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Vaccinating boys against human papillomavirus not cost-effective
Date:10/8/2009

ne'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 individua
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Contact: Todd Datz
tdatz@hsph.harvard.edu
617-432-3952
Harvard School of Public Health
Source:Eurekalert

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