Public Health Impact and Cost-Effectiveness of 2-Dose vs 1-Dose Human Papillomavirus Vaccination Regimen in Saudi...

The Saudi Food and Drug Authority recently registered a 9-valent human papillomavirus (HPV) vaccine, which provides broader protection than the existing 4-valent vaccine against genital warts and various cancers. A single-dose protocol vs a 2-dose protocol has been considered as an option for girls aged 9 to 14 and 15 to 20 years in the Kingdom of Saudi Arabia (KSA).

To assess cost-effectiveness and health outcomes associated with 2-dose vs 1-dose 9-valent HPV (9vHPV) vaccination in the KSA.

A dynamic transmission model was used to assess public health impact and incremental cost-effectiveness ratio (ICER) of a 2-dose compared with a 1-dose 9vHPV program. Costs (2023 SAR) and quality-adjusted life-years (QALY) were discounted at 3%. Vaccination coverage was estimated using the Ministry of Health school-based program. Scenario analyses considered higher cervical cancer incidence and higher 1-dose vaccine effectiveness.

A 2-dose vs a 1-dose 9vHPV vaccine prevents 13 700 additional cases of HPV-related diseases over a time horizon of 100 years. Furthermore, the model yields an ICER of SAR 30 400/QALY gained. Under scenarios of higher cervical cancer incidence and higher 1-dose vaccine effectiveness, ICERs are SAR 17 400/QALY and SAR 83 200/QALY, respectively. For the scenario with higher cervical cancer incidence (ie, 6.1 per 100 000 women), the 2-dose program achieves cervical cancer elimination within a median time of 54 years, whereas the 1-dose program takes more than 100 years. In sensitivity analyses, the ICER remains below 1×GDP per capita (SAR 129 000).

A 2-dose program shows a positive impact in terms of public health and cost-effectiveness compared with a 1-dose program.