Cost-Effectiveness and Public Health Impact of a Nine-Valent Human Papillomavirus Vaccination Program in Ukraine

OBJECTIVES: To estimate the expected economic and public health impact of nine-valent HPV vaccine (9vHPV; HPV6/11/16/18/31/33/45/52/58) implementation in the National Immunization program (NIP) in Ukraine.

METHODS: A published HPV transmission dynamic model was calibrated to simulate the natural history of HPV infections and estimate the costs associated with HPV-related diseases. The model assumed two-dose schedule over a 100-year time-horizon with herd immunity and a discount rate of 3%. The female-only vaccination with two-dose schedule with gradual increase of vaccination coverage up to 80% by 5^th year of the program was assessed. Local epidemiology and local tariffs from Ukraine’s Program of Medical Guarantees were used. The costs were converted in USD (exchange rate 1 USD = 36.5686 UAH according to National Bank of Ukraine in February 2023).

RESULTS: Over 100 years, 9vHPV vaccination strategy will prevent overall 191,770 HPV-related cancer cases and save 74,987 lives. By disease type, 172,850 (43.4%) cervical cancer cases, 3,121 (37.3%) and 3,281 (33.1%) cases of vaginal and vulvar cancers will be avoided, respectively. Vaccination would prevent additional 2,208,855 (58.6%) cases of anogenital warts in females and 1,034,947 (35.4%) in males. The cumulative number of quality-adjusted life years gained from the HPV vaccination program compared with no vaccination will be 663,179 QALYs. ICER of 9vHPV was 998$ per QALY gained which is below the willingness-to-pay threshold of 14,505$ per QALY (assumed as 3×GDP per capita) in Ukraine.

CONCLUSIONS: The present study suggests that inclusion of 9vHPV in NIP is a highly cost-effective approach for the healthcare system in Ukraine and will result in greater improvement of the public health and economic impact.