Cost-effectiveness modeling for gender-neutral human papillomavirus vaccines: A systematic literature review

Gender-neutral vaccination (GNV) of human papillomavirus (HPV) may help reduce the transmission and incidence of HPV-related diseases. However, approximately 40 countries have implemented HPV GNV schedules. We systematically evaluated HPV GNV cost-effectiveness models from January 2008 to May 2024 using MEDLINE, Embase, and Cochrane to identify key drivers of cost-effectiveness results. Fifty-three publications were included, primarily from high-income countries. Vaccine coverage, price, protection duration, and discount rates impacted cost-effectiveness, with lower prices and protection against HPV-related diseases resulting in cost-effective results. Results in models that included adults (≥18 years) were mixed and dependent on price, inclusion of non-cervical HPV-related diseases, and age groups considered. We conclude that HPV GNV can be a cost-effective strategy for preventing HPV-related diseases. However, its cost-effectiveness is highly dependent on vaccine coverage, price, and inclusion of non-cervical HPV-related diseases in models. Further economic evaluations of HPV GNV in low- and middle-income countries are recommended.