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

• Published in: Human vaccines & immunotherapeutics Vol. 14; no. 12; pp. 3010 - 3018
• Main Authors: Soe, Nyi Nyi, Ong, Jason J., Ma, Xiaomeng, Fairley, Christopher K, Latt, Phyu Mon, Jing, Jun, Cheng, Feng, Zhang, Lei
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 02-12-2018; Taylor & Francis Group
• Subjects: Adult; Age Factors; Cost-Benefit Analysis; cost-effectiveness; Databases, Factual; Female; Heterosexuality; Homosexuality, Male; Human papillomavirus; Humans; Immunization Programs; Male; men who have sex with men; Papillomavirus Infections - economics; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - economics; Review; Sexual and Gender Minorities; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - prevention & control; Vaccination; vaccine; cost-effectiveness; Human papillomavirus; vaccine; men who have sex with men
• ISSN: 2164-5515; 2164-554X
• DOI: 10.1080/21645515.2018.1496878

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.