A 9-valent HPV vaccine that provides broader protection against oncogenic HPV types than the 4-valent vaccine has now been licensed in the United States and Europe. However, it is not used in most countries in the world. We evaluated the cost-effectiveness of the 9-valent vaccine to inform recommendations by the World Health Organization.
We evaluated the contribution of the additional HPV types in the 9-valent vaccine (31/33/45//52/58) in cervical and other cancers. We then considered the proportion of these cancers that could be prevented by 2-valent, 4-valent and 9-valent vaccines (assuming 2-valent and 4-valent vaccines offer cross-protection), with and without herd effects. The incremental cost-effectiveness of the 9-valent vaccine compared to lower valency vaccines was then calculated.
Most HPV-related cancers due to the additional types in the 9-valent vaccine are cervical cancers. The incremental benefit of the 9-valent vaccine compared to 2-valent and 4-valent vaccines differs depending on assumptions about cross-protection and herd effects. The relative cost-effectiveness of the 9-valent vaccine depends on the level of cross-protection expected from lower valency vaccines.
World Health Organization guidelines now include the 9-valent HPV vaccine as one of the recommended HPV vaccines alongside the 2-valent and 4-valent vaccines.
Human papillomavirus vaccines: WHO position paper, May 2017. Weekly Epidemiological Record 2017; 19(92):241-268.