To assess public health impact of the introduction of nine-valent human papillomavirus (HPV) vaccine program for females and males in Hungary.
A previously published HPV dynamic transmission model was adapted and calibrated for Hungary. The natural history of cervical cancer, anogenital cancers, and genital warts in Hungary was simulated using the model. It was assumed that the vaccination program would be combined with current cervical cancer screening in Hungary. The model assumed that 85% of females aged 13-14 years and 50% of the boys aged 13-14 years would receive two doses of the nanovalent HPV vaccine. The relative effectiveness of two dose of the nine-valent HPV vaccine was assumed to be the same as three doses. The duration of protection of the nine-valent HPV vaccine was assumed to be life-long. Impact of only HPV types 6/11/16/18/31/33/45/52/58 were considered in the model. The nine-valent female and male HPV vaccination program (combined with cervical cancer screening) was compared with no HPV immunization (cervical cancer screening only). The time horizon for the model was 100 years. Costs were discounted at 3.7%.
For the comparison with no immunization, over a 100 years, the introduction of the nine-valent vaccine program in females and males showed cumulative reduction in the incidence of 6/11/16/18/31/33/45/52/58 HPV related cervical cancer by 54%, CIN1 by 70%, and CIN2/3 by 67%, anal cancer in females and males by 43% and 41% respectively, cervical cancer related deaths by 50%, anal cancer related death by 41% in females and 39% in males, HPV 6/11 related genital warts in females and males by 82% and 81% respectively. By the end of the 100 year timeframe of the model, the nine-valent HPV vaccine reduced the monitored incidence rates and related death cases for cervical and anal cancers to near zero. Over a 100 years, the nine-valent HPV vaccine would reduce cumulative cost of 6/11/16/18/31/33/45/52/58 HPV related cervical cancer by 19%, CIN1 by 35%, CIN2/3 by 31%, anal cancer in females and males by 13% and 12% respectively, and HPV 6/11 related genital warts in females and males by 54% and 52% respectively.
The burden and costs related to various 6/11/16/18/31/33/45/52/58 HPV-related conditions, especially cervical and anal cancers, could be substantially reduced by the introduction of a nine-valent HPV vaccination program for females and males in Hungary.