Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective

Lei Zhang; David G Regan; Jason J Ong; Manoj Gambhir; Eric P F Chow; Huachun Zou; Matthew Law; Jane Hocking; Christopher K Fairley

doi:10.1016/j.vaccine.2017.07.078

Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective

Vaccine. 2017 Sep 5;35(37):4923-4929. doi: 10.1016/j.vaccine.2017.07.078. Epub 2017 Aug 5.

Authors

Lei Zhang¹, David G Regan², Jason J Ong³, Manoj Gambhir⁴, Eric P F Chow³, Huachun Zou², Matthew Law², Jane Hocking⁵, Christopher K Fairley³

Affiliations

¹ Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Research Centre for Public Health, Tsinghua University, Beijing 100084, China. Electronic address: lei.zhang1@monash.edu.
² Kirby Institute, UNSW Australia, Sydney, Australia.
³ Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
⁴ School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
⁵ Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia.

PMID: 28789853
DOI: 10.1016/j.vaccine.2017.07.078

Abstract

Background: We investigated the effectiveness and cost-effectiveness of a targeted human papillomavirus (HPV) vaccination program for young (15-26) men who have sex with men (MSM).

Methods: We developed a compartmental model to project HPV epidemic trajectories in MSM for three vaccination scenarios: a boys program, a targeted program for young MSM only and the combination of the two over 2017-2036. We assessed the gain in quality-adjusted-life-years (QALY) in 190,000 Australian MSM.

Results: A targeted program for young MSM only that achieved 20% coverage per year, without a boys program, will prevent 49,283 (31,253-71,500) cases of anogenital warts, 191 (88-319) person-years living with anal cancer through 2017-2036 but will only stablise anal cancer incidence. In contrast, a boys program will prevent 82,056 (52,100-117,164) cases of anogenital warts, 447 (204-725) person-years living with anal cancers through 2017-2036 and see major declines in anal cancer. This can reduce 90% low- and high-risk HPV in young MSM by 2024 and 2032, respectively, but will require vaccinating ≥84% of boys. Adding a targeted program for young MSM to an existing boys program would prevent an additional 14,912 (8479-21,803) anogenital wart and 91 (42-152) person-years living with anal cancer. In combination with a boys' program, a catch-up program for young MSM will cost an additional $AUD 6788 ($4628-11,989) per QALY gained, but delaying its implementation reduced its cost-effectiveness.

Conclusions: A boys program that achieved coverage of about 84% will result in a 90% reduction in HPV. A targeted program for young MSM is cost-effective if timely implemented.

Keywords: Cost-effectiveness analysis; Human papillomavirus; Mathematical modelling; Men who have sex with men; Vaccination.

MeSH terms

Adolescent
Adult
Australia
Cost-Benefit Analysis
Homosexuality, Male / statistics & numerical data
Humans
Male
Models, Theoretical
Papillomavirus Infections / immunology*
Papillomavirus Infections / prevention & control*
Papillomavirus Vaccines / therapeutic use*
Quality-Adjusted Life Years
Young Adult

Substances

Papillomavirus Vaccines