Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands

J Infect Dis. 2017 Jul 15;216(2):210-219. doi: 10.1093/infdis/jix272.


Background: Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination.

Methods: We expanded a previously published Bayesian synthesis framework to account for all vaccine type-related cancers and herd immunity effects from vaccinating girls and boys. We evaluated the efficiency of vaccinating boys relative to increasing vaccine uptake among girls and assessed the cost-effectiveness of a sex-neutral program.

Results: Vaccinating 40% of boys along with 60% of girls yielded the same gain in life-years (LYs) as increasing the uptake in girls from 60% to 80%. The incremental cost-effectiveness ratio (ICER) of vaccinating boys was €9134/LY (95% credible interval [CrI], €7323/LY-€11231/LY) under 3% discounting. The ceiling vaccination costs at which the ICER remained below the per capita gross domestic product threshold was €240 (95% CrI, €200-€280) per vaccinated boy. If girls' uptake increased to 90%, the ceiling costs decreased to €70 (95% CrI, €40-€100) per vaccinated boy.

Conclusions: Vaccinating boys along with girls is only modestly less efficient than increasing uptake among girls and highly likely to be cost-effective under current vaccine costs and uptake in the Netherlands.

Keywords: Netherlands; cost-effectiveness analysis; human papillomavirus vaccines; sex-neutral vaccination; tender procedure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bayes Theorem
  • Child
  • Cohort Studies
  • Cost-Benefit Analysis
  • Female
  • Human papillomavirus 16
  • Human papillomavirus 18
  • Humans
  • Immunization Programs / economics*
  • Male
  • Neoplasms / economics
  • Neoplasms / prevention & control*
  • Neoplasms / virology
  • Netherlands
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / administration & dosage*
  • Papillomavirus Vaccines / therapeutic use
  • Sex Factors
  • Vaccination / statistics & numerical data*


  • Papillomavirus Vaccines