Impact of Implementing Alternative Human Papillomavirus (HPV) Vaccination Strategies in Kenya: A Modeling Study

Real-World Effectiveness and Impact of Human Papillomavirus Vaccination in Males: A Comprehensive Review.

BACKGROUND Gender-neutral vaccination (GNV) for human papillomavirus (HPV) has increasingly been implemented worldwide. However, real-world evidence on vaccine effectiveness (VE) in males and the population-level impact of GNV remains heterogeneous. We summarized real-world VE of HPV vaccination in males and the impact of GNV. METHODS A comprehensive review was performed using Embase and PubMed from January 2007 to May 2024, for studies evaluating quadrivalent (4vHPV) or nonavalent (9vHPV) vaccines. Eligible studies assessed VE or GNV impact on HPV infections, precancerous lesions, cancer, or anogenital warts (AGW). Risk of bias was assessed using ROBINS-I and the National Institute of Health quality assessment tool. RESULTS Twenty-one geographically diverse studies were included. Most VE and VI studies demonstrated risk of bias. In males, VE reached up to 100% against oral HPV infection and 41% for penile HPV (4vHPV genotypes), with higher VE among adolescents and those vaccinated before age 23. Among men who have sex with men, VE was higher for penile HPV infection (85%), AGW (55%), and anal infection (60%). CONCLUSIONS Real-world evidence indicates that HPV vaccination substantially reduces anogenital and oral HPV infections and AGW in males. GNV programs further reduce HPV-related disease burden, reinforcing the public health significance of universal HPV vaccination programs worldwide.

Evaluating the cost-effectiveness of implementing HPV vaccination in Turkiye's National Immunization Program using the PRIME model.

OBJECTIVES HPV vaccines have been proven effective against genital warts and various cancers, including cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers. This study aimed to evaluate the cost-effectiveness of including the 9-valent HPV vaccine in the Turkish National Immunization Program (NIP). MATERIAL AND METHODS The Papillomavirus Rapid Interface for Modeling and Economics (PRIME) framework was applied to project the potential financial and societal outcomes of introducing HPV vaccination into Türkiye's 2024 national immunization schedule. Demographic data were obtained from the Turkish Statistical Institute (TUIK, Turkiye Istatistik Kurumu). The cost of vaccine was gathered from Ministry of Health. Epidemiologic inputs, treatment expenditure data, and additional modeling parameters were derived from previously published research sources. Model outputs included projected vaccination expenses, savings from avoided treatment, net costs, prevented cases and deaths, gained life-years, averted disability-adjusted life-years (DALYs), and estimated incremental cost-effectiveness ratios. Potential variability in model projections was examined through deterministic sensitivity testing. RESULTS At the national level, with the 9-valent HPV vaccination of a single age cohort in the base year, an estimated 772 cervical cancer cases and 369 related deaths could be avoided through implementation of the vaccination program. With an estimated US$13,754 per DALY gained, the 9-valent HPV vaccine fell within the acceptable cost-effectiveness threshold, defined as three times the GDP per capita. Sensitivity testing confirmed consistent outcomes across parameter variations, identifying the discount rate as the major driver influencing baseline estimates. CONCLUSIONS Findings from this analysis support the inclusion of HPV vaccination within the National Immunization Program (NIP) as a cost-effective public health strategy capable of reducing the burden of cervical cancer. Even when considering only cervical cancer, HPV vaccination proves to be cost-effective; when benefits against genital warts and other HPV-related cancers are included, the overall impact increases significantly.

Missed Opportunities for Human Papillomavirus Vaccine Prescription in French Military Primary Care: A KAP Survey With Scenario-Based Modeling.

Effects of School-Entry Vaccination Mandates on Adolescent Human Papillomavirus Vaccination Uptake: United States, 2008-2023.

Although mandates alone are unlikely to achieve national HPV vaccination targets, they may serve as an important component of comprehensive state efforts to increase uptake and prevent HPV-related cancers.

