Cost-effectiveness and health impact of gender-neutral and single-dose HPV vaccination in Hong Kong: a modeling analysis.

BACKGROUND

Since 2019, Hong Kong has implemented a routine nonavalent human papillomavirus (HPV) vaccination program for schoolgirls aged 10-12 years with two-dose uptake of over 85%. However, Hong Kong is one of the high-income populations in Asia that lacks an assessment of the impacts of gender-neutral vaccination (GNV) with a single-dose schedule. This study evaluates the cost-effectiveness of expanding the two-dose female-only vaccination (2dFOV) to GNV and reducing the schedule to one dose.

METHODS

We modeled the impacts of 2dFOV and GNV (a single- or two-dose schedule) on the burden of HPV-related cancers and genital warts in both genders. We estimated the associated costs and health outcomes over a time horizon of 100 years with a 3% annual discount rate. We compared the incremental cost-effectiveness ratio (ICER) of expanding 2dFOV to GNV to a threshold of one gross domestic product per capita (US$52,120).

FINDINGS: Assuming a base case vaccination cost of US$177 per dose and 85% uptake for both genders, two-dose GNV (2F2M) has an ICER of US$71,105 (90% prediction interval: (US$44,085, US$153,197)) compared to 2dFOV and is not cost-effective. Compared to 2dFOV, giving one dose to both genders (1F1M) is cost-effective or dominant in all simulations, if boys' uptake is more than 50% and if the single-dose schedule provides 30 years of protection. If the single-dose schedule gives only 20 years of protection, 1F1M is cost-effective or dominant in 92% and 73% of simulations if boys' uptake is 85% and 50%, respectively.

INTERPRETATION: Expanding the current 2dFOV to GNV with a one-dose schedule for males (1F1M or 2F1M) could be a cost-effective strategy if the uptake among boys is sufficiently high.

FUNDING: Health and Medical Research Fund, AIR@InnoHK.