Vaccination of preadolescent girls against HPV 16/18 within national immunization programmes has been established in most European countries, but coverage varies substantially between countries. In addition, HPV vaccines in many countries are purchased via national public procurements that reduce the cost per vaccinee considerably. This study sought to evaluate the cost-effectiveness profile of gender-neutral national HPV immunization programmes in settings with organized tender procedures for the acquisition of the HPV vaccine.
A previously published Bayesian synthesis framework was expanded to account for the full spectrum of the HPV-related cancers in both males and females and for all herd immunity effects from vaccinating girls as well as boys. Our analysis assessed the cost-effectiveness of a sex-neutral vaccination programme within 6 European countries (Austria, Belgium, Croatia, Latvia, the Netherlands and Sweden) for which we collected publicly available information on national tender procedures. Country and site-specific incidence data from the last edition of the Cancer Incidence in Five Continents (CI5) were used to inform the model and national mortality data were obtained from the World Health Organization mortality database.
The incremental cost-effectiveness ratios (ICERs) of girls-only vaccination compared to no vaccination ranged from €500 (95% CrI: 0 - 1,000) per life-year gained in Latvia to €5,000 (95% CrI: 4,000 - 6,000) per life-year gained in Austria, while the incremental cost-effectiveness ratios of the sex-neutral vaccination programmes compared to girls-only vaccination ranged from €4,000 (95% CrI: 3,000 - 6,000) per life-year gained in Croatia to €26,000 (95% CrI: 20,000 - 33,000) per life-year gained in Sweden. The ICERs remained below the country-specific GDP thresholds for cost-effective intervention, recommended by the WHO. Ninety-five percent of the variation in ICERs for sex-neutral vaccination among countries could be explained by coverage among girls, vaccination cost, cervical cancer incidence and survival, and oropharyngeal cancer incidence in males.
Gender-neutral vaccination against HPV is likely to be cost-effective in settings where tender procedures can be organized for the acquisition of the HPV vaccine in national immunization programmes. This finding seems generalizable over a wide range of epidemiologic and economic constraints.