Should young men who have sex with men be targeted for HPV vaccinations?
Vaccinating men who have sex with men (MSM) against the human papillomavirus is a cost-effective method for preventing anal cancer and gential warts, a new analysis published in Lancet Infectious Diseases has found. Last year the FDA approved the use of Merck’s HPV vaccine Gardasil to prevent genital warts for boys and men ages 9 to 26, but the CDC didn’t make it a routine vaccination because cost-effectiveness data were lacking. Study author Jane J. Kim, Ph.D., of the Harvard School of Public Health found that a universal vaccination for young boys might not be necessary to protect MSM from future development of anal cancer and genital warts. Instead, she recommended targeting men who have sex with men for vaccination.
Dr. Ross asks the obvious question: “How do you decide which 12- and 14-year-olds are going to grow up to be men who have sex with men?”
In her analysis, Dr. Kim writes that while ideally vaccines would be given to gay boys that young (before “sexual debut”), “HPV vaccination of MSM need not occur at the earliest ages to be good value for money.” Even vaccinating 26-year-old men who have sex with men makes economic sense, she says.
Dr. Whelan notes: “Unfortunately, by that age, most of the target group will likely have already acquired HPV infection, thereby reducing the efficacy of the vaccine. Earlier vaccination would also likely be protective against other HPV-related cancers, such as oral cancer.” (acsh.org)
Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis
by: Hina Radia (nelm.nhs.uk, 3/11/2010)
The Lancet Infectious Diseases has published a study concluding that human papillomavirus vaccination (HPV) of men who have sex with men (MSM) is likely to be a cost-effective intervention for the prevention of genital warts and anal cancer.
The research was based on a decision-analytic model 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 in USA. 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. The models were used to conduct sensitivity analyses, including duration of vaccine protection, vaccine cost, and burden of anal cancer and genital warts.
According to the author, 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.
The author highlights several limitations and also concludes that “The findings suggest that routine vaccination of all men and boys, already thought to have diminishing value as uptake in girls increases in the USA, might not be the best way to prevent anal cancer and genital warts in MSM. Instead, programmes targeting HPV vaccination of MSM at older ages—when more men have established and are willing to disclose their sexual identity—might be a good approach to reach this high-risk group.”
A separate editorial has discussed the study.
The US FDA is currently considering approval of vaccination for boys and men – please see link below to previous report on the NeLM.
Vaccinating men who have sex with men (MSM) against the human papillomavirus is a cost-effective method for preventing anal cancer and gential warts, a new analysis published in Lancet Infectious Diseases has found. Last year the FDA approved the use of Merck’s HPV vaccine Gardasil to prevent genital warts for boys and men ages 9 to 26, but the CDC didn’t make it a routine vaccination because cost-effectiveness data were lacking. Study author Jane J. Kim, Ph.D., of the Harvard School of Public Health found that a universal vaccination for young boys might not be necessary to protect MSM from future development of anal cancer and genital warts. Instead, she recommended targeting men who have sex with men for vaccination.
Dr. Ross asks the obvious question: “How do you decide which 12- and 14-year-olds are going to grow up to be men who have sex with men?”
In her analysis, Dr. Kim writes that while ideally vaccines would be given to gay boys that young (before “sexual debut”), “HPV vaccination of MSM need not occur at the earliest ages to be good value for money.” Even vaccinating 26-year-old men who have sex with men makes economic sense, she says.
Dr. Whelan notes: “Unfortunately, by that age, most of the target group will likely have already acquired HPV infection, thereby reducing the efficacy of the vaccine. Earlier vaccination would also likely be protective against other HPV-related cancers, such as oral cancer.” (acsh.org)
Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysisby: Hina Radia (nelm.nhs.uk, 3/11/2010)
The Lancet Infectious Diseases has published a study concluding that human papillomavirus vaccination (HPV) of men who have sex with men (MSM) is likely to be a cost-effective intervention for the prevention of genital warts and anal cancer.
The research was based on a decision-analytic model 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 in USA. 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. The models were used to conduct sensitivity analyses, including duration of vaccine protection, vaccine cost, and burden of anal cancer and genital warts.
According to the author, 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.
The author highlights several limitations and also concludes that “The findings suggest that routine vaccination of all men and boys, already thought to have diminishing value as uptake in girls increases in the USA, might not be the best way to prevent anal cancer and genital warts in MSM. Instead, programmes targeting HPV vaccination of MSM at older ages—when more men have established and are willing to disclose their sexual identity—might be a good approach to reach this high-risk group.”
A separate editorial has discussed the study.
The US FDA is currently considering approval of vaccination for boys and men – please see link below to previous report on the NeLM.
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The Lancet: Human papillomavirus vaccination
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