Including Boys In HPV Vaccination Programmes Would Not Offer Value For Money

Main Category: Cervical Cancer / HPV Vaccine
Article Date: 11 Oct 2009 - 0:00 PDT

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Including boys in human papillomavirus (HPV) vaccination programmes of pre-adolescent girls would not be cost-effective if there is high vaccine coverage and efficacy in girls, as it is likely that the costs of vaccinating boys will outweigh the added health benefits, finds new research published on bmj.com today.

Previous studies have consistently shown that HPV vaccination of pre-adolescent (12 year-old) girls provides good value for money. Recent data from clinical trials also suggest that HPV vaccination in males has high efficacy against vaccine-type infections and genital lesions. Because HPV infections are sexually transmitted, vaccinating boys will likely provide direct health benefits to the boys themselves as well as indirect health benefits to their sexual partners by reducing HPV transmission. Whether or not these benefits are worth their investment is unclear.

To provide more evidence, researchers from The Harvard School of Public Health in Boston conducted a cost-effectiveness analysis to compare HPV vaccination of pre-adolescent girls alone with vaccination of both pre-adolescent girls and boys in the US.

The study used models that take into account the dynamics of HPV infection and cervical cancer screening strategies to predict the health benefits and economic costs of programmes by combining epidemiological, clinical, and demographic information from the US population.

The researchers also examined how alternative scenarios might impact on cost-effectiveness, varying assumptions regarding screening practice, vaccine efficacy in boys, duration of vaccine protection, and long-term impact on health outcomes not yet observed in clinical trials (e.g. anal and oral cancers).

Interventions were considered good value for money if they were less than cost-effectiveness values ranging from $50,000 to $100,000 per quality-adjusted life year (QALY).

Findings showed that HPV vaccination of pre-adolescent girls (with continued screening in adulthood) is good value for money. Assuming 75% vaccination coverage and lifelong vaccine protection, routine vaccination of 12-year-old girls was consistently found to be less than $50,000 per QALY gained, compared with screening alone.

However, including boys in the routine vaccination programme generally surpassed the higher cost-effectiveness threshold of $100,000 per QALY, even when assuming high vaccine protection and health benefits.

The authors predicted that vaccinating both boys and girls would only fall below the cost-effectiveness threshold of $100,000 per QALY under conditions of high, lifelong vaccine efficacy against all potential health benefits (including other anogenital and oral cancers, genital warts, and juvenile onset recurrent respiratory papillomatosis), or under assumptions of lower efficacy with lower coverage or vaccine costs.

"Our results suggest that if vaccine coverage and efficacy are high among pre-adolescent girls, including boys in an HPV programme is unlikely to provide comparatively good value for resources," say the authors.

They conclude: "As new data become available and new information emerges, assumptions and analyses will need to be iteratively revised to continue to inform policies with respect to HPV vaccination."

The health economic implications are clear - good coverage of females obviates the need to vaccinate boys, say two US researchers in an accompanying editorial.

They also point out that more than 80% of the 500,000 annual cases of cervical cancer occur in low resource settings and developing countries, which cannot afford or access HPV vaccines. Targeting young women in these populations for HPV vaccination and screening older women would therefore have a bigger effect on reducing the burden of cervical cancer than widespread HPV vaccination of young men from resource rich areas, they write.

The best policy is to ensure that preadolescent females are vaccinated worldwide, they conclude.

Link to paper
Link to editorial

Source
British Medical Journal