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Cited by 156Cervical Cancer and HPV ResearchHealth Systems, Economic Evaluations, Quality of LifeGenital Health and Disease

The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting

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Kim, J J, Andres-Beck, B, Goldie, S J·2007·British Journal of Cancer
DOI 10.1038/sj.bjc.6604023PMC PMC2360471
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Abstract

We assessed the cost-effectiveness of including boys vs girls alone in a pre-adolescent vaccination programme against human papillomavirus (HPV) types 16 and 18 in Brazil. Using demographic, epidemiological, and cancer data from Brazil, we developed a dynamic transmission model of HPV infection between males and females. Model-projected reductions in HPV incidence under different vaccination scenarios were applied to a stochastic model of cervical carcinogenesis to project lifetime costs and benefits. We assumed vaccination prevented HPV-16 and -18 infections in individuals not previously infected, and protection was lifelong. Coverage was varied from 0-90% in both genders, and cost per-vaccinated individual was varied from IUSD 25 to 400. At 90% coverage, vaccinating girls alone reduced cancer risk by 63%; including boys at this coverage level provided only 4% further cancer reduction. At a cost per-vaccinated individual of USD 50, vaccinating girls alone was <USD 200 per year of life saved (YLS), while including boys ranged from USD 810-18,650 per YLS depending on coverage. For all coverage levels, increasing coverage in girls was more effective and less costly than including boys in the vaccination programme. In a resource-constrained setting such as Brazil, our results support that the first priority in reducing cervical cancer mortality should be to vaccinate pre-adolescent girls.

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  • The individual-based microsimulation model was chosen over the HPV 16 and 18 transmission model because the former can simulate detailed screening strategies as well as vaccination, and includes other HPV types not targeted by the vaccine, enabling calibration to many epidemiological targets.

    “This was a purposeful decision as the former can simulate detailed screening strategies as well as vaccination, and includes other HPV types not targeted by the vaccine, enabling us to take advantage of all available data by calibrating to many epidemiological targets (Garnett et al, 2006).”

    From Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India (2008) · cites this paper as Kim et al, 2007b

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  • Sensitivity analyses that reduced incidence based on herd immunity findings found the main policy results would be unlikely to change.

    “While our independent dynamic model (Kim et al, 2007b) has been previously used to include the herd immunity effects in an HPV vaccine policy analysis, sensitivity analyses that reduced incidence based on these findings, found the main policy results would be unlikely to change.”

    From Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India (2008) · cites this paper as Kim et al, 2007b

    The Methods (Dynamic model; page unavailable) say that projected reductions in HPV incidence, including herd-immunity effects, were used as inputs to the policy model. The Results report sensitivity analyses and the Discussion favours prioritising vaccination of girls, but our copy does not identify a sensitivity analysis that reduced incidence based on those herd-immunity findings or state that such an analysis left the main policy results unchanged. (LLM, conf=0.82)

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Research works printed but not linked: 1

  1. Ho GY, Kadish AS, Burk RD, Basu J, Palan PR, Mikhail M, Romney SL (1998) HPV 16 and cigarette smoking as risk factors for high-grade cervical intra-epithelial neoplasia. Int J Cancer 78: 281–285 9766558

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Authors
Kim, J. J., Andres-Beck, B., & Goldie, S. J.
Affiliations
Harvard University (US)
Corresponding author
Kim, J J
Venue
British Journal of Cancer
Publisher
Springer Science and Business Media LLC
Published
2007-10-09
Volume
97
Issue
9
Pages
1322-1328
ISSN
  • 0007-0920 (ISSN-L)
  • 1532-1827
DOI
10.1038/sj.bjc.6604023
PMC
PMC2360471
OpenAlex
W2148968089
Cited by
156
References
37
Citations by year
2025: 3 · 2024: 2 · 2023: 1 · 2022: 6 · 2021: 5 · 2020: 1 · 2019: 2 · 2018: 5 · 2017: 9 · 2016: 6 · 2015: 14 · 2014: 6 · 2013: 20 · 2012: 17
FWCI
10.82
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Cancer (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Bill and Melinda Gates Foundation (30505)
  • National Cancer Institute (R01CA093435, R01-CA93435, CA93435)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Surgery › Genital Health and Disease
Keywords
HPV vaccination, boys, girls, cost-effectiveness, HPV16, HPV 18, cervical cancer prevention, cervical carcinogenesis, vaccination coverage, resource-limited settings, Brazil
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Brazil, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Child, Child, Preschool, Cost-Benefit Analysis, Female, Health Policy, Humans, Infant, Infant, Newborn, Male, Mass Screening, Middle Aged, Vaccination, Quality-Adjusted Life Years, Papillomavirus Infections, Human papillomavirus 18, Human papillomavirus 16

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