Background This study aims to describe the epidemiological trends and estimate the economic burden of genital warts (GW) in Dutch primary care. Methods A retrospective, non-interventional, multiyear study (2011-2021) was performed using data from the Nivel Primary Care Database. Changes in incidence by age group, sex, and level of urbanisation of individuals with GW and associated healthcare resource use (general practitioner consultations, prescribed medication, and referrals) were estimated over the 11-year period. Total annual healthcare costs and cost per incident case were estimated via a bottom-up gross costing approach. Results Between 2011 and 2021, GW incidence increased, which was especially seen in men (from 2.0 to 3.5 per 1 000 inhabitants) and to a lesser extent in women (from 1.9 to 2.1 per 1 000 inhabitants). GW incidence was most common in age group 20-29 years (men: 43.6%; women: 50.7%) and highly urbanised areas. Medication was prescribed in 61.4% of GW cases, and 5.4% of GW patients were referred to secondary care. Total costs in Dutch primary care increased by 108% from EUR 2.3 million in 2011 to EUR 4.9 million in 2021. The cost per incident case also showed an increasing trend from EUR 72 in 2011 to EUR 99 in 2021. Referrals to secondary care resulted in a 14-30% increase of total costs. Conclusions This study provides novel insights into recent epidemiological trends of GW and its associated costs in Dutch primary care. Incidence especially increased among men and total annual costs of GW in primary care doubled between 2011 and 2021.

CV, JB, and LJ do not report any conflicts of interest. CD is an employee of MSD the Netherlands who may own stock and/or hold stock options in in Merck & Co., Inc., Rahway., NJ, USA. MJP reports grants and honoraria from various pharmaceutical companies, inclusive those potentially interested in the subject matter of this paper.

This study was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The retrospective analysis was conducted based on aggregate data obtained from the Netherlands Institute for Health Services Research (Nivel) Primary Care Database containing no directly identifiable data, and therefore, according to Dutch legislation, neither informed consent from study subjects nor approval by a medical ethics committee is obligatory, (art. 24 General Data Protection Regulation (GDPR) Implementation Act jo art. 9.2 sub j GDPR). Patient-level data was stored and handled by Nivel in accordance with their guidelines. To protect the privacy of individual patients, healthcare professionals, and providers such as hospitals and primary care practices, an agreement on the handling of data was signed by all researchers. In the privacy regulations for the Primary Care Database, Nivel states what data are collected, how they are managed and what the rights of registered participants are. GDPR is adhered to. Steering committees with representatives from national associations of healthcare providers take part in the decision-making process of the use of data. This study was approved by the relevant governance bodies of the Nivel Primary Care Database (nr. NZR00322.032).

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