Abstract
BackgroundThe decrease in human papillomavirus (HPV) vaccine prices may allow upscale already started vaccination programmes but the advantages of different options are unclear.MethodsUsing a mathematical model of HPV16 and 18 transmission and data on vaccination coverage from Italy, we compared 3 options to upscale an already started programme targeting 11-year old girls (coverage 65%): a) coverage improvement (from 65% to 90%); b) addition of 11-year-old boys (coverage 65%); or c) 1-year catch-up of older girls (coverage 50%).ResultsThe reduction of cervical HPV16/18 infection as compared to no vaccination (i.e. effectiveness against HPV16/18) increased from 76% to 98% with coverage improvement in girls and to 90% with the addition of boys. With higher coverage in girls, HPV16/18 infection cumulative probability by age 35 decreased from 25% to 8% with a 38% increase in vaccine number. The addition of boys decreased the cumulative probability to 18% with a 100% increase in the number of vaccinees. For any coverage in girls, the number of vaccinees to prevent 1 woman from being infected by HPV16/18 by age 35 was 1.5, whereas it was 2.7 for the addition of boys. Catch-up of older girls only moved forward the vaccination effectiveness by 2–5 years.ConclusionsIncreasing vaccination coverage among girls is the most effective option for decreasing HPV16/18. If not achievable, vaccinating boys is justifiable if vaccine cost has at least halved, because this option would almost double the number of vaccinees.
Highlights
The debate on the best target population of human papillomavirus (HPV) vaccination programmes in highincome countries has been renewed by the decision to vaccinate boys in Australia [1,2] and the similar recommendations from the United States [3] and by the relevance of non-cervical HPV-related cancers [4]
We eventually reported the impact of vaccination against the combination of the two types (HPV16/18)
As a result of herd immunity [25], effectiveness against HPV16/18 exceeded by 14 and 13 percentage points the one expected if vaccination had only protected vaccinated women (62% effectiveness at 65% coverage and 86% at 90% coverage)
Summary
The debate on the best target population of human papillomavirus (HPV) vaccination programmes in highincome countries has been renewed by the decision to vaccinate boys in Australia [1,2] and the similar recommendations from the United States [3] and by the relevance of non-cervical HPV-related cancers [4]. The steady decrease in HPV vaccine prices makes an upscale attractive for those high-income countries which initially targeted only one or few birth cohorts of girls or achieved low coverage. Cost-effectiveness models are sensitive to the broad variations in the cost of HPV vaccines in different countries and depend on a variety of assumptions regarding incidence, incubation time and incidence rates of the various HPV-associated diseases. The decrease in human papillomavirus (HPV) vaccine prices may allow upscale already started vaccination programmes but the advantages of different options are unclear
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