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Background: Human papillomavirus (HPV) vaccine programs targeting preadolescent girls has been implemented successfully in several countries. But the commercially available vaccines have also been shown to have good clinical effect on boys. With a high female coverage, it has been predicted that the boys receive adequate protection through herd immunity. The aim of this study is to explore the benefits and cost-effectiveness of introducing a quadrivalent HPV-vaccination program for both 12-years old girls and boys in Swedish schools.

Method: A lifetime single cohort static Markov model was constructed using Swedish epidemiological-, economical- and demographical data. The model included the potential effect on CIN, cervical-, anal-, oropharyngeal-, vulvar, penile- and vaginal cancer. The outcome of the analysis was the incremental cost per quality-adjusted life-year and the model accounted for both direct- and indirect costs. Single-way, multi-way and probabilistic sensitivity analysis where used to adjust for parameter uncertainty.

Results: In the base-case analysis vaccinating a birth cohort of 12-years boys would cost an additional € 83.576 per QALY. In realistic scenarios where the tenure price is lower than the current list price the estimated ICER ranges between € 39.702 - € 54.644. With an 85% price reduction the intervention has an 62% to 98% probability of being cost-effective.

Conclusion: The results from this health economic analysis indicate that implementing a universal HPV-vaccination in Sweden could be a cost-effective intervention, but only if the tenure price is substantial lower than the current list price.