Amsterdam Public Health

Since 2022, girls and boys in the Netherlands have been eligible to receive the HPV vaccine, which provides preventive protection against six types of cancer. However, even stronger protection is possible with the more expensive HPV9 vaccine. This version protects against nine strains of the virus, which not only cause cancer but can also lead to genital and respiratory warts. Researchers at Amsterdam UMC have now calculated that investing in this more comprehensive vaccine will pay off over time. It reduces unnecessary suffering as well as the healthcare and screening costs associated with diseases the HPV9 vaccine can prevent. The researchers therefore advocate for the inclusion of HPV9 in the national vaccination program.

HPV (human papillomavirus) is a common virus that nearly everyone, both men and women, contracts at some point. There are many different strains. In most cases, the body clears the infection on its own, but certain strains can lead to cancer.

Improved protection is possible

The current Dutch vaccination program is already highly effective in preventing HPV-related cancers, says researcher Hans Bogaards. “The current HPV vaccine protects against six types of cancer, especially cervical cancer and cancers of the mouth and throat. It mainly targets the two most cancer-causing HPV strains.” However, stronger protection is possible. The more comprehensive HPV9 vaccine protects against nine HPV variants, covering nearly all types of HPV-related cancers. An additional advantage is that HPV9 also protects against strains that cause genital and respiratory warts, which is something the current vaccine does not do. That’s why Bogaards and his colleagues decided to investigate the added value of the broader HPV9 vaccine.

Avoiding unnecessary hospital visits

Broader protection through HPV9 vaccination in adolescents can lead to fewer medical appointments later, especially in cervical cancer screening. The current screening process starts with testing for HPV. If the virus is present, follow-up involves a Pap smear at the GP or an examination by a gynecologist to check for cancer or pre-cancerous changes. Only a small fraction of HPV infections develop into cancer. If the HPV9 vaccine prevents infection altogether, it reduces anxiety and eliminates the need for follow-up tests and doctor visits for many women. Preventing HPV-related warts also reduces discomfort and costs. “These warts can be painful and cause embarrassment,” says Bogaards. “They often require multiple treatments to remove. The healthcare costs saved by preventing warts through vaccination offset the higher price of the HPV9 vaccine.”

Worth the investment

All things considered, the researchers conclude that using the more expensive HPV9 vaccine in the Netherlands is cost-effective in the long run. The estimated higher vaccination costs are likely to be largely, or even fully, recovered over time. The team reached this conclusion through modeling. They looked at various scenarios, including vaccination uptake rates, the duration and breadth of vaccine protection, the vaccine’s impact on wart prevention and potential price differences between vaccines. The results indicate that switching to HPV9 is a favorable choice under realistic assumptions. Still, since these are projections, it's important to continue monitoring the long-term effectiveness of HPV vaccines.

Towards limination

Offering broad protection to both boys and girls benefits not only the individuals vaccinated but also helps reduce HPV-related diseases in the population. The World Health Organization (WHO) has set the goal of eliminating cervical cancer in the 21st century.

The study was funded by ZonMw and published in the scientific journal BMC Medicine.

^{Image: Adobe Stock}