health-economic analysis regarding HPV-vaccination of boys

The health economic analysis compared the health effects and costs of introducing sex-neutral HPV vaccination to a situation where only girls are vaccinated. The analysis used a time horizon of 100 years and took herd immunity into account. Costs included the direct costs for the vaccine and for resource use within the healthcare sector, and indirect costs in the form of productivity losses.

If girls are offered vaccination against HPV with a bi- or tetravalent vaccine, it would be cost-effective to also vaccinate boys with the same type of vaccine, even at the current list price (Incremental Cost Effectiveness Ratio, ICER, of 375 000 SEK). If girls are offered the nonavalent vaccine, the ICER would be about 615 000 SEK to also offer boys vaccination with this vaccine, given the current list price. If procurement led to a 35 percent lower price, the ICER using the nine-valent vaccine would be comparable to using the bi- or tetravalent vaccine, and be considered cost-effective.

In a situation where both girls and boys are already offered vaccination with a bi- or tetravalent vaccine, the ICER would be close to 1.5 million SEK (at list price) to offer them vaccination with a nonavalent vaccine instead. If the price difference between the two types of vaccines was to be decreased by approximately 30 percent, a switch from a bi-/tetravalent to a nonavalent vaccine could be considered cost-effective.

The yearly cost of a bi- or tetravalent vaccine for one cohort of boys at 80 percent vaccination coverage would be about 80 million SEK, at list price. If the price of the vaccine was about 85 percent lower than today’s list price, similar to the 2017 procurement price of the tetravalent vaccine Gardasil in Sweden, the introduction of sex-neutral vaccination would imply an increase in costs of about 12 million SEK annually. The corresponding figures for the nonavalent vaccine would be 135 million SEK at list price and 20 million SEK with an 85 percent rebate. Costs of administering the vaccinations to boys would amount to an additional 5‒11 million SEK annually according to prior estimations, and would be independent of the choice of vaccine. The costs for vaccinating girls are not included in these calculations.