Research Round-Up: Cost-Effectiveness of Male HPV Vaccination

Katherine Buller - Sunday, 11 December 2016 01:39

In December 2015, the Centers for Disease Control (CDC) issued a call-to-attention for the benefits of the human papillomavirus (HPV) vaccine for boys aged 11-12 years of age stating that “every year, over 900,000 males are affected by cancers caused by HPV infections.”1

Additionally, in the United Kingdom, another call-to-action was issued by Nobel scientist, Professor Harald Zur Hausen, a German virologist, who said “that vaccinating boys was of the ‘utmost importance’, not only because boys can also contract HPV-related cancers of the throat, anus, and penis, but because protecting boys is a key to ending transmission of the virus all together.”2 This Research Round-Up focuses on HPV vaccination of boys and its cost-effectiveness.

Cost-Effectiveness Analysis of Including Boys in a HPV Vaccination Program in the United States


An article in the BMJ3 assessed the cost effectiveness of an HPV vaccination program that included both American girls and boys aged 12-years. The authors used two models to simulate the effects of HPV infections between males and females: (1) the “dynamic transmission model” was used to simulate HPV 16 and HPV 18 infections for both men and women and (2) the “individual based microsimulation model” was used to mirror cervical cancer in women (p.2). These models helped to “synthesise epidemiological, clinical, and economic data to evaluate the incremental benefits and cost effectiveness of including preadolescent (age 12 years) boys in a routine HPV vaccination programme for preadolescent girls in the context of screening for cervical cancer in the US” (p.2).

The strategies/models used by the authors analyzed the outcomes of the vaccination program for both males and females and for girls only. They determined that past programs that had proven to be successful had 75% vaccination coverage of both sexes and in cases where neither participant had family history of HPV related diseases, 100% of females and 85% of males were protected by the program (p.3).  In the individual model, females were screened for HPV DNA alongside a history of cervical cancer (p.3). The authors compared the two models against one another based off of each model’s Quality-adjusted Life Years (QALYs) for both sexes.

Assuming that there would be 75% coverage for 12 year-olds girl from the HPV vaccine from the individual model, it was determined that the cost effectiveness should be $40,310/QALY; however, including boys of the same age, the cost effectiveness increases to $290,290/QALY (p.3).  Additionally, all HPV 16 and HPV 18 related diseases that have a 50% efficacy rate of protection by the vaccine resulted in a decrease of cost effectiveness of $32,000/QALY for the girls-only vaccine and a $200,000/QALY for the sex neutral vaccine (p.3).  It is further stated that “when including cancer benefits for both sexes, the cost effectiveness ratio for vaccinating boys in addition to girls remained above $100,000/QALY” (p.3).

While the authors claim that including boys into an HPV program would not “provide good value for resources compared with vaccinating girls only,” they neglected the population category of men who have sex with men (MSM) and the cost effectiveness of an HPV vaccination program that could prove fruitful in good results to fight the high risk of anal cancer (p.7).

Impact of Vaccinating Boys and Men Against HPV in the United States

An article in Vaccine4 explains the cost-effectiveness of a sex neutral HPV vaccine for boys and men to protect them and their partners from the related diseases stemming from HPV. The authors took the HPV4 program, which is already in effect in the United States, for males and females aged 9-26 years old and evaluated the direct and indirect benefits for heterosexual males.  The program simulation used in the study was designed to assess “the public health impact of vaccination by estimating age-specific prevalence and incidence of infection and disease by HPV type, gender, and at any given time point over 100 years … [and] calculated the incremental cost-effectiveness ratio (ICER) by dividing the cost difference by the QALY difference” (p.6859).

It was determined that the variations of prevention programs for HPV with boys and girls were considerably less in cost if the program was for girls alone. For example, vaccination prevention programs for cervical cancer is $46,084/QALY or all female-related diseases are $3282/QALY, and vaccinating boys and men only to help prevent cervical cancers in females is $178,908/QALY or vaccinating males to help prevent all HPV-related cancers in females is $69,038/QALY; however, if a sex neutral vaccination prevention program is developed to protect against all HPV-related diseases, it is $25,664/QALY (p.6863). Thus, the costs per QALY are actually lower if there were a sex neutral vaccination prevention programs for all HPV-related cancers supporting the case that the HPV vaccine is cost-effective to include males.

The study was compared to two other studies that stated that should an HPV vaccination program include boys, the cost-effectiveness would be unattractive and prove ineffective. However, the authors concluded that while the models and outcomes were different, the other studies significantly underestimated the potential benefits for males, and that by “adding boys and men 9-26 years of age to the HPV vaccine program [are] … cost-effective at the commonly cited thresholds of $100,000/QALY and $50,000/QALY” when all HPV-related diseases are added to the simulation and assessment (pp.6864-5).


  1. “HPV Vaccine Is Recommended for Boys.” Centers for Disease Control and Prevention. December 02, 2015.
  2. Cooper, Charlie, and Gloria Nakajubi. “Professor Harald Zur Hausen: Nobel Scientist Calls for HPV Vaccination for Boys.” The Independent. July 11, 2015.
  3. Kim, Jane J., and Sue J. Goldie. “Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States.” Bmj 339 (2009): b3884.
  4. Elbasha, Elamin H., and Erik J. Dasbach. “Impact of vaccinating boys and men against HPV in the United States.” Vaccine 28, no. 42 (2010): 6858-6867.


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