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Home HPV Vaccines HPV Vaccines Cost-Effectiveness of Including Boys in HPV Vaccine Programs

Cost-Effectiveness of Including Boys in HPV Vaccine Programs

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A new study suggests immunizing larger numbers of girls may be more cost-effective than adding boys to HPV vaccine programs.

Cervical cancer usually develops over many years – meaning it will likely be decades before its known just how well HPV vaccines work in preventing the disease in the broad population – so researchers rely on sophisticated mathematical models to predict the impact of vaccines. With concerns over the bottom line present in any health care discussion, Harvard University researchers Jane Kim, PhD, and Sue Goldie, MD, developed a model to assess the cost-effectiveness expanding HPV vaccine programs to include boys.

The Kim/Goldie model estimates the costs of HPV vaccine programs across a number of variables including different rates of vaccine coverage and effectiveness, and duration of protection. They also looked at scenarios where HPV diseases other than cervical cancer are included.

The researchers found that under most scenarios where females only were included in HPV vaccines, the cost per quality adjusted life year (QALY) was under $50,000, but adding males typically cost over $100,000. QALY is a common measure used to determine cost-effectiveness of medical interventions such as vaccines, with those falling in the $50,000-$100,000 range generally deemed to be of fair value.

With the Kim/Goldie model, a strategy of reducing the burden of cervical cancer by vaccinating only preadolescent females cost $40,310, compared to $290,290 when boys are included. When other HPV-diseases are added – including genital warts, laryngeal warts, and noncervical cancers in both sexes– the cost remained over $100,000 to add boys.

The scenarios where the cost of adding boys dipped below the $100,000 threshold were ones where the vaccine is effective for a lifetime against a broad range of HPV-related diseases. The exact duration of protection the vaccines will provide against the range of HPV-related diseases isn’t fully evaluated yet.

Noting the limitations to their study, the investigators acknowledge their model doesn’t account for the cost-impact of preventing HPV disease in men who have sex with men, a population especially at risk for anal cancers. Also, the authors note their assumption of 75% vaccine coverage may be optimistic, and cost-effectiveness of including males increases in scenarios where coverage with females declines.

Any vaccine cost model is also limited in its ability to assess a number of social factors. For example, adding males to HPV vaccine programs promotes a sense of gender equity, making it more difficult to categorize HPV as a “women’s” infection, where responsibility begins and ends with females. Also, studies show that HPV diagnosis carries a significant emotional burden, often far out of proportion to the medical impact. While genital warts aren’t usually harmful, for example, patients often must undergo a series of uncomfortable treatments involving multiple office visits, which can cause much stress and embarrassment. Uncertainty about the need to discuss HPV with current or future partners – and just what needs to be said – is another source of worry for many.

The discussion is timely given the October decision by the Food and Drug Administration (FDA) granting approval for use of Merck’s HPV with males (see related story in News Desk). Shortly after the FDA ruling, the Advisory Committee on Immunization Practices (ACIP) decided to recommend use of the vaccine (at the discretion of health care providers) with boys and young men. ACIP also voted to include Gardasil for boys in the federal program that provides free immunizations to poor children, Vaccines for Children.

J Kim, S Goldie. Cost effectiveness analysis of including boys in a human papillomavirus vaccination program in the United States. British Medical Journal, 2009. 339:b3884.