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HPV vaccination for school boys not yet cost-effective

Monday 14 July 2014

HPV vaccination for school boys not yet cost-effective – study

HPV vaccination of New Zealand school boys is not yet a value-for-money option, according to a study just published by the University of Otago, Wellington.

Until the vaccine price drops and various other cost-saving strategies are also adopted – such as using just two doses rather than the current three doses of vaccine – the Government should focus on increasing HPV vaccination uptake in girls at schools, the authors say.

One of the study’s authors, Associate Professor Nick Wilson, says New Zealand has “some way to go” to catch up to the coverage levels of over 80% of school girls seen in some other countries such as the UK.

One way to achieve this could be to follow these other countries by continuing to allow free vaccination in the school setting for 12-year-old girls, but not funding other out-of-school options which parents sometimes don’t follow up on, Wilson says.

HPV vaccination is showing benefits around the world in terms of markedly dropping rates of genital warts and some types of pre-cancer, which can proceed on to cervical cancer. The vaccination is also very likely to prevent a range of other genital cancers and head and neck cancer in both women and men.

The University of Otago, Wellington study found that the current programme for girls was good value for money, but adding vaccination for boys would cost a lot more per amount of health gained - vaccination of boys at the level of coverage as currently achieved for girls would cost $117,500 per quality-adjusted life-year (QALY) gained.

“This is clearly not cost-effective when using a typical threshold of the GDP-per-capita of New Zealand to gain an extra year of healthy life, which is around $45,000,” Wilson says.

“If New Zealand invested in vaccinating boys, there would be the likely opportunity cost of not funding interventions that achieve more health gain or, more bluntly, not getting the biggest ‘bang for our buck’ elsewhere in the health sector.”

Wilson suggests New Zealand would perhaps be better off investing in other vaccinations such as the meningococcal C vaccination used in a campaign in Northland recently.

However, the price of the HPV vaccine is almost certain to drop in the future, especially as PHARMAC has now taken over the role of price negotiating from the Ministry of Health, Wilson says.

PHARMAC can now negotiate vaccine prices at the same time as contracts for other products from the same pharmaceutical manufacturers.

The study found that a lower vaccine price would improve the cost-effectiveness of vaccinating boys. However, the combined vaccine and administration costs had to be under $125 per dose of vaccine delivered, before vaccinating boys became cost-effective at the GDP-per-capita threshold.

“Vaccinations are usually great value for money – but we are not at this point with giving the HPV vaccination for boys,” Wilson says.

The Australian Government is now providing fully subsidised HPV vaccination to school boys – in large part because this government seems to have struck a particularly good deal with the vaccine manufacturer, Wilson says.

“But national pride might also have played a part – since the HPV vaccine was first invented in Australia.”

The study is published in the international peer-reviewed journal BMC Infectious Diseases, and the study team was predominantly funded by the Health Research Council.

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