Introduction The objective of this study was to assess the health impact and cost-effectiveness of human papillomavirus (HPV) vaccination strategies in the United States. Specifically, we examined the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared to the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58.

Methods We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the five additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, we assumed 9vHPV cost $13 more per dose than 4vHPV. Our model included a wide range of HPV-associated health outcomes that could potentially be averted by vaccination: cervical intraepithelial neoplasia; genital warts; juvenile-onset recurrent respiratory papillomatosis; and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers

Results Compared to no vaccination, 4vHPV for both sexes cost $5,100 to $22,300 (in 2013 US dollars) per quality-adjusted life year (QALY) depending on assumptions regarding vaccine coverage and 4vHPV cross-protection against HPV 31, 33, 45, 52, and 58. Providing 9vHPV for females instead of 4vHPV was cost-saving in most scenarios we examined. The cost per QALY gained by providing 9vHPV to males instead of 4vHPV varied substantially depending on assumptions such as vaccine coverage and cross-protection of 4vHPV. However, the strategy of 9vHPV for both sexes (compared to the strategy of 4vHPV for both sexes) was cost-saving under most scenarios.

Conclusion A vaccination program of 9vHPV for both sexes can save money and improve health outcomes compared to a vaccination program of 4vHPV for both sexes.

Disclosure of interest statement The authors have no conflicts to declare. No pharmaceutical grants were received in the development of this study.