OBJECTIVES: To retrospectively investigate the decision-making process around the introduction of HPV vaccination in the Netherlands and to identify which actors were involved and what role (economic) evidence played in this process.

METHODS: Using the introduction of HPV vaccination since 2006 in the Netherlands as a case study, a retrospective analysis based on existing policy documents was performed. Evidence used or asked for by various stakeholders in different stages of the policy process (prioritization, development and implementation) was identified. In total, 36 documents were analyzed and synthesized, for the period between August 2006 (when a first question by the parliament was raised on the possibilities of introducing HPV vaccination) and September 2009 (when HPV vaccination was planned to be introduced in the national vaccination program). Documents were analyzed in NVIVO, using directed content analysis based on the decision-making framework of Burchett et all (2012).

RESULTS: Our analysis demonstrates that a wide variety of stakeholders are involved in the process with a key role for the Minister of Health, the parliament and the Health Council. In 90% of the documents, the decision-making process itself was discussed, in 72% financial or economic issues were stipulated and in 64% evidence on vaccine characteristics were discussed. Economic evidence from economic evaluations was discussed most (50%) followed by evidence on funding sources for HPV vaccination (28%) and incremental costs related to the implementation of the vaccination in the Netherlands (16%).

CONCLUSIONS: It can be concluded that next to the decision-making process itself economic evidence played an important role during the decision-making process on the introduction of HPV-vaccination, in particular the use of evidence resulting from economic evaluations.