Palmer Cody, Matsuki Taizo, Tobe Keisuke, You Xuedan, Chen Ya-Ting
Biostatistics & Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA.
Outcomes Research, MSD K.K, Tokyo, Japan.
J Med Econ. 2025 Dec;28(1):974-985. doi: 10.1080/13696998.2025.2520703. Epub 2025 Jun 20.
This study aimed to assess the public health impact and cost-effectiveness of gender-neutral vaccination (GNV) using a nonavalent vaccine (9vHPV) in Japan.
We used a published, validated dynamic transmission model to estimate the cases of, deaths from, quality-adjusted life years (QALYs) lost to, and costs of diseases associated with HPV genotypes included in the 9vHPV vaccine. These outcomes were modeled over a 100-year time horizon under different GNV and female-only vaccination (FOV) strategies. The primary analysis compared GNV to FOV at a female vaccination coverage rate (VCR) of 30% and male VCR of 15%. Scenario analyses assessed the effects of varying these VCRs, the age at vaccination, and the discount rate.
In the base case, GNV averted an additional 2,070 female and 1,773 male deaths from HPV-associated cancers compared to FOV and was cost effective, with an incremental cost-effectiveness ratio (ICER) of 4,798,537 ¥/QALY from the payer perspective (direct medical costs) and 4,248,586 ¥/QALY from the societal perspective (including costs of lost work productivity). The ICER of GNV versus FOV was higher in scenarios with higher VCRs. However, the ICER could be reduced compared to the base case by implementing vaccination at <15 years of age to reduce the number of vaccine doses required or by reducing the discount rate to assign greater value to the long-term cancer prevention benefits of HPV vaccination.
This study may be limited by inaccuracies in the model's input data and assumptions, as well as the exclusion of some societal costs, which may have underestimated cost-effectiveness.
Including boys and men in Japan's HPV vaccination strategy is predicted to provide additional public health benefits compared to FOV and to be cost effective, particularly while the female VCR remains low and if the full vaccine series is completed before age 15.
本研究旨在评估在日本使用九价人乳头瘤病毒疫苗（9vHPV）进行性别中立疫苗接种（GNV）的公共卫生影响和成本效益。
我们使用已发表的、经过验证的动态传播模型，来估计9vHPV疫苗中包含的人乳头瘤病毒（HPV）基因型相关疾病的病例数、死亡数、质量调整生命年（QALY）损失以及成本。这些结果是在不同的性别中立疫苗接种和仅女性接种（FOV）策略下，在100年的时间范围内进行建模的。主要分析在女性疫苗接种覆盖率（VCR）为30%且男性VCR为15%的情况下，将性别中立疫苗接种与仅女性接种进行了比较。情景分析评估了改变这些VCR、接种年龄和贴现率的影响。
在基础案例中，与仅女性接种相比，性别中立疫苗接种避免了另外2070名女性和1773名男性因HPV相关癌症死亡，并且具有成本效益，从支付者角度（直接医疗成本）的增量成本效益比（ICER）为4798537日元/QALY，从社会角度（包括工作生产力损失成本）为4248586日元/QALY。在VCR较高的情景中，性别中立疫苗接种与仅女性接种相比的ICER更高。然而，与基础案例相比，通过在15岁以下实施接种以减少所需疫苗剂量数量，或者通过降低贴现率以赋予HPV疫苗接种的长期癌症预防益处更大价值，可以降低ICER。
本研究可能受到模型输入数据和假设不准确以及排除一些社会成本的限制，这可能低估了成本效益。
预计在日本的HPV疫苗接种策略中纳入男孩和男性，与仅女性接种相比将提供额外的公共卫生益处，并且具有成本效益，特别是在女性VCR仍然较低且在15岁之前完成完整疫苗系列接种的情况下。
