Economic evidence

Several studies have shown that the feasibility of HPV vaccination is high, which means that the vaccine's benefits in terms of disease prevention outweigh the costs of administering the vaccine. The cost-effectiveness of HPV vaccination varies depending on several factors, including the vaccinated population, the cost of the vaccine, the effectiveness of the vaccine, and the cost of treating HPV-related diseases. However, most studies have shown that HPV vaccination is feasible and even reduces costs in the system, especially when it is given to girls and boys before they start their sex lives [1].

As recommended by the WHO in 2019, all countries should conduct research to determine the cost-effectiveness of HPV vaccination before implementing national programs. Programs dedicated to HPV vaccination and studies on the subject adapted for low- and middle-income countries are needed to increase vaccination coverage [2].

Multiple studies across various countries and settings have consistently shown that the HPV vaccine is cost-effective, especially when considering the long-term healthcare costs associated with treating HPV-related diseases, such as cervical cancer, other anogenital cancers, and oropharyngeal cancers.

Cost of Illness: Treating HPV-associated diseases is expensive. For instance, in the United States, the annual direct medical cost of treating cervical diseases and cancers caused by HPV is estimated to be over $1 billion.

Vaccine Cost vs. Treatment Cost:

A study conducted in the U.S. found that the cost of vaccinating 12-year-old girls was less than the lifetime costs associated with treating new cases of cervical cancer and genital warts [3].
According to the World Health Organization (WHO), in low-resource settings where cervical cancer screening and treatment are limited or absent, HPV vaccination of girls has shown to be highly cost-effective [4].

Modeling Studies:

Various modeling studies have found HPV vaccination to be cost-effective, particularly when vaccination coverage is high and provided at younger ages, usually before sexual debut.
A study in the UK found that the HPV vaccination program, targeting 12-year-old girls, would prevent up to 400 deaths from cervical cancer annually. The program's cost-effectiveness was even more pronounced when considering the broader spectrum of HPV-related diseases.
A study from Australia, which has one of the earliest and most comprehensive HPV vaccination programs, found that the program was cost-saving when considering the cumulative costs of cervical cancer screening and treatment over a lifetime.

Inclusion of Boys:

Several analyses have assessed the cost-effectiveness of expanding HPV vaccination to boys. The results vary based on settings, HPV types in the vaccine, coverage in girls, and other factors. However, many studies, especially those from settings where vaccine uptake in girls is low, suggest that vaccinating boys can be cost-effective [5].

The cost-effectiveness of a one-dose vaccination scheme:

Reviews of the available scientific data have shown that a single dose of the vaccine is just as effective as two doses at preventing HPV-related cancers. A single-dose vaccination offers comparable health advantages to a two-dose regimen, streamlining the vaccination process, lowering expenses, and easing vaccine supply limitations. If protection from a single dose has a shorter lifespan, and if there are more affordable vaccine options, efficient delivery methods, and a significant incidence of cervical cancer, then a second dose might become economically viable [7].

Health and Economic Benefits:

Beyond the direct medical costs saved, HPV vaccination has broader societal and economic benefits. Preventing cervical and other HPV-associated cancers means fewer years of life lost to the disease, improved quality of life, reduced pain and suffering, and decreased work and productivity losses.

Catch-Up Vaccination Programs:

Some studies have assessed the cost-effectiveness of catch-up vaccination programs for older adolescents and young adults. While the cost-effectiveness generally decreases with age (due to prior HPV exposure), these programs can still be deemed cost-effective, especially in settings where the vaccine coverage among younger cohorts has been low [6].

It's essential to note that while HPV vaccination has a front-loaded cost (the cost of buying and administering the vaccine), the benefits — both in terms of health outcomes and cost savings from averted treatment — accrue over the long term. Overall, the consensus in the public health community is that HPV vaccination provides excellent value for money, especially when considering the full range of HPV-associated diseases it can prevent.

Understanding the costs associated with different strategies for large-scale vaccination implementation is key to identifying opportunities to optimize current vaccination programs. For example, the stigma associated with vaccination for a sexually transmitted disease is a factor influencing vaccination coverage in many region. In this context, interventions are needed to target citizens' behaviour.

Given the current public attitude towards vaccination, the cultural and historical aspects of each region must be taken into account when implementing vaccination strategies. The inclusion of community representatives in the initial phases of the planning of these strategies can facilitate the creation and promotion of safe, personalized and coordinated public health messages.

References:

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.