title: Extending the Human Papillomavirus Vaccination Programme to Include Males in High-Income Countries: A Systematic Review of the Cost-Effectiveness Studies.
abstract: OBJECTIVE
  Giving the human papillomavirus (HPV) vaccination to females has been shown to be cost-effective in most countries. The epidemiological evidence and economic burden of HPV-related diseases have gradually been shown to be gender neutral. Randomized clinical trials report high efficacy, immunogenicity and safety of the HPV vaccine in males aged 16-26 years. Some pioneering countries extended their HPV vaccination programme to include males, regardless of the cost-effectiveness analysis results. Nevertheless, decision makers need evidence provided by modelling and economic studies to justify the funding of mass vaccination. This systematic review aims to assess the cost-effectiveness of extending the HPV vaccination programme to include males living in high-income countries.
  
  
  METHODS
  A systematic review of the cost-effectiveness analyses of HPV vaccination in males was performed. Data were extracted and analysed using a checklist adapted from the Consolidated Health Economic Evaluation Reporting Standards Statement.
  
  
  RESULTS
  Seventeen studies and 12 underlying mathematical models were identified. Model filiation showed evolution in time from aggregate models (static and dynamic) to individual-based models. When considering the health outcomes HPV vaccines are licensed for, regardless of modelling approaches and assumptions, extending vaccinations to males is rarely found to be cost-effective in heterosexual populations. Cost-effectiveness ratios become more attractive when all HPV-related diseases are considered and when vaccine coverage in females is below 40%.
  
  
  CONCLUSIONS
  Targeted vaccination of men who have sex with men (MSM) seems to be the best cost-effectiveness option. The feasibility of this strategy is still an open question, since early identification of this specific population remains difficult.
authors.affiliation: Department of Epidemiology, Health Economics and Prevention, Lille University Hospital, CHRU de Lille, Pôle S3P, Maison Régionale de la Recherche Clinique, 6, rue du Pr Laguesse, CS 70001, 59037, Lille Cedex, France, bechirbhy@gmail.com.
authors.forename: Mohamed-Béchir
authors.initials: MB
authors.lastname: Ben Hadj Yahia
authors.forename: Anaïs
authors.initials: A
authors.lastname: Jouin-Bortolotti
authors.forename: Benoît
authors.initials: B
authors.lastname: Dervaux
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D019049:Developed Countries; D005260:Female; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000276:immunology*; D014611:Vaccination / Q000191:economics
chemical_list: D053918:Papillomavirus Vaccines