Human papillomavirus (HPV) is one of the most frequent sexually transmitted infection and one of the main causes of infection-related cancer, accounting for 5% of the total burden of human cancer worldwide. Since 2007, two vaccines were available in Spain: the quadrivalent HPV vaccine (HPV4), that contains types 6/11/16/18 and the bivalent HPV vaccine (HPV2), that contains types 16/18. It is estimated that 6/11/16/18 are responsible of 47% of precancerous anogenital lesions due to HPV, and 79% of cancers related to HPV. A nonavalent vaccine (HPV9) containing HPV types 6/11/16/18/31/33/45/52/58 has been developed. According to epidemiological data, the 9 types are responsible of 82% precancerous lesions and 90% of cancers related to HPV.
The aim of this project is to assess the epidemiological impact and the cost effectiveness of 9vVPH in Spain.
We adapted to the Spanish setting an integrated HPV disease transmission model that accounts for herd protection effects and with a 100-year time horizon.
The model shows further reductions in the incidence and mortality of diseases related to HPV16/18/31/33/45/52/58 types over the analyzed time horizon with HPV9 vaccination when compared to HPV4 or HPV2 in both girls-only and universal vaccination scenarios. 9vVPH would avoid additional 161,485 CIN1 cases, 112,393 CIN2/3 cases, and 15,380 cervical cancer cases compared to HPV4 and HPV2 in a girls only vaccination scenario. With regards to genital warts, 1,466,379 and 1,395,111 cases, in females and males respectively, would be prevented by HPV9 versus HPV2 in a girls only vaccination and 1,629,959 cases in females and 2,027,372 cases in males, in a universal vaccination setting.
Girls-only vaccination strategy of a 12 years old cohort with HPV9 was found to be cost effective compared to HPV4 (ICER of €14,000/QALY) and a dominant strategy compared to bivalent HPV vaccine (HPV2). In a universal vaccination scenario, HPV9 is cost-effective compared to HPV2 (ICER of €3,716/QALY) and is cost-effective vs. HPV4 Girls if HPV9 price does not exceed €121 per dose.
A significant reduction in the HPV-related disease is expected after HPV9 introduction. In addition, HPV9 vaccination is cost-effective when compared to the current HPV4 and HPV2 vaccination programs. Moreover, the inclusion of boys in the HPV9 vaccination program could potentially further reduces the burden of HPV-related diseases in both genders in Spain.