title: The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Harrell W
authors.initials: HW
authors.lastname: Chesson
authors.affiliation: a Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
authors.affiliation: a Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.affiliation: b Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.affiliation: b Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: cost-effectiveness; cost-utility; disease transmission models; human papillomavirus; nonavalent HPV vaccine; quadrivalent HPV vaccine; vaccines