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Lancet Infect Dis. 2010 Dec;10(12):845-52. doi: 10.1016/S1473-3099(10)70219-X. Epub 2010 Nov 2.

Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis.

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1
Harvard School of Public Health, Department of Health Policy and Management, Center for Health Decision Science, Boston, MA, USA. jkim@hsph.harvard.edu

Abstract

BACKGROUND:

A vaccine targeting human papillomavirus (HPV) types 16 and 18, which are associated with 80% of anal cancers, is efficacious in men. High-risk populations such as men who have sex with men (MSM) might especially benefit from vaccination. I aimed to estimate the cost-effectiveness of HPV vaccination of MSM in the USA.

METHODS:

I constructed decision-analytic models to estimate the direct health and economic outcomes of HPV vaccination (against types 6, 11, 16, and 18) for prevention of HPV-related anal cancer and genital warts. The model parameters that were varied were age at vaccination (12 years, 20 years, and 26 years), previous exposure to vaccine-targeted HPV types, and prevalence of HIV-1. I used the models to conduct sensitivity analyses, including duration of vaccine protection, vaccine cost, and burden of anal cancer and genital warts.

FINDINGS:

In a scenario of HPV vaccination of MSM at 12 years of age without previous exposure to HPV, compared with no vaccination, vaccination cost US$15,290 per quality-adjusted life-year gained. In scenarios where MSM are vaccinated at 20 years or 26 years of age, after exposure to HPV infections, the cost-effectiveness ratios worsened, but were less than $50,000 per quality-adjusted life-year under most scenarios. For example, HPV vaccination of MSM at 26 years cost $37,830 per quality-adjusted life-year when previous exposure to all vaccine-targeted HPV types was assumed to be 50%. Outcomes were most sensitive to variations in anal cancer incidence, duration of vaccine protection, and HIV prevalence in MSM.

INTERPRETATION:

HPV vaccination of MSM is likely to be a cost-effective intervention for the prevention of genital warts and anal cancer.

FUNDING:

US National Cancer Institute.

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PMID:
21051295
PMCID:
PMC3982926
DOI:
10.1016/S1473-3099(10)70219-X
[Indexed for MEDLINE]
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