Table 4.

Base case estimates of cost-effectiveness: Discounted incremental costs, incremental number of quality-adjusted life years (QALYs) gained, and cost-effectiveness (incremental cost per QALY gained) of 9vHPV vaccination strategies

Item estimated	Comparison strategy (vaccination of females aged 12–26 years, and males aged 12–21 years)	Mid-adult vaccination strategy (vaccination of females and males aged 12–45 years)
Vaccination costs ($ millions)	44,306	57,662
Direct medical costs averted ($ millions)	33,786	34,307
Number of QALYs gained	1,146,255	1,165,901
Incremental cost ($ millions)	10,520	12,835
Incremental gain in QALYs	1,146,255	19,645
Incremental cost per QALY gained ($/QALY)	9,200	653,300

QALY: quality-adjusted life year. All future costs and QALYs were discounted at 3% annually. For both columns of results, the first three rows show the vaccination costs, direct medical costs averted, and QALYs gained, compared to no vaccination. The cost per QALY gained by the comparison strategy was calculated versus no vaccination, and the incremental cost ($10,520 million) reflects vaccination costs ($44,306 million) minus averted direct medical costs ($33,786 million). The cost per QALY gained by the mid-adult vaccination strategy was calculated versus the comparison strategy, and the incremental cost ($12,835 million) reflects the additional vaccination costs ($57,662 million minus $44,306 million) minus the additional direct medical costs averted ($34,307 million minus $33,786 million). Incremental cost-effectiveness ratios have been rounded to the nearest $100. 

Costs are reported in third quarter 2018 U.S. dollars. When updated to second quarter 2020 U.S. dollars, the cost effectiveness ratios shown in this table changed from $9,200 to $9,500 and from $653,300 to $678,700.