Giving Gardasil to Boys Not Worth the Cost

THURSDAY, Oct. 8 (HealthDay News) -- The cost of giving boys the human papillomavirus (HPV) vaccine would outweigh any health benefit, researchers say.

Last month, a U.S. Food and Drug Administration panel recommended expanding use of the Gardasil vaccine to males aged 9 to 26 to protect them from genital warts, but the cost effectiveness of such a program was unclear at the time.

But researchers from the Harvard School of Public Health conducted such an analysis comparing a girls-only vaccination program with a co-ed vaccination program. Currently, Gardasil is approved for girls aged 9 and over to protect them from cervical cancer.

"This study found that while vaccine coverage and efficacy are high in girls, including boys in an HPV vaccination program generally exceeds what the U.S. typically considers good value for money," said lead researcher Jane Kim, an assistant professor of health decision science.

The report is published in the Oct. 9 online edition of the British Medical Journal.

Vaccination was considered a good value if cost-effectiveness ratios ranged from $50,000 to $100,000 per quality-adjusted life year, meaning the cost of the vaccine vs. the number of added years someone would gain by getting the vaccine.

Assuming 75 percent coverage and lifelong protection, the researchers found routine vaccination of 12-year-old girls was a good value at less than $50,000 per quality-adjusted life year. However, adding preadolescent boys increased the cost-effectiveness ratio to more than $100,000 per quality-adjusted life year. The researchers considered treatment for conditions caused by HPV, including anogenital and oral cancers, genital warts, and juvenile-onset recurrent respiratory papillomatosis.

"Only under optimistic assumptions of high, lifelong vaccine efficacy against all HPV-related health conditions, or lower vaccine efficacy accompanied by lower coverage or vaccine costs, did vaccinating both girls and boys fall below $100,000 per quality-adjusted life year," Kim said.

Philip E. Castle, an investigator in the division of cancer epidemiology and genetics at the U.S. National Cancer Institute and co-author of an accompanying journal editorial, agreed it is more cost effective to vaccinate just girls, rather than girls and boys.

Scientific reasons do exist to vaccinate boys, Castle said. "And from a social standpoint, people want gender equality, and those are fine things, but it is not a great investment to do that."

Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, also agreed with the findings.

"If we can vaccinate a high enough proportion of young girls, then vaccinating boys is not cost-effective," she said.

Other experts disagreed.

Anna R. Giuliano, chair of the department of cancer epidemiology and genetics at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., said more data is needed to decide the issue appropriately.

"Some of the assumptions in the study, such as low HPV attributable risk for male cancers, and the very optimistic scenario of 75 percent vaccine dissemination in both females and males in the U.S. may have led to the relatively unfavorable cost estimates provided for male vaccination in this publication," she said.

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