Cost-effectiveness of nonavalent HPV vaccination in the Netherlands

ABSTRACT

Background

A bivalent human papillomavirus vaccine (2vHPV) is currently used in the Netherlands; a nonavalent vaccine (9vHPV) is also licensed.

Research design and methods

We compared the public health and economic benefits of 2vHPV- and 9vHPV-based vaccination strategies in the Netherlands over 100 years using a validated deterministic dynamic transmission metapopulation model.

Results

Compared to 2vHPV, the 9vHPV strategy averted an additional 3,245 cases of and 825 deaths from 9vHPV-strain-attributable cancers, 4,247 cases of and 190 deaths from recurrent respiratory papillomatosis (RRP), and 1,009,637 cases of anogenital warts (AGWs), with an incremental cost-effectiveness ratio (ICER) of €4,975 per quality-adjusted life year (QALY) gained. The ICER increased in a scenario with increased HPV vaccination coverage rates and was relatively robust to one-way deterministic sensitivity analyses, with variation in the disease utility parameter having the most impact. When catch-up vaccination for individuals ≤26 years of age was added to the model, vaccinating with 9vHPV averted additional cancers and AGWs compared to 2vHPV vaccination.

Conclusion

Our analyses predict that transitioning from a 2vHPV- to a 9vHPV-based vaccination strategy would be cost-effective in the Netherlands.

KEYWORDS:

• Cost-effectiveness modeling
• health economics
• HPV vaccination
• human papilloma virus
• netherlands

Declaration of interests

C Palmer, W Wang, and K Saxena are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, U.S.A. and own stock in Merck & Co., Inc., Rahway, NJ, U.S.A. C Dolk is an employee of MSD, the Netherlands and owns stock in Merck & Co., Inc., Rahway, NJ, U.S.A. U Sabale is an employee of MSD, Lithuania and owns stock in Merck & Co., Inc., Rahway, NJ, U.S.A. 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.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they were an investigator on the Phase II and III studies for the bivalent vaccine (2HPV). Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Ethics statement

Since this was a modeling study using deidentified published data as model inputs, no ethical approval or informed consent was required.

Author contributions

Conception and design: CP, CD, US, WW, and KS. Analysis and interpretation of the data: CP, CD, US, WW, and KS. Drafting of the paper or revising it critically for intellectual content: CP, CD, US, WW, and KS. All authors made a substantial contribution to the study and were involved in drafting, writing, and/or revising the article. All authors approved and agree to be accountable for the final version of the article approved for publication.

Acknowledgments

A version of this study was previously presented as a conference poster: Dolk C, Sabale U, Palmer C. The public health impact and cost-effectiveness of gender neutral 9vHPV vaccination in the Netherlands. EUROGIN International Multidisciplinary HPV Congress 2022, Düsseldorf, Germany. Abstract #3493. The authors thank Cath Ennis, PhD, in collaboration with ScribCo for medical writing assistance.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14760584.2024.2322543.

Additional information

Funding

This work was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.