PIN10 ESTIMATING THE IMPACT OF A GENDER-NEUTRAL QUADRIVALENT HUMAN PAPILLOMAVIRUS VACCINATION PROGRAM IN ALL HPV6/11/16/18-RELATED DISEASES IN BRAZIL WITH A HIGHER VACCINE COVERAGE RATE

Human papillomavirus (HPV) infection is associated with the development of genital warts (GW), recurrent respiratory papillomatosis (RRP), cervical, vulvar, vaginal, penile, anal and head and neck cancers. The aim of this analysis is to estimate the public health impact of increasing the vaccination coverage rate (VCR) for the existing gender-neutral vaccination with the quadrivalent HPV vaccine (4vHPV). A validated HPV-type dynamic transmission model was employed to simulate GNV two-dose 4vHPV vaccination in the 9-14-year-old female cohort and 11-14-year-old male cohort. The model compared the base case (current first and second dose VCRs in females [80% and 50%] and males [50% and 20%]) with the same VCR scenario for both genders [30% VCR increase in males]). Brazil-specific data were used for calibration. The model assumed a 100-year time-horizon, lifelong immunity following vaccination, herd immunity, ongoing cytology screening, and a 5% discount rate. The predicted health outcomes included HPV6/11/16/18-related disease cases averted, direct healthcare cost prevented by vaccination and incremental cost-effectiveness ratios (ICERs). With an 30% VCR increase in males, the reduction of HPV6/11/16/18-related disease incidence was greater and began earlier in both genders. The estimated HPV6/11/16/18-related cancers and deaths cases averted were 58,227 and 26,934, respectively, compared to the current program. The greatest averted cases reductions were seen in HPV6/11-related diseases (10.5 million). The estimated direct heath care cost savings in the scenario with higher VCR in males compared with base case was US$134.6 million over 100 years, driven by HPV6/11-related treatment costs. The ICER per QALY reduced from US$5,831 (cervical cancer) to US$702 when all the outcomes were included in the analysis. In Brazil, a GNV 4vHPV program with higher VCR in males relative to the current VCR is a highly cost-effective strategy, providing earlier and greater cumulative reductions in all HPV6/11/16/18-related diseases in both genders.