• J. Natl. Cancer Inst. · Jan 2016

    Health and Economic Impact of Switching from a 4-Valent to a 9-Valent HPV Vaccination Program in the United States.

    • Marc Brisson, Jean-François Laprise, Harrell W Chesson, Mélanie Drolet, Talía Malagón, Marie-Claude Boily, and Lauri E Markowitz.
    • Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Canada (MB, JFL, MD, TM); Département de médecine sociale et préventive, Université Laval, Québec, Canada (MB, MD, TM); Department of Infectious Disease Epidemiology, Imperial College, London, UK (MB, MCB); National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA (HWC, LEM). marc.brisson@crchudequebec.ulaval.ca.
    • J. Natl. Cancer Inst. 2016 Jan 1; 108 (1).

    BackgroundRandomized clinical trials have shown the 9-valent human papillomavirus (HPV) vaccine to be highly effective against types 31/33/45/52/58 compared with the 4-valent. Evidence on the added health and economic benefit of the 9-valent is required for policy decisions. We compare population-level effectiveness and cost-effectiveness of 9- and 4-valent HPV vaccination in the United States.MethodsWe used a multitype individual-based transmission-dynamic model of HPV infection and disease (anogenital warts and cervical, anogenital, and oropharyngeal cancers), 3% discount rate, and societal perspective. The model was calibrated to sexual behavior and epidemiologic data from the United States. In our base-case, we assumed 95% vaccine-type efficacy, lifelong protection, and a cost/dose of $145 and $158 for the 4- and 9-valent vaccine, respectively. Predictions are presented using the mean (80% uncertainty interval [UI] = 10(th)-90(th) percentiles) of simulations.ResultsUnder base-case assumptions, the 4-valent gender-neutral vaccination program is estimated to cost $5500 (80% UI = 2400-9400) and $7300 (80% UI = 4300-11 000)/quality-adjusted life-year (QALY) gained with and without cross-protection, respectively. Switching to a 9-valent gender-neutral program is estimated to be cost-saving irrespective of cross-protection assumptions. Finally, the incremental cost/QALY gained of switching to a 9-valent gender-neutral program (vs 9-valent girls/4-valent boys) is estimated to be $140 200 (80% UI = 4200->1 million) and $31 100 (80% UI = 2100->1 million) with and without cross-protection, respectively. Results are robust to assumptions about HPV natural history, screening methods, duration of protection, and healthcare costs.ConclusionsSwitching to a 9-valent gender-neutral HPV vaccination program is likely to be cost-saving if the additional cost/dose of the 9-valent is less than $13. Giving females the 9-valent vaccine provides the majority of benefits of a gender-neutral strategy.© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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