To assess the public health and economic impact of a gender neutral vaccination program for 9-14 year olds with a nine-valent human papillomavirus (HPV) in Sweden.
A previously validated transmission dynamic model was adapted and calibrated for Sweden. The natural history of cervical cancer, CIN 1-3, vaginal cancer, vulvar cancer, anal cancer, and genital warts, was simulated in the model. The current screening program for cervical cancer in Sweden was included in the model. In the model a gender neutral vaccination program (boys and girls) for 9-14 year olds with a nine-valent HPV vaccine was compared to a girls only (9-14 year old) quadrivalent HPV vaccination program. The vaccination coverage and other inputs to the model were collected from relevant local sources where available. Life-long duration of protection was assumed in the model for vaccine HPV types for both vaccines and the model time horizon was set to 100 years. Costs and QALYs were discounted by 3%. Sensitivity analyses were performed on comparisons with adherence rates and discounting.
The gender neutral vaccination program resulted in an added reduction of 22% in cervical cancer incidence and mortality for females, and 13% additional decrease in anal cancer incidence and 12% mortality in females and 32% decrease in incidence and mortality in males. An additional 110,148 cases genital warts in girls and 466,960 cases in boys would be prevented if a gender neutral vaccination with a nine-valent vaccine would be introduced compared to the current scenario in Sweden. Gender neutral vaccination with a nine-valent HPV vaccine as compared to the quadrivalent vaccine resulted in an additional overall 14.5% decrease in disease specific costs.
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 Sweden.