Universal vaccination with the quadrivalent HPV vaccine in Austria: impact on virus circulation, public health and cost–effectiveness analysis

Abstract

The International Agency for Research on Cancer acknowledges that HPV is a human carcinogen affecting both sexes. This study aimed to evaluate the public health impact of universal HPV vaccination in Austria, to assess its cost–effectiveness and to estimate the HPV prevalence reduction over time. Vaccinating 65% of 9-year-old boys and girls in Austria would result in a 70% decrease in HPV infections in both males and females, hereby avoiding 9500 cases of genital warts annually and 431 HPV 16/18-related cancers in males and females. This strategy would be cost effective with base case analysis of €26,701/quality-adjusted life year (QALY) gained for cervical cancer only, €15,820/QALY also including vaginal/vulvar cancers and genital warts, and €10,033/QALY also considering anal, oropharyngeal and penile cancers, with an incremental cost–effectiveness ratio ranging from €2500 to €21,000/QALY in sensitivity analyses. HPV circulation would be controlled hereby preventing subsequent HPV-related cancers.

Keywords::

• Austria
• cost–effectiveness
• HPV
• papillomavirus
• public health
• universal vaccination

Acknowledgements

The authors thank M Adam, R Drury and S Samson (Sanofi Pasteur MSD) for their assistance in critically reviewing the manuscript.

Disclaimer

The authors take sole responsibility for the contents of the manuscript.

Financial & competing interests disclosure

This study was conducted by Sanofi Pasteur MSD. X Bresse, C Goergen and B Prager are employees of Sanofi Pasteur MSD. E Joura received no consultancy fee for his role as an advisor in the data to be used for the Austrian setting and in interpreting results. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors thank P Pradat and N Voirin (alpha005) for writing assistance in the production of this manuscript.

Key issues

• In most European countries, human papillomavirus (HPV) vaccination is recommended and funded only for girls, not for boys. Austria is the country which initially recommended a universal HPV vaccination.

• The model used in the present study is based on Austrian data and a conservative approach for assumptions and model parameters is taken into account.

• Vaccinating 65% of boys and girls aged 9 in Austria versus current standard of care (i.e., cervical cancer screening and medical management of HPV-related diseases) would allow decreasing virus circulation through decrease in infections (∼ −70% in females and males), hereby avoiding 9500 genital warts annually and reducing HPV 16/18-related cancers in males and females.

• An increase of vaccine coverage by 15 points among females and males (from 65 to 80%) would accelerate and increase the reduction in the prevalence of HPV 16/18-related infections by 10 and 14 points in females and males, respectively.

• This strategy was estimated cost-effective with a base case incremental cost–effectiveness ratio of €10,033 per quality-adjusted life-year, ranging from €2500 to €21,000 per quality-adjusted life-year in sensitivity analyses, even at high coverage rate.

• Our results based on a previously published model are in line with other published studies.

Notes