Sollie Birgit, Berkhof Johannes, Bogaards Johannes A
Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
Amsterdam Public Health, Amsterdam, The Netherlands.
BMC Med. 2025 Jun 9;23(1):339. doi: 10.1186/s12916-025-04170-3.
Most European countries offer human papillomavirus (HPV) vaccination through organised immunisation programmes, but the choice of vaccine varies. We compared the expected health and economic effects of the currently used bivalent vaccine, targeting HPV-16/18, and the nonavalent vaccine, targeting seven additional genotypes, for the Netherlands.
We estimated the incremental impact of nonavalent versus bivalent vaccination in a cohort of 100,000 girls and 100,000 boys offered vaccination at age 10, by projecting type-specific infection risk reductions onto expected number of cervical screening outcomes, HPV-related cancers, and treatments for anogenital warts and recurrent respiratory papillomatosis (RRP). In the base-case, we assumed two-dose vaccination with 60% uptake, lifelong partial cross-protection against HPV-31/33/45 for the bivalent vaccine and EUR 25 extra cost per dose for the nonavalent vaccine. Cost-effectiveness was assessed from a healthcare provider perspective by comparing the incremental cost-effectiveness ratio (ICER) per life-year gained (LYG) with the Dutch threshold of EUR 20,000/LYG.
Compared with bivalent vaccination, nonavalent vaccination prevents an additional 1320 high-grade cervical lesions, 70 cancers, 34,000 anogenital warts episodes and 30 RRPs and generates EUR 4.1 million discounted savings from fewer treatments. The ICER is EUR 5489 (95% credible interval: 3765; 7019)/LYG in the base-case and exceeds the cost-effectiveness threshold only if the cross-protection for the bivalent vaccine extends permanently to non-31/33/45 genotypes or if the vaccine efficacy wanes past age 20 for both vaccines.
Sex-neutral vaccination with the nonavalent vaccine is likely to be cost-effective. Long-term monitoring of type-specific vaccine effectiveness is essential because of the impact of cross-protection and waning efficacy on cost-effectiveness.
大多数欧洲国家通过有组织的免疫规划提供人乳头瘤病毒（HPV）疫苗接种，但疫苗的选择各不相同。我们比较了荷兰目前使用的针对HPV-16/18的二价疫苗和针对另外七种基因型的九价疫苗预期的健康和经济影响。
我们通过将特定类型感染风险的降低推算到预期的宫颈筛查结果、HPV相关癌症以及肛门生殖器疣和复发性呼吸道乳头瘤病（RRP）的治疗次数上，估计了在10万名10岁接受疫苗接种的女孩和10万名男孩队列中，九价疫苗与二价疫苗接种的增量影响。在基础病例中，我们假设两剂接种，接种率为60%，二价疫苗对HPV-31/33/45有终身部分交叉保护作用，九价疫苗每剂额外成本为25欧元。从医疗服务提供者的角度，通过将每获得一个生命年（LYG）的增量成本效益比（ICER）与荷兰20000欧元/LYG的阈值进行比较来评估成本效益。
与二价疫苗接种相比，九价疫苗接种可额外预防1320例高级别宫颈病变病例、70例癌症、34000例肛门生殖器疣发作和30例RRP，并因治疗减少产生410万欧元的贴现节省。基础病例中的ICER为5489欧元（95%可信区间：3765；7019）/LYG，只有在二价疫苗对非31/33/45基因型的交叉保护永久延长或两种疫苗在20岁以后效力减弱的情况下，才会超过成本效益阈值。
九价疫苗的性别中性接种可能具有成本效益。由于交叉保护和效力减弱对成本效益的影响，对特定类型疫苗效力进行长期监测至关重要。
