National vaccination programs against human papillomavirus (HPV) started with girls-only immunization because of the high burden of cervical cancer around the world. Currently, there is substantial evidence that HPV can also cause vulvar, vaginal, anal, and oropharyngeal cancers in women and anal, oropharyngeal and penile cancers in men. Therefore, vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases especially since tender negotiations have driven down the cost of the vaccine. Several high-income countries are already vaccinating preadolescent boys in addition to girls at public expense.
To evaluate the health and economic impact of vaccinating preadolescent boys along with girls in the national immunization program.
We expanded a previously published Bayesian synthesis framework to account for all vaccine type-related cancers and indirect protective effects (i.e. herd immunity effects) from vaccinating girls and boys. The efficiency of boys’ vaccination was evaluated relative to efforts to increase the current vaccine uptake among girls, which is around 60%. The cost-effectiveness of a gender-neutral national immunization program was evaluated in comparison to the current girls-only vaccination program.
- Vaccinating 2 boys yields the same gain in life-years (LYs) as vaccinating one extra girl. The incremental cost-effectiveness ratio of boys’ vaccination is far below the cost-effectiveness threshold. The ceiling vaccination cost, beyond which vaccination is not cost-effective, is €240 as shown in Figure 1 below.
- If girls’ uptake increases to 90%, the ceiling cost of vaccinating a boy decreases to €70 (Figure 1).
Figure 1. Incremental cost-effectiveness ratio of vaccinating 40% of boys in addition to A) 60% and B) 90% of girls over a wide range of cost per fully vaccinated boy. Red horizontal line represents the threshold of €40,000/LY gained.
Vaccinating preadolescent boys along with girls is only modestly less efficient than increasing uptake among girls and highly likely to be cost-effective under current vaccine costs and uptake in the Netherlands.