Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis.
BACKGROUND
A vaccine targeting human papillomavirus (HPV) types 16 and 18, which are associated with 80% of anal cancers, is efficacious in men. High-risk populations such as men who have sex with men (MSM) might especially benefit from vaccination. I aimed to estimate the cost-effectiveness of HPV vaccination of MSM in the USA.


METHODS
I constructed decision-analytic models to estimate the direct health and economic outcomes of HPV vaccination (against types 6, 11, 16, and 18) for prevention of HPV-related anal cancer and genital warts. The model parameters that were varied were age at vaccination (12 years, 20 years, and 26 years), previous exposure to vaccine-targeted HPV types, and prevalence of HIV-1. I used the models to conduct sensitivity analyses, including duration of vaccine protection, vaccine cost, and burden of anal cancer and genital warts.


RESULTS
In a scenario of HPV vaccination of MSM at 12 years of age without previous exposure to HPV, compared with no vaccination, vaccination cost US$15,290 per quality-adjusted life-year gained. In scenarios where MSM are vaccinated at 20 years or 26 years of age, after exposure to HPV infections, the cost-effectiveness ratios worsened, but were less than $50,000 per quality-adjusted life-year under most scenarios. For example, HPV vaccination of MSM at 26 years cost $37,830 per quality-adjusted life-year when previous exposure to all vaccine-targeted HPV types was assumed to be 50%. Outcomes were most sensitive to variations in anal cancer incidence, duration of vaccine protection, and HIV prevalence in MSM.


CONCLUSIONS
HPV vaccination of MSM is likely to be a cost-effective intervention for the prevention of genital warts and anal cancer.


BACKGROUND
US National Cancer Institute.
Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision Science, Boston, MA, USA. jkim@hsph.harvard.edu
Jane J
JJ
Kim
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001005:Anus Neoplasms / Q000276:immunology / Q000517:prevention & control* / Q000821:virology*; D002648:Child; D015331:Cohort Studies; D003198:Computer Simulation; D003218:Condylomata Acuminata / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D003362:Cost-Benefit Analysis; D018451:Homosexuality, Male; D006801:Humans; D007114:Immunization / Q000191:economics; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D027383:Papillomaviridae / Q000276:immunology*; D030361:Papillomavirus Infections / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000276:immunology / Q000627:therapeutic use*; D014481:United States; D055815:Young Adult
D053918:Papillomavirus Vaccines