• BJOG · May 2016

    The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low-resource setting.

    • M Sharma, S Sy, and J J Kim.
    • Department of Epidemiology, University of Washington, Seattle, WA, USA.
    • BJOG. 2016 May 1; 123 (6): 917-26.

    ObjectiveTo 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.DesignModel-based economic evaluation.SettingSouthern Vietnam.PopulationMales and females aged ≥9 years.MethodsWe simulated dynamic HPV transmission to estimate cervical cancer and genital warts cases. Models were calibrated to epidemiological data from south Vietnam.Main Outcome MeasuresIncremental cost-effectiveness ratios (ICERs): cost per quality-adjusted life-year (QALY).ResultsVaccinating 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 ICERs 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 ICERs, 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.ConclusionVaccination 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 AbstractLimited cervical cancer reduction from including boys in HPV vaccination of girls in low-resource settings.© 2015 Royal College of Obstetricians and Gynaecologists.

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