Epidemiological, economic and humanistic burden of cervical intraepithelial neoplasia in Europe: A systematic literature review

Introduction: High-grade cervical intraepithelial neoplasia (CIN) is a premalignant lesion of the cervix caused by persistent human papillomavirus (HPV) infection, which can lead to cervical cancer. Despite ongoing primary prevention efforts, considerable burden of illness remains. This study assessed the epidemiological, economic, and humanistic burden associated with high-grade CIN among adult women in Europe. Methods: Systematic literature reviews (SLRs) were conducted for epidemiological, economic, and humanistic burden, in adult women with high-grade CIN in the broader European region. Search strategies were aligned to Cochrane and PRISMA guidelines. Databases searched included Medline (R), Embase (R), and Cochrane databases (2012-2022). Conference proceedings were also searched (2018-2022). Outcomes of interest included incidence, prevalence, HPV genotype, cost burden, resource use and quality of life burden. Results: Evidence from 41 epidemiological, 11 economic burden, and 8 humanistic burden studies was included. Incidence of high-grade CIN was 31-186/100,000 women-years in a screened population, with prevalence rates of 0.1-2.2 %. Incidence and prevalence of high-grade CIN peaked among women aged 25-39 years. In women with high-grade CIN, high-risk genotypes were among those most commonly identified, including HPV16/18 (57.0-58.7 %), HPV16 (47.4-52.0 %), HPV18 (4.0-15.0 %) and HPV 31/33/45 (38 %). Cost burden and healthcare resource utilization was higher for CIN3 vs. CIN2. High-grade CIN significantly impaired quality of life, across multiple domains vs. healthy population. Conclusion: High-grade CIN was associated with considerable burden in Europe. These findings reveal the multifaceted nature of the impact incurred by women with high-grade CIN, and highlight some of the key areas of unmet need among this patient population.