title: The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting.
abstract: We assessed the cost-effectiveness of including boys vs girls alone in a pre-adolescent vaccination programme against human papillomavirus (HPV) types 16 and 18 in Brazil. Using demographic, epidemiological, and cancer data from Brazil, we developed a dynamic transmission model of HPV infection between males and females. Model-projected reductions in HPV incidence under different vaccination scenarios were applied to a stochastic model of cervical carcinogenesis to project lifetime costs and benefits. We assumed vaccination prevented HPV-16 and -18 infections in individuals not previously infected, and protection was lifelong. Coverage was varied from 0-90% in both genders, and cost per-vaccinated individual was varied from IUSD 25 to 400. At 90% coverage, vaccinating girls alone reduced cancer risk by 63%; including boys at this coverage level provided only 4% further cancer reduction. At a cost per-vaccinated individual of USD 50, vaccinating girls alone was <USD 200 per year of life saved (YLS), while including boys ranged from USD 810-18,650 per YLS depending on coverage. For all coverage levels, increasing coverage in girls was more effective and less costly than including boys in the vaccination programme. In a resource-constrained setting such as Brazil, our results support that the first priority in reducing cervical cancer mortality should be to vaccinate pre-adolescent girls.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Program in Health Decision Science, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA. jkim@hsph.harvard.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Kim
authors.forename: B
authors.initials: B
authors.lastname: Andres-Beck
authors.forename: S J
authors.initials: SJ
authors.lastname: Goldie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006291:Health Policy / Q000191:economics; D052162:Human papillomavirus 16 / Q000276:immunology*; D052161:Human papillomavirus 18 / Q000276:immunology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D014611:Vaccination; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*