Cost-effectiveness analysis of HPV vaccination of men who have sex with men in Germany

IntroductionMen who have sex with men (MSM) have a high risk of human papillomavirus (HPV) infection and HPV-related diseases. While gender neutral HPV vaccination between the ages of 9-14 years (with the option for catch-up between 15- and 17-years-of-age) has been recommended in Germany since 2018, adult MSM are currently not included and thus do not benefit from its advantages. This analysis aims to quantify the reduction in public health and health economic burden of including 18-26-year-old or 18-45-year-old MSM in the national HPV vaccination recommendation, compared to the status quo of vaccinating adolescent boys only.MethodsWe developed a dynamic transmission model of HPV, with an integrated HIV model, to analyze the potential impact of the 9-valent HPV vaccination on HPV infections and HPV-related diseases (anal, penile, and oropharyngeal cancers, and anogenital warts). By including economic outcomes, the model provides estimates of the cost-effectiveness of HPV vaccination among adult MSM in Germany.ResultsVaccinating MSM aged 18-26 years could prevent an additional 2,583 anal, penile and oropharyngeal cancers, 709 deaths and 81,372 anogenital warts. Expanding vaccination to MSM aged 18-45 years, 4,091 cancers, 1,516 deaths and 114,117 anogenital warts could be averted. The highest reductions were found in anal cancers and anogenital warts; significant incidence reductions in cancers were seen within about 20 years. Vaccinating 18-26 and 18-45-year-old MSM resulted in Incremental Cost-Effectiveness Ratios (ICERs) of 35,300.09<euro>/QALY and 42,088.06<euro>/QALY, respectively, when compared to the vaccination of adolescent boys only.ConclusionsVaccination of MSM up to 26 and 45 years of age can profoundly accelerate beneficial public health outcomes while reducing the economic burden of HPV-related cancers and anogenital warts in a cost-effective way compared to vaccinating adolescent boys only.