title: The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low-resource setting.
abstract: OBJECTIVE
  To estimate health benefits and incremental cost-effectiveness of human papillomavirus (HPV) vaccination of pre-adolescent boys and girls compared with girls alone for preventing cervical cancer and genital warts.
  
  
  METHODS
  Model-based economic evaluation.
  
  
  METHODS
  Southern Vietnam.
  
  
  METHODS
  Males and females aged ≥9 years.
  
  
  METHODS
  We simulated dynamic HPV transmission to estimate cervical cancer and genital warts cases. Models were calibrated to epidemiological data from south Vietnam.
  
  
  METHODS
  Incremental cost-effectiveness ratios (ICERs): cost per quality-adjusted life-year (QALY).
  
  
  RESULTS
  Vaccinating girls alone was associated with reductions in lifetime cervical cancer risk ranging from 20 to 56.9% as coverage varied from 25 to 90%. Adding boys to the vaccination programme yielded marginal incremental benefits (≤3.6% higher absolute cervical cancer risk reduction), compared with vaccinating girls alone at all coverages. At ≤25 international dollars (I$) per vaccinated adolescent (I$5 per dose), HPV vaccination of boys was below the threshold of Vietnam's per-capita GDP (I$2800), with ICERs ranging from I$734 per QALY at 25% coverage to I$2064 per QALY for 90% coverage. Including health benefits from averting genital warts yielded more favourable ICERs, and vaccination of boys at I$10/dose became cost-effective at or below 75% coverage. Using a lower cost-effectiveness threshold of 50% of Vietnam's GDP (I$1400), vaccinating boys was no longer attractive at costs above I$5 per dose regardless of coverage.
  
  
  CONCLUSIONS
  Vaccination of boys may be cost-effective at low vaccine costs, but provides little benefit over vaccinating girls only. Focusing on achieving high vaccine coverage of girls may be more efficient for southern Vietnam and similar low-resource settings.
  
  
  CONCLUSIONS
  Limited cervical cancer reduction from including boys in HPV vaccination of girls in low-resource settings.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sy
authors.affiliation: Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D002648:Child; D003198:Computer Simulation; D003218:Condylomata Acuminata / Q000517:prevention & control* / Q000821:virology; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D005260:Female; D052162:Human papillomavirus 16; D052161:Human papillomavirus 18; D006801:Humans; D008297:Male; D018803:Models, Economic; D009010:Monte Carlo Method; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination / Q000191:economics*; D014744:Vietnam
keywords: Boys; Vietnam; cervical cancer; cost-effectiveness; human papillomavirus; vaccination