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Review
. 2018;14(12):3010-3018.
doi: 10.1080/21645515.2018.1496878. Epub 2018 Sep 11.

Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness

Nyi Nyi Soe  1 , Jason J Ong  2   3   4 , Xiaomeng Ma  1 , Christopher K Fairley  2   3 , Phyu Mon Latt  5 , Jun Jing  1 , Feng Cheng  1 , Lei Zhang  1   2   3   6
Affiliations
Review

Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness

Nyi Nyi Soe et al. Hum Vaccin Immunother. 2018.

Abstract

Background: Human papillomavirus (HPV) vaccination for young women up to age 26 is highly cost-effective and has been implemented in 65 countries globally. We investigate the cost-effectiveness for HPV vaccination program in older women (age > 26 years), heterosexual men and men who have sex with men (MSM).

Method: A targeted literature review was conducted on PubMed for publications between January 2000 and January 2017 according to the PRISMA guidelines. We included English-language articles that reported the incremental cost-effectiveness ratio (ICER) of HPV vaccination programs for women over age 26, heterosexual men, and MSM and identified the underlying factors for its cost-effectiveness.

Results: We included 36 relevant articles (six, 26 and four in older women, heterosexual men and MSM, respectively) from 17 countries (12 high-income (HICs) and five low- and middle-income (LMICs) countries). Most (4/6) studies in women over age 26 did not show cost-effectiveness ($65,000-192,000/QALY gained). Two showed cost-effectiveness, but only when the vaccine cost was largely subsidised and protection to non-naïve women was also considered. Sixteen of 26 studies in heterosexual men were cost-effective (ICER = $19,600-52,800/QALY gained in HICs; $49-5,860/QALY gained in LMICs). Nonavalent vaccines, a low vaccine price, fewer required doses, and a long vaccine protection period were key drivers for cost-effectiveness. In contrast, all four studies on MSM consistently reported cost-effectiveness (ICER = $15,000-$43,000/QALY gained), particularly in MSM age < 40 years and those who were HIV-positive. Countries' vaccination coverage did not significantly correlate with its per-capita Gross National Income.

Conclusion: Targeted HPV vaccination for MSM should be next priority in HPV prevention after having established a solid girls vaccination programme. Vaccination for heterosexual men should be considered when 2-dose 4vHPV/9vHPV vaccines become available with a reduced price, whereas targeted vaccination for women over age 26 is unlikely to be cost-effective.

Keywords: Human papillomavirus; cost-effectiveness; men who have sex with men; vaccine.

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Figures

Figure 1.
Figure 1.
Selection of papers with PRISMA Statement.
Figure 2.
Figure 2.
Cost-effectiveness of included studies for women (> 26yr), heterosexual men and MSM.
See this image and copyright information in PMC

References

    1. Walboomers JMM, Jacobs MV, Mnos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJF, Peto J, Meijer CJLM, Munoz N.. Human Papillomavirus is a necessary cause of invasive cervical cancer worldwide. 1999; Sep;189(1):12-9. - PubMed
    1. Centers for Disease Control and Prevention HPV and men- CDC fact sheet. 2015. February https://www.cdc.gov/std/hpv/hpv-and-men-factsheet-feb-2015.pdf.
    1. World Health Organization Cervical cancer. 2018. http://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer....
    1. World Health Organization Human papillomavirus (HPV) and cervical cancer. 2016. June http://www.who.int/mediacentre/factsheets/fs380/en/.
    1. World Health Organization Safety update of HPV vaccines. 2017. accessed http://www.who.int/vaccine_safety/committee/topics/hpv/June_2017/en/.

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