OBJECTIVES: Currently the immunization program of the Wallonia-Brussels Federation provides free vaccination with a 2-dose HPV bivalent vaccine (2vHPV; HPV16/18) via a school-based program to girls aged 13-14 years. We assessed the public health and economic impact of a gender-neutral vaccination program with a nonavalent HPV-vaccine (9vHPV; HPV6/11/16/18/31/33/45/52/58) compared to the current program.

METHODS: A validated HPV disease transmission dynamic model that accounts for herd protection effects with a 100-year time horizon was calibrated to the Wallonia region and used to assess 2 doses of 9vHPV in males and females aged 13-14 years compared with 2vHPV vaccination in females only for the prevention of HPV-related cervical cancer (CC); cervical lesions (CIN 2/3, CIN1); vulvar lesions (VaIN); vulvar, vaginal, penile, anal, and head and neck cancers; recurrent respiratory papillomatosis (RRP); and genital warts (GW). A local Belgian study (Dominiak-Felden, 2015) was used to estimate the incidence of GW in the model. Base-case vaccination rate was 50%.

RESULTS: Compared to the current vaccination program, 9vHPV vaccination in both males and females will result in cumulative reductions in HPV6/11/16/18/31/33/45/52/58-related-disease incidence: 16.4% for CC; 29.3% for CIN2/3; 32.4% for CIN1; 17.7% and 7.8% for male and female anal cancer, respectively; 20.8% for penile cancer; and 63.8 and 65.1% for male and female RRP, respectively; 63.2% (119,794 cases) and 65.3% (73,474 cases) for male and female GW, respectively. Further, the model demonstrates that gender-neutral 9vHPV vaccination in this age cohort is cost-effective (incremental cost-effectiveness ratio=3418€/quality adjusted life year), and remains so even when extending the base-case vaccination rate from 50% to 90%, and when excluding penile cancer, RRP, and head and neck cancer.

CONCLUSIONS: The model analyses suggest that compared to a 2vHPV vaccination program in females only, gender-neutral 9vHPV vaccination has significant public health and economic benefits and is a cost-effective strategy.