title: Vaccination of boys or catch-up of girls above 11 years of age with the HPV-16/18 AS04-adjuvanted vaccine: where is the greatest benefit for cervical cancer prevention in Italy?
abstract: BACKGROUND
  Since 2007, a Human Papillomavirus (HPV) vaccination programme against cervical cancer (CC) is implemented in Italy in 11-year-old girls. The extension of HPV vaccination to young adult women, or to 11-year-old boys could further reduce the CC burden, in the latter case from indirect effect on HPV transmission. The objective of the study was to compare the potential CC cases prevention from HPV-16/18 AS04-adjuvanted vaccination of adding catch-up targeting 15- or 25-year-old girls to the addition of boys vaccination in Italy. The models assessing the impact of these alternative vaccination strategies are usually dynamic models requiring numerous input data. Simpler models could however provide some insight into this question, as reported in the current study.
  
  
  METHODS
  A published cohort model adapted to the Italian setting was used to estimate the potential CC reduction following different HPV vaccination strategies with a HPV-16/18 AS04-adjuvanted vaccine: vaccination of 11-year-old girls, female aged 15 or 25 years. The model assumed that the maximum benefit obtained from vaccinating boys equals the CC reduction that would result from immunisation of all non-vaccinated girls of the same age. Each cohort of 11-year-olds (either girls or boys) was assumed to include 281,000 individuals and a 70% vaccination coverage was applied. Sensitivity analysis was performed by varying the vaccination coverage and the overlap in potential sexual contacts between vaccinated boys and girls of the same age-group.
  
  
  RESULTS
  Under base case, compared with the screening-only scenario, HPV vaccination of 11-year-old girls, 15-year-old females, 25-year-old females or 11-year-old boys, would prevent 1,146, 1,082, 788 or 491 CC cases respectively. HPV vaccination of boys could result in more CC cases prevented than adding a female catch-up only in scenarios with low vaccination coverage in the primary target cohort and when combined with small overlap between vaccinated boys and girls of the same age cohort.
  
  
  CONCLUSIONS
  For a fixed limited additional budget allowing the inclusion of a single catch-up cohort, the extension of HPV vaccination to girls or young women instead of boys was estimated to maximise the number of CC cases prevented.
authors.affiliation: Department of Health Sciences, University of Florence, Viale Morgagni 48, 50134, Florence, Italy. paolo.bonanni@unifi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonanni
authors.affiliation: Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/b, 44121, Ferrara, Italy. giovanni.gabutti@unife.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gabutti
authors.affiliation: Health Economics, GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium. nadia.x.demarteau@gsk.com.
authors.forename: Nadia
authors.initials: N
authors.lastname: Demarteau
authors.affiliation: Department of Health Sciences, University of Florence, Viale Morgagni 48, 50134, Florence, Italy. sara.boccalini@unifi.it.
authors.forename: Sara
authors.initials: S
authors.lastname: Boccalini
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy. giuseppe.latorre@uniroma1.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
mesh_terms: D000276:Adjuvants, Immunologic; D002648:Child; D015331:Cohort Studies; D005260:Female; D052162:Human papillomavirus 16 / Q000276:immunology* / Q000378:metabolism; D052161:Human papillomavirus 18 / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D007558:Italy; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D053918:Papillomavirus Vaccines / Q000276:immunology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D000276:Adjuvants, Immunologic; D053918:Papillomavirus Vaccines