The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Hum Vaccin Immunother. 2016 Jun 2;12(6):1363-72. doi: 10.1080/21645515.2016.1140288. Epub 2016 Feb 18.


Introduction: The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58.

Methods: We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information.

Results: Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV.

Conclusions: Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.

Keywords: cost-effectiveness; cost-utility; disease transmission models; human papillomavirus; nonavalent HPV vaccine; quadrivalent HPV vaccine; vaccines.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis*
  • Disease Transmission, Infectious / prevention & control*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / epidemiology
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Infections / transmission*
  • Papillomavirus Vaccines / administration & dosage*
  • Papillomavirus Vaccines / economics
  • Treatment Outcome
  • United States / epidemiology
  • Vaccination / economics*
  • Young Adult


  • Papillomavirus Vaccines