The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting

Br J Cancer. 2007 Nov 5;97(9):1322-8. doi: 10.1038/sj.bjc.6604023. Epub 2007 Oct 9.


We assessed the cost-effectiveness of including boys vs girls alone in a pre-adolescent vaccination programme against human papillomavirus (HPV) types 16 and 18 in Brazil. Using demographic, epidemiological, and cancer data from Brazil, we developed a dynamic transmission model of HPV infection between males and females. Model-projected reductions in HPV incidence under different vaccination scenarios were applied to a stochastic model of cervical carcinogenesis to project lifetime costs and benefits. We assumed vaccination prevented HPV-16 and -18 infections in individuals not previously infected, and protection was lifelong. Coverage was varied from 0-90% in both genders, and cost per-vaccinated individual was varied from IUSD 25 to 400. At 90% coverage, vaccinating girls alone reduced cancer risk by 63%; including boys at this coverage level provided only 4% further cancer reduction. At a cost per-vaccinated individual of USD 50, vaccinating girls alone was <USD 200 per year of life saved (YLS), while including boys ranged from USD 810-18,650 per YLS depending on coverage. For all coverage levels, increasing coverage in girls was more effective and less costly than including boys in the vaccination programme. In a resource-constrained setting such as Brazil, our results support that the first priority in reducing cervical cancer mortality should be to vaccinate pre-adolescent girls.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brazil
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Female
  • Health Policy / economics
  • Human papillomavirus 16 / immunology*
  • Human papillomavirus 18 / immunology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mass Screening / economics*
  • Middle Aged
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / prevention & control*
  • Quality-Adjusted Life Years
  • Uterine Cervical Dysplasia / diagnosis
  • Uterine Cervical Dysplasia / economics
  • Uterine Cervical Dysplasia / prevention & control*
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control*
  • Vaccination*