PT  - JOURNAL ARTICLE
AU  - HW Chesson
AU  - LE Markowitz
AU  - S Hariri
AU  - DU Ekwueme
AU  - M Saraiya
TI  - O16.4 The estimated impact and cost-effectiveness of nonavalent hpv vaccination in the united states
AID  - 10.1136/sextrans-2015-052270.168
DP  - 2015 Sep 01
TA  - Sexually Transmitted Infections
PG  - A61--A62
VI  - 91
IP  - Suppl 2
4099  - http://sti.bmj.com/content/91/Suppl_2/A61.3.short
4100  - http://sti.bmj.com/content/91/Suppl_2/A61.3.full
SO  - Sex Transm Infect2015 Sep 01; 91
AB  - 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 cancersResults 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.