Peer-reviewed article
Public health impact and cost-effectiveness of implementing gender-neutral immunization with the nonavalent human papillomavirus vaccine in South Korea.
Sangrak Bae, Ji Hyun Park, Seyoung Oh, Gyongseon Yang, Wei Vivian Wang et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study modeled the public health impact of vaccinating both boys and girls with the nonavalent HPV vaccine in South Korea, compared to the current practice of vaccinating only girls with the quadrivalent vaccine. Over 100 years, gender-neutral vaccination was projected to prevent over 36,000 cases of cervical cancer and nearly 10,000 cervical cancer deaths in women, plus significant reductions in other HPV-related cancers and genital warts in both sexes. The intervention was found to be cost-effective at ₩38.9 million per quality-adjusted life year, below South Korea's accepted threshold.
Key points
- Gender-neutral nonavalent HPV vaccination prevented an estimated 36,248 cervical cancer cases and 9,313 cervical cancer deaths in females over 100 years
- In males, the intervention prevented 666,182 genital wart cases, 7,422 recurrent respiratory papillomatosis cases, and 5,458 HPV-related cancers
- Additional reductions of 4.8-8.2% in HPV-related vaginal, vulvar, anal, and head and neck cancers in females were projected
- The incremental cost-effectiveness ratio of ₩38.9 million per QALY was below South Korea's accepted threshold
- Gender-neutral vaccination reduced genital warts by 14.6% and recurrent respiratory papillomatosis by 15.8%
Limitations
This study used a mathematical model based on adapted epidemiological data rather than real-world trial results, so actual outcomes may differ from projections depending on vaccine uptake, coverage rates, and implementation fidelity. The analysis assumes specific vaccine price and boys' coverage scenarios that may change.
Abstract
This study assessed the impact and cost-effectiveness of gender-neutral immunization with the nonavalent human papillomavirus (HPV) vaccine in South Korea. An established dynamic transmission model of HPV epidemiology was adapted to the South Korean population. Vaccinating both girls and boys with the nonavalent HPV vaccine was compared to the currently administered program of vaccinating girls only with the quadrivalent vaccine. Compared to vaccination of girls only with the quadrivalent HPV vaccine, gender-neutral vaccination with the nonavalent HPV vaccine was projected to prevent 1,282,415 cases of cervical intraepithelial neoplasia grade 1 (CIN1), 918,384 cases of CIN2/3, 36,248 cases of cervical cancer, and 9,313 cervical cancer deaths in females over 100 years. Gender-neutral vaccination was projected to reduce HPV-related vaginal, vulvar, anal, and head & neck cancers in females by 4.8-8.2%, in addition to reductions of 14.6% and 15.8% in genital warts and recurrent respiratory papillomatosis, respectively. In males, gender-neutral vaccination was projected to prevent 666,182 cases of genital warts, 7,422 cases of RRP, 995 cases of anal cancer, 2,441 cases of head & neck cancer, and 122 cases of penile cancer. The incremental cost-effectiveness ratio (ICER) was ₩38.9 million per quality-adjusted life year (QALY), which is below the accepted cost-effectiveness threshold in South Korea. These findings suggest that gender-neutral vaccination with the nonavalent HPV vaccine would reduce the public health burden of HPV disease in both females and males in South Korea and would be cost-effective under base case assumptions about vaccine price and coverage of boys.