Universal vaccination with the quadrivalent HPV vaccine in Austria: impact on virus circulation, public health and cost–effectiveness analysis

Abstract

The International Agency for Research on Cancer acknowledges that HPV is a human carcinogen affecting both sexes. This study aimed to evaluate the public health impact of universal HPV vaccination in Austria, to assess its cost-effectiveness and to estimate the HPV prevalence reduction over time. Vaccinating 65% of 9-year-old boys and girls in Austria would result in a 70% decrease in HPV infections in both males and females, hereby avoiding 9500 cases of genital warts annually and 431 HPV 16/18-related cancers in males and females. This strategy would be cost effective with base case analysis of €26,701/quality-adjusted life year (QALY) gained for cervical cancer only, €15,820/QALY also including vaginal/vulvar cancers and genital warts, and €10,033/QALY also considering anal, oropharyngeal and penile cancers, with an incremental cost-effectiveness ratio ranging from €2500 to €21,000/QALY in sensitivity analyses. HPV circulation would be controlled hereby preventing subsequent HPV-related cancers.

Public health value of universal HPV vaccination

“…• accelerate the control of HPV vaccine types circulation and related cancers and diseases with quasi-elimination of vaccine HPV strains in the population (64,65,66);…”

“…The reported data from the literature show a different economic interpretation in the mentioned countries (see Table 4.) of a substantial answer to a correct interpretation of the concepts on health rights (74,65,75,76,56,77,78,79,80 Published studies on cost effectiveness of HPV vaccination suggest that vaccination against HPV can be used and can be cost effective. Over 64 countries around the world were included in cost effectiveness analyses of HPV vaccination (81).…”

Could the human papillomavirus vaccination be cost-effective in males for the prevention of oropharyngeal cancer?

“…Expanding the males' age group to 9-26 would reduce the ICER to approximately US$70,000/QALY [18]. In Austria, vaccinating 65% of males and females was discussed as a possible cost-effective option with an ICER below US$40,000/QALY when including several HPV-associated outcomes [19]. Similarly across studies, costeffectiveness analyses of HPV vaccine in males were sensitive to factors such as uptake rate and outcomes of interest, which are likely to vary by jurisdiction [9,17].…”

Pre-vaccine era cervical human papillomavirus infection among screening population of women in west Austria

“…In Austria these vaccines have been recommended and available for use since their approval [11, 12]. However, it is only since the beginning of 2014 that the country integrated HPV vaccine in the free of charge immunization program [12].…”