Male HPV vaccination cost-effective preventive method for oropharyngeal cancer
HPV vaccination of boys aged 12 years for the prevention of oropharyngeal cancer can save costs and produce quality-adjusted life-years, according to results of a modeling study.
HPV vaccination is recognized as a preventive measure for cervical cancer in women. However, the efficacy and cost-effectiveness of HPV vaccination in boys as a preventive measure for oropharyngeal cancer remained undetermined, according to the study background.
Lillian L. Siu
“Policymakers in Australia, Canada and the United States have recommended HPV vaccination in boys,” Lillian L. Siu, MD, FRCPC, of the Princess Margaret Cancer Center in Toronto, and colleagues wrote. “However, male HPV vaccination remains unfunded and is excluded from national immunization programs in many countries worldwide.”
Siu and colleagues conducted a literature review to ascertain vaccine efficacy, disease-specific survival and all-cause mortality estimates associated with HPV-related oropharyngeal cancer. They also evaluated data from all males with HPV-related oropharyngeal cancer treated at one institution from 2000 to 2010.
Using these data, the researchers created a model of the cost and efficacy of HPV vaccination compared with non-vaccination applied to a theoretical cohort of Canadian boys aged 12 years in 2012 (n = 192,940). The researchers focused on boys aged 12 years to correspond with the average age of girls upon receipt of the HPV vaccination. All cost analyses were conducted in Canadian dollars.
Assuming a vaccine efficacy of 83.8% (95% CI, 61.2-94.9) and an uptake rate of 50%, vaccination produced 0.0385 more quality-adjusted life-years and saved $94.49 per individual compared with no vaccination.
When researchers adjusted the uptake rate to 70%, vaccination produced 0.0539 more quality-adjusted life-years and saved $144.97 per individual.
Results of the model indicated HPV vaccination in boys could potentially result in a savings of $8 million to $28 million during the course of the population model’s lifetime, the researchers wrote.
Sensitivity analyses indicated additional cost savings would occur when vaccine uptake increased, cancer treatment cost increased, vaccine efficacy increased, infection rate increased and survival probability increased.
However, male HPV vaccination would become more costly and less effective if the vaccine uptake rate is 12% or less (base = 50%), the rate of developing oral HPV infection is 0.11% or less (base = 0.5%), the rate of developing oropharyngeal cancer after oral HPV infection is 0.09% or less (base = 0.4%) or the vaccine efficacy rate is 21% or less (base = 83.8%).
“According to the findings of this preliminary analysis, HPV vaccination for boys aged 12 years may be a cost-effective strategy in relation to the prevention of oropharyngeal cancer alone, strengthening the cost effectiveness of a male vaccination program,” Siu and colleagues concluded. “The argument for funding male HPV vaccination in North America is becoming more compelling given the additional benefits of reductions in genital warts and anal cancers and the potential benefits for the female population because of increased herd immunity. Prospective data collection for male HPV vaccination and oropharyngeal cancer may validate these findings in the future.” – by Cameron Kelsall
Disclosure: Siu reports no relevant financial disclosure. One researcher reports an advisory role with Novartis and Pfizer.