Economic evaluation of 22 HPV vaccination strategies to minimize the risk of penile, anal, and oropharyngeal cancers in Chinese males: A Markov model analysis

Males can benefit significantly from human papillomavirus (HPV) vaccination. This study developed a decision-Markov model to evaluate the lifetime effectiveness and cost-effectiveness of 22 HPV vaccination strategies for preventing penile, anal, and oropharyngeal cancers. From a healthcare system perspective, vaccination strategies targeting males aged 14 and 40 were compared against no vaccination. Key parameters, including disease progression probabilities, cancer incidence, health state utilities, and direct medical costs, were sourced from the published literature and national databases. We calculated the number of cancer cases and deaths under different strategies and compared their cost-effectiveness. Results demonstrated that male vaccination is highly cost-effective. Vaccinating 14-y-old males averted between 73,724 and 416,654 cancer cases and between 1,102 and 6,229 deaths, depending on the vaccine valency and coverage rate. Similarly, strategies targeting 40-y-old males demonstrated substantial benefits. Overall, 20 of the 22 strategies were deemed highly cost-effective against a willingness-to-pay threshold of three times the national gross domestic product per capita. Sensitivity analysis confirmed the results' robustness. This study provides economic evidence to inform national HPV vaccination policies, demonstrating that including males, particularly adolescents, in vaccination programs represents a cost-effective investment for reducing the burden of HPV-associated cancers in China.