Increasing HPV vaccination coverage in Switzerland: a return-on-investment analysis.
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BACKGROUND: Human papillomavirus (HPV) is associated with a range of cancers that pose a considerable public health burden, considerable medical costs, and productivity losses. This study aims to assess the societal and fiscal gains from increasing vaccine coverage rates (VCRs) to 90% by 2030 for both sexes and all eligible age groups (higher VCR scenario) compared to present coverage rates in Switzerland. METHODS: A previously published dynamic transmission model was used to project gains from higher VCRs of the nonavalent vaccine compared to current coverage trends on vaccine-preventable HPV-related mortality, morbidity, and direct costs. Prevented deaths and morbidity, from cancers and genital warts were converted into averted loss of productive output and tax revenue, avoided disability and healthcare costs savings. Using evidence from the literature on the impact of HPV-related diseases on absenteeism, employment and disability rates, the averted economic burden was estimated and was compared with vaccination costs to assess the benefit-cost ratio (BCR) of higher VCRs. Economic effects were discounted at 3%, and the analytic time horizon was 100 years. RESULTS: Compared to current coverage rates, the higher VCR scenario results in healthcare cost savings of CHF834 million. Moreover, higher VCR scenarios likely generate societal gains of CHF218 million and CHF181 million from averted deaths and prevented morbidity, respectively. Averted absenteeism is expected to increase productive output by CHF147 million. Fiscally, the higher VCR scenario generates CHF100 million in tax revenue and CHF85 million in averted disability costs. Considering the incremental costs of vaccination, the resulting societal and fiscal BCRs are 1.5 and 1.2, respectively. CONCLUSION: Attaining the 90% VCR targets by 2030 is projected to generate favorable economic returns for the Swiss government. Specifically, over the lifetime of the vaccinated cohorts, a CHF1 investment is estimated to yield societal and fiscal returns of CHF1.5 and 1.2, respectively.