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The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low‐resource setting
Author(s) -
Sharma M,
Sy S,
Kim JJ
Publication year - 2016
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13503
Subject(s) - medicine , genital warts , vaccination , cervical cancer , demography , per capita , cost effectiveness , hpv infection , human papillomavirus , environmental health , gynecology , cancer , population , immunology , risk analysis (engineering) , sociology
Objective To estimate health benefits and incremental cost‐effectiveness of human papillomavirus ( HPV ) vaccination of pre‐adolescent boys and girls compared with girls alone for preventing cervical cancer and genital warts. Design Model‐based economic evaluation. Setting Southern Vietnam. Population Males and females aged ≥9 years. Methods We simulated dynamic HPV transmission to estimate cervical cancer and genital warts cases. Models were calibrated to epidemiological data from south Vietnam. Main outcome measures Incremental cost‐effectiveness ratios ( ICER s): cost per quality‐adjusted life‐year ( QALY ). Results Vaccinating girls alone was associated with reductions in lifetime cervical cancer risk ranging from 20 to 56.9% as coverage varied from 25 to 90%. Adding boys to the vaccination programme yielded marginal incremental benefits (≤3.6% higher absolute cervical cancer risk reduction), compared with vaccinating girls alone at all coverages. At ≤25 international dollars (I$) per vaccinated adolescent (I$5 per dose), HPV vaccination of boys was below the threshold of Vietnam's per‐capita GDP (I$2800), with ICER s ranging from I$734 per QALY at 25% coverage to I$2064 per QALY for 90% coverage. Including health benefits from averting genital warts yielded more favourable ICER s, and vaccination of boys at I$10/dose became cost‐effective at or below 75% coverage. Using a lower cost‐effectiveness threshold of 50% of Vietnam's GDP (I$1400), vaccinating boys was no longer attractive at costs above I$5 per dose regardless of coverage. Conclusion Vaccination of boys may be cost‐effective at low vaccine costs, but provides little benefit over vaccinating girls only. Focusing on achieving high vaccine coverage of girls may be more efficient for southern Vietnam and similar low‐resource settings. Tweetable abstract Limited cervical cancer reduction from including boys in HPV vaccination of girls in low‐resource settings.