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The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting
Open accessAbstract
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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“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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“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
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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
- Published
- 2007-10-09
- Volume
- 97
- Issue
- 9
- Pages
- 1322-1328
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- 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
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.springer.com/tdm (unspecified)
- 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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