title: Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.
abstract: BACKGROUND
  Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted.
  
  
  METHODS
  A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program.
  
  
  RESULTS
  Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage.
  
  
  CONCLUSIONS
  At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.
authors.affiliation: University of Oslo, Department of Health Management and Health Economics, Oslo, Norway.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Burger
authors.affiliation: Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision Science Boston, Massachusetts, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sy
authors.affiliation: Cancer Registry of Norway Department of Research, Oslo, Norway.
authors.forename: Mari
authors.initials: M
authors.lastname: Nygård
authors.affiliation: University of Oslo, Department of Health Management and Health Economics, Oslo, Norway.
authors.forename: Ivar S
authors.initials: IS
authors.lastname: Kristiansen
authors.affiliation: Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision Science Boston, Massachusetts, United States of America.
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D003362:Cost-Benefit Analysis; D005260:Female; D052162:Human papillomavirus 16 / Q000276:immunology; D052161:Human papillomavirus 18 / Q000276:immunology; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000276:immunology; D012680:Sensitivity and Specificity; D014565:Urogenital Neoplasms / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology*; D014611:Vaccination / Q000191:economics*
chemical_list: D053918:Papillomavirus Vaccines