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

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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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Figure 1 Schematic of dynamic model for females. Females who are uninfected can acquire HPV-16 or -18 infection (at an annual rate of λ16 or λ18, respectively). Once infected, females can develop precancerous lesions (i.e., CIN 1 and CIN 2,3), and over time may develop invasive cervical cancer. Females who clear their infection or lesion develop a degree of natural immunity to that same HPV type (i.e., immune16 or immune18); future type-specific infections can be acquired at a reduced rate (e.g., λ16*(1-immune16)). History of prior infection is tracked throughout the analysis. Note: not all health states and transitions are shown. The model for males has a similar structure for HPV-16 and -18 infection only (the schematic and corresponding model equations can be found in the Supplementary information). Once vaccination is introduced, females and males enter a corresponding vaccinated state; vaccine efficacy is modelled as protection against future type-specific infection.
Figure 1 Schematic of dynamic model for females. Females who are uninfected can acquire HPV-16 or -18 infection (at an annual rate of λ16 or λ18, respectively). Once infected, females can develop precancerous lesions (i.e., CIN 1 and CIN 2,3), and over time may develop invasive cervical cancer. Females who clear their infection or lesion develop a degree of natural immunity to that same HPV type (i.e., immune16 or immune18); future type-specific infections can be acquired at a reduced rate (e.g., λ16*(1-immune16)). History of prior infection is tracked throughout the analysis. Note: not all health states and transitions are shown. The model for males has a similar structure for HPV-16 and -18 infection only (the schematic and corresponding model equations can be found in the Supplementary information). Once vaccination is introduced, females and males enter a corresponding vaccinated state; vaccine efficacy is modelled as protection against future type-specific infection.CC BY · PubMed Central
Figure 2 Model output of age-specific prevalence of HPV-16 (upper panel) and HPV-18 (lower panel) among females compared to empirical data. Red dotted line represents model output for the best-fitting set; grey lines represent model output for the next nine best-fitting sets. Black solid lines depict the 95% confidence interval of the empirical data at each age group (Franco et al, 1999; Molano et al, 2002; Clifford et al, 2005, 2006).
Figure 2 Model output of age-specific prevalence of HPV-16 (upper panel) and HPV-18 (lower panel) among females compared to empirical data. Red dotted line represents model output for the best-fitting set; grey lines represent model output for the next nine best-fitting sets. Black solid lines depict the 95% confidence interval of the empirical data at each age group (Franco et al, 1999; Molano et al, 2002; Clifford et al, 2005, 2006).CC BY · PubMed Central
Figure 3 Model output of age-specific incidence of cervical cancer (HPV-16 and-18 associated only) compared to empirical data. Red dotted line represents model output for the best-fitting set; grey lines represent model output for the next nine best-fitting sets. Black solid lines depict the 95% confidence interval of the empirical data at each age group (International Agency for Research on Cancer, 1976; Clifford et al, 2003a, 2003b, 2006).
Figure 3 Model output of age-specific incidence of cervical cancer (HPV-16 and-18 associated only) compared to empirical data. Red dotted line represents model output for the best-fitting set; grey lines represent model output for the next nine best-fitting sets. Black solid lines depict the 95% confidence interval of the empirical data at each age group (International Agency for Research on Cancer, 1976; Clifford et al, 2003a, 2003b, 2006).CC BY · PubMed Central

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Metadata

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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