Cost-effectiveness of human papillomavirus vaccination programmes parallel to current routine vaccination of young teenage girls

Objectives: Since 2009, 12-year-old Dutch teenage girls are vaccinated against human papillomavirus (HPV) infection. The current uptake of HPV vaccination, being approximately 60% nowadays, is however comparatively low. Consequently, a large group of women are still at risk of developing HPV-induced cervical cancer later on in life. Therefore, alternative HPV vaccination scenarios have been proposed, in addition to the existing programme, to provide additional protection against cervical cancer. Here, we assessed the cost-effectiveness of three different vaccination scenarios: (i) increased coverage of the existing programme, (ii) vaccination of girls at an older age, and (iii) vaccination of 12-year-old boys. Methods: A dynamic model was used to estimate the full health-economic consequences of the existing programme with and without the above alternative scenarios. Costs and health effects of the alternative scenarios, expressed as life years (LYs) or quality-adjusted life years (QALYs) gained, were compared with the outcomes of the existing programme. In sensitivity analyses, the robustness of the model-predicted outcomes was evaluated. Results: We found the incremental cost-effectiveness ratio of the existing HPV vaccination programme to be € 9,500 per QALY gained. The cost-effectiveness of the alternative programs highly depends on the coverage at 12 years of age. The cost-effectiveness of girls 24 years of age remained below € 50,000/QALY if coverage at 12 years of age increased up to 70%. Cost-effectiveness of vaccination boys at 12 years of age becomes unfavourable if coverage among 12-year old girls increases. Conclusions: From a health-economic perspective, alternative HPV vaccination programmes should be considered in the Netherlands to further reduce the burden of HPV-induced cancer. Until a high coverage among 12-year old girls in reached the addition of older girls to the current vaccination program is most cost-effective.