Health impact and cost effectiveness of implementing gender-neutral HPV vaccination in Japan

To assess the public health impact and cost effectiveness of gender-neutral vaccination (GNV) versus female-only vaccination (FOV) with human papillomavirus (HPV) vaccination in Japan. We modeled the public health impact and cost effectiveness of GNV versus FOV to prevent HPV-associated diseases in Japan over the next 100 years. We used one-way sensitivity analyses to examine the impact of varying key model input parameters and conducted scenario analyses to explore the effects of varying the vaccination coverage rate (VCR) of each cohort. In the base-case analysis, GNV averted additional cancer cases (17,228 female/6,033 male) and deaths (1,892 female/1,849 male) compared to FOV. When all HPV-associated diseases were considered, GNV had an incremental cost-effectiveness ratio of ¥4,732,320 (US$35,987)/quality-adjusted life year gained compared to FOV. The model was most sensitive to the discount rate and the disutility associated with HPV-related diseases. GNV had greater relative public health benefits when the female VCR was lower and was cost effective at a female VCR of 30%. Immediate implementation of GNV would reduce the disease burden and mortality associated with HPV in Japan, and would be cost effective compared to FOV if the female VCR remains low (30%). Human papillomavirus (HPV) is a common sexually transmitted infection and, in Japan, the prevalence of HPV infection and the incidence of its associated diseases are high among both men and women. In the present manuscript we modeled the public health impact and cost effectiveness of gender-neutral vaccination versus female-only vaccination to prevent HPV-associated diseases in Japan over the next 100 years and found that immediate implementation of a gender-neutral vaccination strategy would reduce the burden and mortality associated with HPV in Japan.

本研究旨在评估日本地区采用人乳头瘤病毒（human papillomavirus, HPV）疫苗实施性别中立接种（gender-neutral vaccination, GNV）与仅女性接种（female-only vaccination, FOV）的公共卫生影响及成本效益。我们针对日本未来100年内HPV相关疾病的预防场景，构建了GNV与FOV的公共卫生影响及成本效益模型。本研究采用单因素敏感性分析，探究关键模型输入参数变动的影响；同时开展情景分析，以考察各队列疫苗接种率（vaccination coverage rate, VCR）的变化效应。基准情景分析结果显示，相较于FOV，GNV可额外减少癌症病例17228例（女性）/6033例（男性），以及死亡病例1892例（女性）/1849例（男性）。若纳入全部HPV相关疾病，相较于FOV，GNV的增量成本效益比为每获得1个质量调整生命年（quality-adjusted life year）4732320日元（合35987美元）。该模型对贴现率及HPV相关疾病带来的失能效用最为敏感。当女性疫苗接种率较低时，GNV的相对公共卫生收益更高；且当女性疫苗接种率为30%时，GNV具备成本效益。在日本立即推行GNV，可降低HPV相关疾病负担与死亡人数；若女性疫苗接种率维持在30%的低位水平，相较于FOV，GNV同样具备成本效益。人乳头瘤病毒（HPV）是一类常见的性传播感染病原体，在日本，男女群体的HPV感染率及相关疾病发病率均处于较高水平。本研究针对日本未来100年内HPV相关疾病的预防场景，构建了性别中立接种与仅女性接种的公共卫生影响及成本效益模型，结果证实，立即推行性别中立接种策略可有效降低日本地区HPV相关疾病的疾病负担与死亡人数。