OBJECTIVES: Human papillomavirus (HPV) is a sexually transmitted infection responsible for various types of cancer and genital warts. Vaccination programs have been shown to be effective in reducing HPV-related disease burden. This study investigates the health outcomes and cost-effectiveness of different vaccination strategies to prevent HPV-related diseases in Italy.

METHODS: We adapted a published age-structured HPV infection and disease-progression model to Italian incidence/prevalence data. We compare the health outcomes and cost-effectiveness of several vaccination strategies: (a) adolescents (AA), (b) adolescent+young adults (AA+YA) with catch-up to age 26 (females) and to age 18 years (males), which corresponds to the “proposed Italian NIP”, (c) adolescent+mid-adult (AA+YA+MAW) with mid-adult female catch-up of age 45 years, and (d) adolescent+opportunistic single cohorts for females aged 30, 35 and 40 years (AA+YA+SC). For each (b)-(d), we consider 3-, 5-, and 10-year duration.

RESULTS: The preliminary results suggest that, compared to AA, all scenarios may lead to a marginal decrease in the cumulative cases of all HPV-related cancers. The duration of the strategy also had an impact, with extending the duration from 3 to 10 years providing between 5.35% and 10.15% reduction in the cancer cases across all strategies. These catch-up and single cohort scenarios have higher costs and lower QALYs than the AA scenario. The results suggest that catch-up campaigns, depending on the duration, may provide significant health benefits at a reasonable cost. These strategies required additional cost per QALY gained, with ICERs ranging from €25,703/QALY to €49,868/QALY. Among the strategies, AA+YA (all durations), AA+YA+SC (5-, 10-year duration), AA+YA+MAW (10-year duration) are relatively more cost-effective compared to AA.

CONCLUSIONS: While temporary catch-up and single cohort vaccination programs may advert additional cancer cases as compared to AA, the results suggest that certain strategies may offer a reasonable balance between cost and health outcomes in a high historical vaccination and screening coverages.