A recent study on the cost-effectiveness of transitioning from the bivalent human papillomavirus vaccine (2vHPV) to the nonavalent vaccine (9vHPV) in the Netherlands provides a detailed analysis of the potential public health and financial benefits. The study highlights how adopting the 9vHPV vaccine could lead to significant improvements in public health outcomes while achieving substantial cost savings.

Background

The Netherlands currently uses the 2vHPV vaccine; however, the 9vHPV vaccine is also licensed for use. The study employed a deterministic dynamic transmission metapopulation model to compare the public health and economic benefits of the 2vHPV and 9vHPV vaccination strategies over 100 years. The model incorporated data on population demographics, vaccine efficacy, vaccination coverage, healthcare costs, disease incidence, and mortality rates.

Human papillomavirus vaccine Cost-effectiveness and Outcomes

Replacing the 2vHPV vaccine with the 9vHPV vaccine in the Dutch National Immunization Program (NIP) could significantly improve public health over 100 years. The 9vHPV vaccine would prevent more cases and deaths from HPV-associated diseases than 2vHPV. Adding a catch-up vaccination program would amplify these benefits, accelerating the elimination of anogenital warts (AGWs) and recurrent respiratory papillomatosis (RRP) by 5–6 years.

The 9vHPV strategy is highly cost-effective, with an incremental cost-effectiveness ratio (ICER) of ~10% of the 2021 per-capita GDP of the Netherlands. Pairing 9vHPV with a catch-up program delivers the greatest public health gains, though it may exceed some cost-effectiveness thresholds. Even with permanent catch-up vaccination, the 9vHPV strategy remains valuable, with an ICER of €5,665 per QALY compared to a permanent 2vHPV strategy.

Disease-specific benefits were particularly significant for AGWs and RRP, largely caused by HPV strains 6 and 11, as well as cervical cancer, which is more strongly associated with the additional strains targeted by 9vHPV. Compared internationally, the Dutch ICERs for 9vHPV are competitive, being lower than those reported in Germany and Singapore.

Despite limitations in the modeling, including reliance on proxy data and assumptions about static vaccination behaviors, the analysis strongly supports the transition to 9vHPV in the Dutch NIP. This approach offers a clear pathway to improved health outcomes, reduced disease burden, and long-term cost-effectiveness, making it a compelling choice for policymakers.

Conclusion

The study concludes that adopting the 9vHPV vaccine would be a cost-effective strategy for the Netherlands, providing significant public health benefits and improved health outcomes. Overall, the transition from the 2vHPV to the 9vHPV vaccine presents a promising avenue for enhancing healthcare in the country.