Volume 196 - Issue 7
Universal human papillomavirus vaccination of Australian boys — neither cost-effective nor equitable
Authors: Peter D Massey and David N Durrheim
Med J Aust 2012; 196 (7): 446. || doi: 10.5694/mja12.10025
Published online: 16 April 2012
Published online: 16 April 2012
To the Editor: The possible extension of the Australian preadolescent female vaccination program against human papillomavirus (HPV) to preadolescent males is not a sensible use of public health resources.
In Australia, 71% of 15-year-old girls completed ...
To the Editor: The possible extension of the Australian preadolescent female vaccination program against human papillomavirus (HPV) to preadolescent males is not a sensible use of public health resources.
In Australia, 71% of 15-year-old girls completed the three-dose HPV vaccine course through the school-based vaccination program in 2009. A recent cost-effectiveness analysis in the United States found that vaccinating males is only cost-effective if female HPV vaccination rates are low (20%–30%): at 30% coverage, the cost per quality-adjusted life-year (QALY) gained by adding male vaccination is US$41 400 for all health outcomes; at 75% coverage, the cost per QALY gained is US$184 300.1 This latter figure is about 10 times the cost per QALY gained in the current Australian female vaccination program ($18 735).2 In addition, modelling has shown limited herd immunity gains from adding male vaccination in populations with moderately high rates of female vaccination.3
It would be preferable to establish the feasibility and cost-effectiveness of selective vaccination of higher-risk groups, particularly men who have sex with men, to reduce the incidence of oropharyngeal cancer and anal cancer in these groups. In the US, where vaccination rates are low, current economic and epidemiological data do not support universal routine vaccination of preadolescent males for preventing HPV-related cancer in females and in men who have sex with men.4
Australia has one of the lowest cervical cancer rates in the world, whereas our near neighbours have some of the highest.5 The cumulative cervical cancer incidence during 2010 (with 95% confidence intervals) for 15–79-year-olds was 4.3% in Oceania (2.7%–5.6%) and 2.0% (1.2%–2.4%) in South-East Asia, while for Australia it was 0.7% (0.5%–1.0%). Thus the risk for women in Oceania is more than sixfold that for Australian women. Australia also has high rates of cervical cancer screening, unlike our near neighbours.
The burden of HPV-related cancers disproportionally falls on developing countries and the differential availability of HPV vaccine is likely to lead to an increase in this inequity. In resource-constrained settings, the first priority in reducing HPV-related cancer mortality is to vaccinate preadolescent girls. Australia is well placed to support HPV vaccination of preadolescent girls in the Asia–Pacific region, which would be more cost-effective and equitable than introducing universal vaccination of Australian boys.
Competing interests
No relevant disclosures.
References
- Chesson HW, Ekwueme DU, Saraiya M, et al. The cost-effectiveness of male HPV vaccination in the United States. Vaccine 2011; 29: 8443-8450. 0_CBBFIHDA
- Kulasingam S, Connelly L, Conway E, et al. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sexual Health 2007; 4: 165-175. 0_i1142863
- Brisson M, Van de Velde N, Franco EL, et al. Incremental impact of adding boys to current human papillomavirus vaccination programs: role of herd immunity. J Infect Dis 2011; 204: 372-376. 0_i1142865
- Palefsky J. Can HPV vaccination help to prevent anal cancer? Lancet Infect Dis 2010; 10: 815-816. 0_i1142867
- Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 2011; 378: 1461-1484. 0_i1142871