title: Impact of coverage-dependent marginal costs on optimal HPV vaccination strategies.
abstract: The effectiveness of vaccinating males against the human papillomavirus (HPV) remains a controversial subject. Many existing studies conclude that increasing female coverage is more effective than diverting resources into male vaccination. Recently, several empirical studies on HPV immunization have been published, providing evidence of the fact that marginal vaccination costs increase with coverage. In this study, we use a stochastic agent-based modeling framework to revisit the male vaccination debate in light of these new findings. Within this framework, we assess the impact of coverage-dependent marginal costs of vaccine distribution on optimal immunization strategies against HPV. Focusing on the two scenarios of ongoing and new vaccination programs, we analyze different resource allocation policies and their effects on overall disease burden. Our results suggest that if the costs associated with vaccinating males are relatively close to those associated with vaccinating females, then coverage-dependent, increasing marginal costs may favor vaccination strategies that entail immunization of both genders. In particular, this study emphasizes the necessity for further empirical research on the nature of coverage-dependent vaccination costs.
authors.affiliation: Department of Mathematics, Duke University, Durham, NC 27708, USA. Electronic address: ryser@math.duke.edu.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Ryser
authors.affiliation: Department of Mathematics, Duke University, Durham, NC 27708, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: McGoff
authors.affiliation: Department of Mathematics, Drake University, Des Moines, IA 50311, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Herzog
authors.affiliation: Department of Statistics, The Ohio State University, Columbus, OH 43210, USA; Department of Mathematics, The Ohio State University, Columbus, OH 43210, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Sivakoff
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical School, Durham, NC 27708, USA.
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D015276:Health Care Rationing / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D052162:Human papillomavirus 16; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Human papillomavirus vaccination; Male HPV vaccination; Marginal distribution costs; Optimal vaccine distribution; Stochastic agent-based models