Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis

Lancet Infect Dis. 2010 Dec;10(12):845-52. doi: 10.1016/S1473-3099(10)70219-X. Epub 2010 Nov 2.


Background: A vaccine targeting human papillomavirus (HPV) types 16 and 18, which are associated with 80% of anal cancers, is efficacious in men. High-risk populations such as men who have sex with men (MSM) might especially benefit from vaccination. I aimed to estimate the cost-effectiveness of HPV vaccination of MSM in the USA.

Methods: I constructed decision-analytic models 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. 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. I used the models to conduct sensitivity analyses, including duration of vaccine protection, vaccine cost, and burden of anal cancer and genital warts.

Findings: 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. For example, HPV vaccination of MSM at 26 years cost $37,830 per quality-adjusted life-year when previous exposure to all vaccine-targeted HPV types was assumed to be 50%. Outcomes were most sensitive to variations in anal cancer incidence, duration of vaccine protection, and HIV prevalence in MSM.

Interpretation: HPV vaccination of MSM is likely to be a cost-effective intervention for the prevention of genital warts and anal cancer.

Funding: US National Cancer Institute.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Anus Neoplasms / immunology
  • Anus Neoplasms / prevention & control*
  • Anus Neoplasms / virology*
  • Child
  • Cohort Studies
  • Computer Simulation
  • Condylomata Acuminata / immunology
  • Condylomata Acuminata / prevention & control
  • Condylomata Acuminata / virology
  • Cost-Benefit Analysis
  • Homosexuality, Male
  • Humans
  • Immunization / economics
  • Male
  • Markov Chains
  • Models, Economic
  • Papillomaviridae / immunology*
  • Papillomavirus Infections / immunology
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Infections / virology
  • Papillomavirus Vaccines / economics*
  • Papillomavirus Vaccines / immunology
  • Papillomavirus Vaccines / therapeutic use*
  • United States
  • Young Adult


  • Papillomavirus Vaccines