Cost Effectiveness and Public Health Impact of Implementing Gender-Neutral Vaccination with the 9-Valent Human Papillomavirus Vaccine in Turkiye

OBJECTIVES: Human Papillomavirus (HPV) is a family of viruses comprising over 100 genotypes and responsible for significant proportion of cancers and precancerous lesions of the cervix, vulva, vagina, anus, penis, head & neck, and genital warts. Cervical cancer accounts for most HPV related cancers in Turkiye with 2,532 diagnoses and 1,245 deaths in 2020. In Turkiye, HPV vaccines are not included in National Immunization Program (NIP) yet. This study will assess the cost effectiveness and health impact of inclusion of Gender-Neutral Vaccination (GNV) with 9-Valent HPV (9vHPV) in NIP in Turkiye for individuals aged 11-12 years old.

METHODS: A published HPV dynamic transmission model was used to estimate the potential economic and health impact of inclusion of 9vHPV in NIP, comparing this strategy with no vaccination. Vaccination coverage with two-dose schedule is assumed to be 90% and sensitivity analyses were conducted. Costs calculated based on Social Security Institute (SSI) perspective, outcomes were reported over a 100-year time horizon, costs and outcomes were discounted by 3%.

RESULTS: The results showed that over 100 years, GNV may result in an avoiding 86,736 cases and 37,155 deaths in cervical cancer; 39,181 cases and 11,721 deaths in head & neck cancer; 5,670 cases and 1,847 deaths in anal cancer; 2,074 cases and 529 deaths in vaginal cancer; 1,224 cases and 335 deaths in vulvar cancer; and avoiding 5,695,781 genital warts compared to no vaccination with an ICER of 3,744 $/QALY which is much lower than the willingness-to-pay threshold of 31,965$ per QALY in Turkiye.

CONCLUSIONS: GNV with the 9vHPV vaccine may be very cost effective compared to no-vaccination and result in greater improvement of the public health and economic impact in both women and men. It should be considered for inclusion in NIP policies in Turkiye.