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. 2025 Dec;28(1):974-985.
doi: 10.1080/13696998.2025.2520703. Epub 2025 Jun 20.

Public health impact and cost-effectiveness of implementing gender-neutral vaccination with a 9-valent HPV vaccine in Japan: a modeling study

Cody Palmer  1 , Taizo Matsuki  2 , Keisuke Tobe  2 , Xuedan You  3 , Ya-Ting Chen  3
Affiliations
Free article

Public health impact and cost-effectiveness of implementing gender-neutral vaccination with a 9-valent HPV vaccine in Japan: a modeling study

Cody Palmer et al. J Med Econ. 2025 Dec.
Free article

Abstract

Aims: This study aimed to assess the public health impact and cost-effectiveness of gender-neutral vaccination (GNV) using a nonavalent vaccine (9vHPV) in Japan.

Methods: We used a published, validated dynamic transmission model to estimate the cases of, deaths from, quality-adjusted life years (QALYs) lost to, and costs of diseases associated with HPV genotypes included in the 9vHPV vaccine. These outcomes were modeled over a 100-year time horizon under different GNV and female-only vaccination (FOV) strategies. The primary analysis compared GNV to FOV at a female vaccination coverage rate (VCR) of 30% and male VCR of 15%. Scenario analyses assessed the effects of varying these VCRs, the age at vaccination, and the discount rate.

Results: In the base case, GNV averted an additional 2,070 female and 1,773 male deaths from HPV-associated cancers compared to FOV and was cost effective, with an incremental cost-effectiveness ratio (ICER) of 4,798,537 ¥/QALY from the payer perspective (direct medical costs) and 4,248,586 ¥/QALY from the societal perspective (including costs of lost work productivity). The ICER of GNV versus FOV was higher in scenarios with higher VCRs. However, the ICER could be reduced compared to the base case by implementing vaccination at <15 years of age to reduce the number of vaccine doses required or by reducing the discount rate to assign greater value to the long-term cancer prevention benefits of HPV vaccination.

Limitations: This study may be limited by inaccuracies in the model's input data and assumptions, as well as the exclusion of some societal costs, which may have underestimated cost-effectiveness.

Conclusions: Including boys and men in Japan's HPV vaccination strategy is predicted to provide additional public health benefits compared to FOV and to be cost effective, particularly while the female VCR remains low and if the full vaccine series is completed before age 15.

Keywords: C02; C50; Human papillomavirus; I18; Japan; cancer prevention; cost-effectiveness analyses; gender-neutral vaccination.

Plain language summary

In Japan, government-funded HPV vaccination was introduced in 2010 for girls aged 12–16 years. However, following media reports of adverse events, the Ministry of Health, Labour and Welfare suspended its official recommendation for routine HPV vaccination in 2013. Although the vaccine remained available, uptake fell below 1%, a sharp decline that is projected to result in a substantial increase in cervical cancer cases and related deaths. To explore potential strategies for addressing this gap in coverage, we used a published validated dynamic transmission model to estimate the public health impact and cost-effectiveness of gender-neutral vaccination (GNV) compared to the current female-only vaccination (FOV) strategy. Our analysis found that implementing GNV prevented an additional 2,070 female and 1,773 male deaths from HPV-associated cancers compared to FOV and was cost-effective. GNV was especially cost-effective when female vaccination coverage remained low, as is currently the case in Japan. These findings support the inclusion of boys and men in Japan’s HPV vaccination program to achieve greater public health benefits and cost-effectiveness- particularly while female vaccine coverage remains low and if the full vaccine series is completed before age 15.

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