Table 2.
Cost effectiveness of including boys in a vaccination programme against human papillomavirus (HPV) types 16 and 18 in the context of current screening for cervical cancer*
| Strategy† | Cancers in women only | Cancers in both sexes | ||||
|---|---|---|---|---|---|---|
| Cervical‡ | Including other HPV 16 and HPV 18 cancers (50% efficacy)§ | Including other HPV 16 and HPV 18 cancers (100% efficacy)¶ | Including other HPV 16 and HPV 18 cancers (50% efficacy)§ | Including other HPV 16 and HPV 18 cancers (90-100% efficacy)¶ | ||
| Current screening using cytology with HPV DNA testing for triage: | ||||||
| No vaccination+screening | — | — | — | — | — | |
| Vaccination of girls aged 12+screening | 40 310 | 31 530 | 25 680 | 27 370 | 20 990 | |
| Vaccination of girls and boys aged 12+screening | 290 290 | 242 520 | 208 110 | 164 580 | 114 510 | |
| Current screening using cytology with HPV DNA testing for triage until age 30, then combined cytology and HPV DNA testing after age 30: | ||||||
| No vaccination+screening | — | — | — | — | — | |
| Vaccination of girls aged 12+screening | 42 450 | 30 370 | 23 310 | 25 270 | 18 130 | |
| Vaccination of girls and boys aged 12+screening | 350 040 | 281 170 | 234 760 | 179 510 | 120 300 | |
*Values represent incremental cost effectiveness ratios (additional cost divided by additional health benefit compared with next less costly strategy) expressed as cost ($) per quality adjusted life year (QALY). Costs expressed in 2006 dollars.
†Separate analyses were done under different scenarios of screening. Competing strategies within each scenario vary by vaccination (no vaccination, vaccination of 12 year old girls only, vaccination of 12 year old girls and boys at 75% coverage). Current screening assumes 53% of women are screened annually, 17% every two years, 11% every three years, 15% every five years, and 5% are never screened.
‡Includes outcomes related to cervical disease only and assumes 100% lifelong vaccine efficacy against HPV 16 and HPV 18 related cervical disease.
§Includes outcomes related to cervical disease and other HPV 16 and HPV 18 related cancers (vulvar and vaginal cancers for women; penile cancer for men; and anal, oral, and oropharyngeal cancers for both sexes) and assumes 50% lifelong vaccine efficacy against HPV 16 and HPV 18 related non-cervical cancers and 100% lifelong efficacy against HPV 16 and HPV 18 related cervical disease.
¶Includes outcomes related to cervical disease and other HPV 16 and HPV 18 related cancers and assumes 100% lifelong vaccine efficacy against HPV 16 and HPV 18 related cancers in women and 90% lifelong vaccine efficacy against HPV 16 and HPV 18 related cancers in men.