Impact of an expanded male catch-up HPV vaccination program on the clinical and economic burden of HPV-associated diseases in Denmark: a modeling study

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Denmark’s publicly funded routine HPV vaccination program has included boys born from 2005 onward, leaving earlier birth cohorts of young men potentially unprotected. A published deterministic dynamic transmission metapopulation model was adapted to evaluate the impacts of a 3-year male catch-up vaccination program on the cases, deaths, and costs of HPV-associated diseases in Denmark over a 100-year time horizon. Routine gender-neutral HPV vaccination of adolescents with a nonavalent vaccine was modeled with and without a male catch-up program, at 4 catch-up vaccination coverage rates (VCRs) from 40% to 70%. Adding a temporary catch-up program for men born in 1997–2005 was projected to avert 253 HPV-associated cancer cases and 89 deaths at a VCR of 40%. Increasing coverage to 70% was estimated to avert 359 cases and 128 deaths. Catch-up vaccination may be considered cost-effective at all modeled VCRs, with incremental cost-effectiveness ratios of €35,584–35,755 per quality-adjusted life year compared to routine adolescent vaccination alone. Expanding Denmark’s male catch-up HPV vaccination program to include all men born in 1997–2005 would reduce the burden of HPV-associated cancers and diseases and may represent a cost-effective public health strategy. Human papillomavirus (HPV) is a major preventable cause of cancer, historically contributing disproportionately to the disease burden in women, although HPV-associated cancers are now increasing among Danish men. Multiple high-risk HPV genotypes—particularly HPV-16 and 18—drive the majority of cervical, anal, and a substantial fraction of head and neck cancers in Denmark, while other oncogenic and non-oncogenic types contribute to additional cancers and anogenital warts. Denmark has implemented HPV vaccination programs for girls since 2009 and expanded to gender-neutral vaccination in 2019, supplemented by several catch-up initiatives; however, vaccination gaps persist due to earlier declines in vaccine uptake and the exclusion of many young men from prior programs. Because nearly 200,000 men born between 1997 and 2005 remain unvaccinated, expanding male catch-up vaccination may help reverse rising HPV-associated cancer trends, increase overall population coverage, and restore indirect protection for women. The present study evaluates the potential public health and economic impact of implementing catch-up HPV vaccination for these unvaccinated male cohorts over the next 100 years. A temporary catch-up vaccination program targeting men born in 1997–2005 was projected to prevent 253 HPV-associated cancer cases and 89 deaths at a vaccination coverage rate (VCR) of 40%. Raising the VCR to 70% increased these estimates to 359 HPV-associated cancer cases and 128 deaths averted. Across all modeled VCRs, catch-up vaccination was considered cost-effective, with incremental cost-effectiveness ratios ranging from €35,584 to €35,755 per quality-adjusted life year compared to routine adolescent vaccination alone. Overall, expanding Denmark’s male catch-up HPV vaccination program to include all men born in 1997–2005 would reduce the burden of HPV-associated cancers and diseases and likely represent a cost-effective public health strategy.

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