Cost-effectiveness of gender neutral vaccination of adolescents against human papillomavirus infection in the Russian Federation

Abstract

The human papillomavirus (HPV) infection is one of the risk factors for the development of a number of diseases in women and men. Vaccination of adolescents with the 4-valent HPV vaccine significantly reduces the prevalence of infection with vaccine strains of HPV.The aim of this study was to assess the cost-effectiveness of gender neutral vaccination with the 4-valent HPV vaccine in 12-year-old adolescents in the Russian Federation.Materials and methods. Markov modeling was used based on epidemiological data for the Russian Federation. In the base case, the analysis was carried out taking into account the social perspective. It was assumed that the effect of vaccination lasts throughout life. The analysis was carried out for the survival period of 12-year-old adolescents. Costs for the treatment of HPV-associated diseases corresponded to compulsory health insurance rates across St. Petersburg for 2023. Costs and life expectancy have been discounted for 3,5% a year.Results. Taking into account the accepted assumptions, vaccination of 12-year-old girls in the Russian Federation with the 4-valent HPV vaccine will prevent, per 100 thousand vaccinated people, 1448 cases of anogenital warts, 4106 cases of cervical intraepithelial neoplasia grade 2+, 1194 cases of invasive cervical cancer and 257 cases of other oncological HPV-associated diseases, and gender-neutral vaccination (100 thousand girls and 100 thousand boys) – an additional 1021 cases of anogenital warts and 162 cases of oncological HPV-associated diseases. Vaccination of girls will reduce the budgetary costs associated with HPV infection by 28.515 thousand rubles per 1 vaccinated girl with vaccination cost equal to 24.606 thousand rubles. Vaccination of adolescents of both sexes increases costs by 10.074 thousand rubles per 1 vaccinated person. The incremental cost-effectiveness ratio (ICER) is equal to 232.5 thousand rubles/QALY (quality adjusted life year), i.e. vaccination is highly cost-effective. Sensitivity analysis shows the high reliability of the results obtained.Conclusions. Gender neutral vaccination of adolescents before the onset of sexual activity with the 4-valent HPV vaccine can be considered as a highly effective health technology in the prevention of HPV associated diseases.