Abstract
Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11–12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12–13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12–18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.
Highlights
In 2007, the Superior Health Council of Belgium announced recommendations for human papillomavirus (HPV) vaccination for females aged 10 to years and catch-up vaccination for females aged to 26 years in addition to screening for the prevention of cervical cancer (Conseil Supérieur de la Santé, 2017; Thiry et al, 2019)
The analysis evaluated the impact of catch-up 9-valent HPV (9vHPV) gender-neutral vaccination (GNV) compared to 9vHPV female-only vaccination (FOV) on the population of Belgium
Limiting the model to only diseases included in the 9vHPV vaccine label leads to an incremental cost-effectiveness ratios (ICERs) of €16,259 per quality-adjusted life years (QALYs), still below the thresholds commonly used for cost-effectiveness evaluations (Figure 2C) (National Institute for Health and Care Excellence, 2014; Bertram et al, 2016; Thiry et al, 2019). This analysis included evaluation of the health impact (i.e., HPVrelated disease incidence and death) and cost-effectiveness of HPV GNV with 9vHPV vaccine on HPV-related diseases based on recommendations from the Superior Health Council of Belgium as well as other health technology assessment agencies (KCE, 2019; Conseil Supérieur de la Santé, 2017; Health Information and Quality Authority, 2018)
Summary
In 2007, the Superior Health Council of Belgium announced recommendations for human papillomavirus (HPV) vaccination for females aged 10 to years and catch-up vaccination for females aged to 26 years in addition to screening for the prevention of cervical cancer (Conseil Supérieur de la Santé, 2017; Thiry et al, 2019). HPV is a common sexually transmitted infection that can lead to the development of cervical, vulvar, and vaginal cancer in women, penile cancer in men, and genital warts, recurrent respiratory papillomatosis (RRP), and anal and head and neck cancers in both sexes (Schiffman and Castle, 2003; Forman et al, 2012; Giuliano et al, 2015; Fortes et al, 2017). HPV-related diseases impart a substantial burden on patients and their communities [The Belgian Health Care Knowledge Center (KCE), 2007]. In both Belgium and worldwide, there has been a trend for increasing HPV-related oropharyngeal cancer incidence, especially among males (incidences of 6.7 per 100,000 and 1.7 per 100,000 among males and females in Belgium, respectively (Bruni, 2017; de Martel et al, 2017). This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium
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