Source: professional.cancerconsultants.com
Author: staff

Researchers from Harvard have reported that including boys in a human papillomavirus (HPV) vaccination program may not be cost effective. The details of this study were published online in the British Medical Journal on October 8, 2009.[1]

Human papillomaviruses are probably the sole cause of cancers of the cervix and have been associated with cancers of the vulva, vagina, penis, and rectum. Epidemiologic and molecular biology studies have also suggested that HPV infection may be associated with cancers of the head and neck.

Gardasil® (Quadrivalent Human Papillomavirus [Types 6, 11, 16, 18] Recombinant Vaccine) is already approved by the U.S. Food and Drug Administration for the prevention of cervical, vulvar, and vaginal cancers caused by HPV types 16 and 18; genital warts caused by HPV types 6 and 11; and precancerous or dysplastic lesions caused by HPV types 6, 11, 16, and 18 in girls and young women nine through 26 years of age. Cervarix®, a human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine made by GlaxoSmithKline, will probably be approved by the U.S. FDA this year.

Male HPV can lead to genital warts, penile cancer, perianal cancer, anal cancer, and head and neck cancer. In addition, it contributes to HPV infection in women and subsequent cervical disease, including cervical cancer. Although males can spread the virus, and many other countries have approved the HPV vaccine for use in males, it has not been approved for males in the United States. However, researchers from the H. Lee Moffitt Cancer Center have reported that Gardasil has now been shown to prevent genital lesions in men ages 16 to 26. Researchers from M. D. Anderson have recommended vaccination of boys and girls against HPV for prevention of squamous cell cancers of the head and neck as well as for prevention of cervical cancer.

The goal of the current study was to assess the cost effectiveness of routinely vaccinating preadolescent boys, as is recommended in girls. These authors started with the hypothesis that 75% vaccination coverage of 12-year-old girls would cost less than $50,000 per quality-adjusted life year (QALY) gained compared with screening alone. Using various scenarios vaccinating both boys and girls generally fell above the $100,000 per QALY threshold for cost effectiveness. These authors suggest that cost effectiveness of vaccinating both boys and girls would improve if the vaccine gave life-long protection against all HPV-related diseases or if the cost of vaccination decreased. These authors concluded: “including boys in an HPV vaccination programme generally exceeds conventional thresholds of good value for money, even under favorable conditions of vaccine protection and health benefits.” However, these authors admit to many uncertainties and suggest continued re-evaluation of this question.

Comment:
It is hard to determine how realistic the models used are. From a common sense point of view, it would appear prudent to vaccinate both boys and girls for optimal prevention of cervical and other cancers.

Reference:
[1] Kim JJ and Goldie SJ. Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States. British Medical Journal [early online publication]. October 8, 2009.