 5, 481, 392 Colposcopy 66. 5% 960 2, 979, 413 Biopsy + Pathology 92. 5% 3150 13, 598, 471 Laser / Cryo 41. 1% 3447 6, 611, 818 LEEP / Cone 68. 5% 11, 458 36, 630, 023 ATH 4. 1% 49, 185 9, 411, 402 RAH 0. 09% 145, 101 609, 468 Total l Data 81, 088, 065 from the quality report of the management of cervical cancer, the Department of National Health insurance, Taiwan, 2002. 31

The Estimated Cost for Cervical precancer Atipia/CINI (no=11179) % Cost (mean) NT$ OPD 273%

The Estimated Cost for Cervical precancer Atipia/CINI (no=11179) % Cost (mean) NT$ OPD 273% 350 10, 681, 535 Pap 239% 450 12, 023, 015 Colposcopy 28. 5% 960 3, 058, 574 Biopsy + Pathology 43. 5% 3150 15, 318, 025 Laser / Cryo 32. 0% 3447 12, 330, 884 LEEP / Cone 11. 6% 11, 458 14, 858, 322 ATH 1. 4% 49, 185 7697, 748 RAH 0% 145, 101 0 Total l Data 75, 968, 102 from the quality report of the management of cervical cancer, the Department of National Health insurance, Taiwan, 2003. 32

Estimated Direct Cost , Taiwan Atypia/CIN III CANCER No 11, 179 4667 3, 618

Estimated Direct Cost , Taiwan Atypia/CIN III CANCER No 11, 179 4667 3, 618 2, 107 Cost 75, 968, 102 Total cost 81, 088, 065 135, 008, 571 613, 499, 552 905, 564, 290 l Total no of Pap smear (2003) : 1, 934, 931 l Total cost of Pap smear (2003) : NT$ 791, 554, 701 (US$: 24736084 ) (US$: l Total cost of CIN and Cx CA (2003) : NT$ 905, 564, 290 (US$: 28298884) 33

Model 2 Estimated Cost for Cervical Cancer and Precancer Total no of women :

Model 2 Estimated Cost for Cervical Cancer and Precancer Total no of women : 11, 062, 426, , Taiwan, 2003 Women (age > 30) : 6, 128, 085 Pap smear total no : 1, 934, 931 Pap smear total cost : NT$: 791, 554, 701 34

Comparing Model 1 & 2 Cost Analysis for Cervical Cancer and Precancer 35

Comparing Model 1 & 2 Cost Analysis for Cervical Cancer and Precancer 35

Post HPV Vaccination Theoretical Cost Reduction 36

Post HPV Vaccination Theoretical Cost Reduction 36

Theoretical Cost Reduction After HPV Vaccination, Taiwan l Total cost of CIN and Cx

Theoretical Cost Reduction After HPV Vaccination, Taiwan l Total cost of CIN and Cx CA : NT$ 1, 007 M (US$: 32 M) l Theoretical reduction of Cost after HPV vaccination : NT$ 531, 901, 800 / per year (US$: 17 M) 53% • • Cost for cervical cancer: 694 M / yr (US$: 22 M) Cost for CIS: NT$ 176 M / yr (US$: 5. 5) CIN II: NT$ 60 M / yr (US$: 1. 9 M) CIN I / ASCUS): NT$ 77 M / yr (US$: 2. 4 M) 37

Cost-effectiveness Analysis of HPV Vaccine Pap smear in Taiwan l Taiwanese: 22, 520, 776

Cost-effectiveness Analysis of HPV Vaccine Pap smear in Taiwan l Taiwanese: 22, 520, 776 (2005) l Male: 11, 485, 409 (73. 6 yrs, lifetime) l Female: 11, 177, 740 (79. 4 yrs, lifetime) l Pap smear screening rate = 54. 76 % / 2005 (3 yrs) l Cervical cancer screening program is covered by government insurance for women age > 30 – 6, 128, 085 l Pap smear : 2, 195, 600 / per-yr / 2005 l Cost of Pap smear = 800 million (US$ 25 million ) / per year l Cost of Pap smear = NT$ 450 (US$ 15) /per test 38

Pap smear in Taiwan 39

Pap smear in Taiwan 39

Estimated Total Annual Costs before HPV Vaccination Screen: 44 % For CIN/Cancer: 56% 40

Estimated Total Annual Costs before HPV Vaccination Screen: 44 % For CIN/Cancer: 56% 40

Estimated Annual Costs Change After HPV Vaccination, in Taiwan 29% 41

Estimated Annual Costs Change After HPV Vaccination, in Taiwan 29% 41

Cost-effectiveness Analysis for Primary Active Prevention National Health Agency View l Reduction of total

Cost-effectiveness Analysis for Primary Active Prevention National Health Agency View l Reduction of total cost per year = NT$ 531, 901, 800 ((US$16, 621, 931) / per year l l One generation women= 150, 000 / per year Reduction of cost per woman 1 woman = NT$ 3546 (US$ 110. 8) l Acceptable cost for HPV Vaccine = NT$ 3, 546 (US$ 110. 8) 42

Cost-effectiveness Analysis for Primary Active Prevention Personal View - Self paid l l l

