Vaccinating boys against human papillomavirus not cost-effective

Oct 09, 2009

Persistent infection with high-risk types of human papillomavirus (HPV), a sexually transmitted virus, is known to be a cause of cervical cancer. Current guidelines prioritize HPV vaccination of pre-adolescent girls, which has been shown to be cost-effective in previous studies, but the value of vaccinating boys in the United States has been unclear. In a new study, Harvard School of Public Health (HSPH) researchers found that if vaccine coverage and efficacy are high in girls, a universal recommendation to vaccinate young boys is unlikely to provide comparatively good value for resources, compared with vaccinating girls only.

The study appears online October 9, 2009, in The and will appear in a later print edition.

The HPV for boys is already licensed in a number of countries and is currently being considered by the U.S Food and Drug Administration (FDA).

"With the near-term possibility of the HPV vaccine being available to boys in the U.S., policymakers will need to decide whether or not to recommend vaccinating boys," said Jane Kim, assistant professor of health decision science and lead author of the study. "To inform these deliberations, both the incremental health benefits that would accrue with vaccination of boys and and the economic costs of the program should be compared to those associated with vaccination of girls alone."

Motivated to inform current decision making, Kim and co-author Sue Goldie, professor of health decision science, evaluated the most current epidemiological, clinical and economic data on HPV infections and cervical disease. Because the most important health benefits (e.g., prevention of cervical cancer) from adolescent HPV vaccination will not be observed for years, and possibly decades, they used computer-based disease models to simulate the course of HPV-related diseases in the U.S. population over time. The analysis looked at the vaccine's potential benefits on a comprehensive set of HPV-related conditions among females and males, including cervical and non-cervical HPV-related cancers, genital warts and juvenile onset recurrent respiratory papillomatosis, a rare but severe respiratory condition usually diagnosed in infancy that may be related to a mother's infection with genital warts.

The results showed that, assuming 75% vaccination coverage and lifelong vaccine protection against cervical disease, routine HPV vaccination of 12-year-old girls was associated with a cost-effectiveness ratio of $40,310 per quality-adjusted life year (QALY), a health metric used to reflect both the excess mortality and reduced quality of life associated with disease. In the U.S., interventions with cost-effectiveness ratios below $50,000 or $100,000 per QALY are informally considered good value for the money. Including boys in the vaccination program had a cost-effectiveness ratio of $290,290 per QALY when compared to vaccinating girls only, exceeding the threshold for good value.

The results were robust across a range of alternative scenarios, such as changes in screening practice, decreased vaccine efficacy in boys, shorter duration of vaccine protection, and the inclusion of other HPV-related outcomes noted above. The authors acknowledge, however, that there are many uncertain factors that can influence the findings. For example, if efficacy against long-term HPV-related diseases in both girls and boys remains high, coverage in girls is low, or the vaccine price is substantially lowered, vaccinating boys looks more attractive.

Since the FDA may consider vaccinating boys in the near future, the findings provide important insight about guidelines regarding what groups to include in routine HPV vaccination recommendations. The authors emphasize, "this analysis does not address decision-making at the individual level; indeed, families who are considering HPV vaccination for an individual boy may consider the vaccine benefits worthwhile in terms of reducing the future risk of genital warts and possibly other health conditions."

While the authors conclude that routine vaccination of boys is unlikely to provide comparative value to other interventions vying for resources, they emphasize that the study was conducted from a public health perspective and with the objective of informing general policy recommendations at the population-level. "Based on currently available information, efforts for cervical cancer prevention in the U.S. should focus on HPV vaccination of pre-adolescent girls and continued screening in adulthood," said Kim.

More information: "Cost-effectiveness analysis of including in a (HPV) vaccination programme in the United States," Jane J. Kim, Sue J. Goldie, British Medical Journal, online October 9, 2009

Source: Harvard School of Public Health (news : web)

Explore further: Scientists find new calorie-burning switch in brown fat

add to favorites email to friend print save as pdf

Related Stories

Study on government's controversial choice of HPV vaccine

Jul 18, 2008

The UK government may save up to £18.6 million a year by deciding to use the HPV vaccine Cervarix, given that it is equally effective as the more expensive Gardasil in preventing cervical abnormalities, according to a study ...

One in four California adolescent girls has had HPV vaccine

Feb 17, 2009

Less than two years after the HPV vaccine was approved as a routine vaccination for girls aged 11 and older, one-quarter of California adolescent girls have started the series of shots that protect against human papillomavirus, ...

Cost-effectiveness of HPV vaccination in the Netherlands

Jul 01, 2009

Even under favorable assumptions, including lifelong protection against 70% of all cervical cancers and no side effects, vaccination against the human papillomavirus (HPV) is not cost-effective in the Netherlands, according ...

Some men want girls' vaccine, too

Feb 23, 2007

Some British gay men want to be vaccinated with the drug approved to protect girls from cervical cancer, saying it could help them, too.

Recommended for you

Clues to curbing obesity found in neuronal 'sweet spot'

6 hours ago

Preventing weight gain, obesity, and ultimately diabetes could be as simple as keeping a nuclear receptor from being activated in a small part of the brain, according to a new study by Yale School of Medicine ...

Small RNAs in blood may reveal heart injury

15 hours ago

(Medical Xpress)—Like clues to a crime, specific molecules in the body can hint at exposure to toxins, infectious agents or even trauma, and so help doctors determine whether and how to treat a patient. ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

Nik_2213
not rated yet Oct 09, 2009
Would it be worthwhile to vaccinate boys whose parents have/had conditions associated with the papilloma virus lest they are carriers ? Current candidates now include prostate cancers...

Or should they be screened, first ? Would screening show in youth, or would the virus remain silent for decades ??