Cost-Effectiveness of an HPV Vaccination Program in the Postpartum Period.

OBJECTIVE The postpartum period represents an opportunity to increase human papillomavirus (HPV) vaccination rates for those not vaccinated previously. This study aimed to evaluate the health outcomes and cost-effectiveness of a postpartum HPV vaccination program. METHODS A Markov model was constructed to estimate the cost-effectiveness of a postpartum HPV vaccination program. A theoretical cohort of 400,000 vaccine-eligible postpartum individuals was simulated based on the U.S. birth rates and HPV vaccination data for those aged 18-26. Simulated health outcomes included diagnoses of cervical intraepithelial neoplasia grade 1 (CIN1), CIN2+ (CIN grade 2 or 3), and early-stage cervical cancer. Inputs were derived from the literature. Cost-effectiveness was assessed in terms of healthcare costs and patient time/quality of life. The cost of the program is represented as the cost of vaccination with staff support per person in 2024 U.S. dollars. We used an incremental cost-effectiveness ratio (ICER) threshold of $100,000 per quality-adjusted life year (QALY). Sensitivity analyses were conducted to assess the impact of varying model parameters. RESULTS Compared to no vaccination program, the postpartum HPV vaccination strategy resulted in 2,575 fewer CIN1 cases, 2,809 fewer CIN2+ cases, and 27 fewer cases of early-stage cervical cancer in our simulated population. The program yielded 3,476 additional QALYs at an incremental cost of $79.7 million. The ICER was $22,922/QALY and thus was cost-effective. The program remained cost-effective across 99% of probabilistic simulations. CONCLUSIONS A postpartum HPV vaccination program is a cost-effective strategy to reduce cervical dysplasia and cancer, meeting standards for preventative care and intervention. These results highlight the postpartum period as an opportunity to complete the HPV vaccine series.

Health economic impact and cost threshold for switching from bivalent to nonavalent HPV vaccination for preadolescent girls in KwaZulu Natal, South Africa: A mathematical modeling analysis accounting for the HIV epidemic.

BACKGROUND Human papillomavirus bivalent (2vHPV) and nonavalent (9vHPV) vaccines protect against HPV types causing 70% and 90% of cervical cancers, respectively. South African guidelines recommend vaccinating girls ages 9-14 with one dose of 2vHPV. Switching recommendations to 9vHPV could avert more cervical cancer burden, but the cost-effectiveness and cost-threshold of 9vHPV in South Africa is unknown. METHODS Using a validated compartmental HPV and HIV transmission model parameterized to KwaZulu-Natal, South Africa, we simulated scenarios of 2vHPV and 9vHPV implementation over 100 years with two doses (72% coverage) and one dose (80% and 90% coverage) with lifelong or waning single-dose vaccine efficacy. We evaluated cervical cancer cases and deaths averted. We also estimated the maximum cost/dose for 9vHPV to be cost-effective using willingness-to-pay thresholds from $500/DALY averted to $3,015/DALY averted (2023 USD). We also assessed the incremental cost-effectiveness ratios (ICERs) of 9vHPV at current costs ($110/dose) compared to 2vHPV ($9.23/dose). RESULTS Single-dose 9vHPV at 80% coverage could avert 7.9% more cervical cancer cases and 6.4% more deaths than 2vHPV (lifelong efficacy). The maximum 9vHPV price to be cost-effective (lifelong efficacy, 80% coverage) ranged from $15 ($500/DALY averted threshold) to $45/dose ($3,015/DALY averted threshold). At current market costs, single-dose 9vHPV at 90% coverage exceeds commonly used cost-effective thresholds with ICERs of $10,480/DALY averted (lifelong efficacy) and $8,806/DALY averted (waning efficacy). CONCLUSION Implementing 9vHPV can result in a greater reduction in cervical cancer burden than 2vHPV, but vaccine costs need to be reduced for 9vHPV to be cost-effective in KwaZulu-Natal.