Cost-effectiveness Analysis for Primary Active Prevention Personal View - Self paid l l l l The cost of cervical cancer prevention program = NT$ 800, 000 (US$ 25, 000 ) / per year The reduction of cervical cancer = 32. 9% The cost of reduction 1% cervical cancer = NT$ 24, 316, 109 (US$ 759, 878 ) / per year The reduction rate of cervical cancer after HPV vaccine = 64. 3 % (Taiwan) The gain of reduction 64. 3 % cervical cancer = NT$ 1, 563, 525, 809 (US$ 48, 860, 155) / per year One generation women= 150, 000 /per year 1 woman = 10, 424 (US$ 325. 73) 43

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HPV Vaccine Program, in Taiwan l l HPV committee of the Taiwan Association of

HPV Vaccine Program, in Taiwan l l HPV committee of the Taiwan Association of Obstetrics and Gynecology HPV committee of the Taiwan Association of Gynecologic Oncology l l l Education program Ø Purple book Ø Physician training program Health information Ø Comic book Registration system Clinical guideline Combined HPV core-committee 48

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Sexual debut, Taiwan l Data from: Taiwan sexuality committee, 2006 l 13~ 25 Y/O

Sexual debut, Taiwan l Data from: Taiwan sexuality committee, 2006 l 13~ 25 Y/O l Questioner l Girls (13 ~ 26 y/o) : 1068 (M:F= 1: 1) l Parents (age < 65 y/o) = 200 l Results: l First sexual debut : 15. 9 Y/O l Sex (+) : 29. 96% (13~ 25 Y/O ) l Sex (+) : 20% (15~ 18 Y/O ) 2006 report of Taiwan sexuality committee, Cheng CJ, et al. 2006 51

Rate of HPV infection / sexual debut Sexual debut and HPV infection, Taiwan 15.

Rate of HPV infection / sexual debut Sexual debut and HPV infection, Taiwan 15. 9 y/o Sexual Debut Age 2006 report of Taiwan sexuality committee, CJ Cheng, et al. 2006 52

Incidence of Abnormal Pap, Taiwan, 2005 Cytology year-report Total no of women : 11,

Incidence of Abnormal Pap, Taiwan, 2005 Cytology year-report Total no of women : 11, 177, 740 , Taiwan, 2005 Women (age > 30) : 6, 128, 085, (age > 21): 8, 019, 171. Pap no Abnormal no ASCUS LSIL HSIL CANCER 2, 195, 600 24, 282 3, 049 11, 612 8, 639 982 Rate 1. 11 0. 14 0. 53 0. 39 0. 04 l Data from the Taiwan Cervix Cancer Screening Registration System, Department of National Health , Taiwan, 2005 53

Type-Specific Prevalence of HPV in Precancer and Carcinomas of the Cervix in Taiwan LSIL

Type-Specific Prevalence of HPV in Precancer and Carcinomas of the Cervix in Taiwan LSIL % HSIL Cancer Tseng Liaw Chu Lai n=168 n=78 N=589 n=379 n=101 N=711 n=255 n=167 N=263 n=94 HRHPVs 45 7 85 91 98 99 90 86 HPV 16 19. 3 37. 18 5. 6 28. 6 50. 50 23. 2 46. 2 65. 9 43. 7 47. 9 HPV 18 17. 2 28. 21 3. 0 14. 3 32. 67 1. 8 15. 5 22. 8 10. 3 8. 5 HPV 58 7. 2 19. 23 3. 6 28. 6 18. 81 11. 7 17. 2 9. 0 8. 7 18. 1 HPV 52 13. 4 21. 79 9. 0 25. 0 18. 81 12. 1 10. 9 3. 0 2. 7 2. 1 HPV 31 8. 6 7. 69 17. 9 9. 90 3. 5 14. 4 HPV 33 9. 3 6. 41 21. 4 7. 92 4. 1 8. 9 Liaw: cytology sample; Tseng: biopsy sample; Chu : biopsy sample; Lai : biopsy sample Liaw: PCR ; Tseng: Genechip ; Chu : PCR ; Lai : PCR Chu TU et al. : From 3 studies (TSGH, T 1899, and CBCP), presented in TAGO, 2002 Huang LW et al. : Type-specific distribution of human papillomavirus in relation to grades of cervical neoplasia. , Int J Gynaecol Obstet. 2006 ; 92: 143 -4. Tseng CJ: Prevalence of cervical human papillomavirus in Taiwanese women , 2005 year’s report of the Department of Health Taiwan. Am J OBGYN, 2006, in press l Favorable Clinical Outcome of Cervical Cancers Infected with Human Papilloma Virus Type 58 and Related Types, Hung-Cheng Lai Int. J. Cancer 1999: 84, 553 -557 l l l 54

Direct Cost , Taiwan, 2003 Atypia/CIN III CANCER Total cost No 11, 179 4667

Direct Cost , Taiwan, 2003 Atypia/CIN III CANCER Total cost No 11, 179 4667 3, 618 2, 107 Model 1 77, 083, 856 59, 560, 254 176, 384, 736 694, 083, 500 1, 007, 112, 346 Reduction 11, 550, 000 11, 748, 000 62, 708, 800 445, 895, 000 531, 901, 800 Model 2 75, 968, 102 81, 088, 065 135, 008, 571 613, 499, 552 Reduction 11, 400, 000 15, 859, 800 48, 100, 500 393, 852, 500 469, 212, 800 905, 564, 290 l Total no of Pap smear (2003) : 1, 934, 931 l Total cost of Pap smear (2003) : NT$ 791, 554, 701 (US$: 24736084 ) (US$: 55