OBJECTIVES: In 2009, a public financed HPV (Human Papilloma Virus) vaccination program for 12-years old females was initiated. Initially vaccination rates were high but recently the vaccination rates have declined which reinforces the argument for inclusion of boys in the program to help increase the efficacy of the program.

In addition, the nine-valent (HPV9) vaccine is now available actualising the need for updated cost-effectiveness analyses which take the reduced vaccination rates and the improved protection from the HPV9 vaccine into account. The HPV9 vaccine prevent infection from most (~90%) of the HPV types with carcinogenic properties.

METHODS: A dynamic HPV transmission model was calibrated to a Danish setting and used to estimate the incremental costs and QALYs associated with different vaccination strategies compared to screening only. In the modelling, the actual vaccination rates for female have been applied and vaccination of males via a public financed program (i.e. vaccination rates higher than 5%) is only included from year 10 and onwards.

RESULTS: Applying the market price for the HPV9 vaccine (pharmacy purchasing price), a 2-dose vaccination scheme and a lifelong time horizon (100 years), the incremental cost-effectiveness ratio (ICER) is estimated to 3,455 Euros/QALY for female vaccination only and 5,901 Euros/QALY for vaccination of females and males.

A gender-neutral vaccination program will increase the number avoided of HPV-related cancers and deaths, especially for anal, penile and head & neck cancer.

CONCLUSIONS: The HPV9 vaccine’s additional protection against HPV-related pre-cancers and cancers lead to improved cost-effectiveness implying that gender-neutral HPV vaccination is cost-effective in a Danish setting (ICER 5,901 Euros/QALY). Given the reduced female vaccination rates as well as the cost-effectiveness and the increased number of avoided HPV-related cancers and deaths offered by a gender-neutral vaccination program, the latter should be considered from a public health perspective.