OBJECTIVES: Global Health Organizations and Scientific Societies, have set Human Papillomavirus (HPV) elimination as a public health priority. Vaccination is among the most effective measures to prevent Human papillomavirus (HPV) infection. The present study assessed the cost-effectiveness of gender-neutral vaccination (GNV) with Gardasil 9(G9) versus female only vaccination (FOV) with Gardasil 9 in Greece.

METHODS: A dynamic transmission cost-effectiveness model was used to simulate the natural history of HPV infections and estimate the costs associated with HPV-related diseases. All HPV related diseases have been included in the model which are associated with the following HPV genotypes (6/11/16/18/31/33/45/54/58). Diseases included in the model were: Cervical, vaginal, vulvar, anal, penile, head and neck cancers; RRP , genital warts and CIN1/CIN2/CIN3. Screening, utilities, clinical, epidemiological, and behavioral data were extracted from the literature. The model used a time horizon of 100 years; Outcomes included QALY’s, cost for each vaccination strategy and reduction in HPV related cancer incidence and mortality. Costs were discounted by 3.5%, whereas outcomes were discounted by 3%. A deterministic sensitivity analysis was performed to correct for the uncertainty in the model.

RESULTS: It is estimated that the GNV vaccination strategy would prevent more than 4,000 HPV related cancer cases and save more than 1600 lives. The model also showed that over a lifetime horizon, total cost of FOV was 218€ per person while the cost of GNV vaccination was 242€ per person. The incremental QALY’s per person in the GNV vaccination strategy were 0.00231; the incremental cost per person was 23.76€ and the ICER was 11,137€ per QALY gained, which is below the willingness-to-pay threshold of 52,770€ per QALY (three-times Greek GDP per capita).

CONCLUSIONS: The present study suggests that GNV with G9 for HPV is a cost-effective approach for the Greek Health care System.