The nonavalent vaccine, by protecting against five additional oncogenic HPV types and nine HPV types in total (6, 11, 16, 18, 31, 33, 45, 52 and 58), is expected to prevent an even broader spectrum of HPV-related cancers and other diseases - 90% of cervical and 90% of HPV related anal cancers could be averted thanks to this new vaccine. The present study aims to estimate the incremental public health impact and cost-effectiveness of a universal vaccination programme with a nonavalent vaccine in Germany as compared to the current girls only quadrivalent (6/11/16/18) HPV vaccination
A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to German epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases only. In the base case, a two dose vaccination program with lifelong protection and a cumulative vaccination coverage rate of 55.6% was assumed in the cohorts aged 17. German costs, including official price for the vaccines, were used. Deterministic sensitivity analyses on key parameters (such as duration of protection, discount rate and inclusion of head and neck cancers) were conducted.
It was estimated that after 100 years, the universal HPV9 vaccination programme would further decrease the vaccine type incidence of cervical cancer and precancers from 57% to 80%, of anal cancer from 64% to 78% in females and from 46% to 75% in males and of genital warts from 40% to 46% in females and from 16% to 38% in males. Overall, the new intervention would avert 46.454 additional cases of cervical cancers, 896.242 cases of precancers, 8.456 cases of anal cancers and 1.448.735 cases of genital warts compared to the current vaccination program. This new intervention would be cost-effective with an incremental cost per QALY of 22,990 €. Sensitivity analyses showed the ICER was significantly improved when all HPV diseases (RRP, penile and head and neck cancers) are included in the analysis.
The switch to a universal vaccination programme with a nonavalent vaccine in Germany is estimated to be cost-effective across a range of sensitivity analyses. Considering a coverage rate of 55%, the intervention could lead to a public health impact comparable to the one observed in other EU countries with a higher VCR in girls (70%).