The Cost-Effectiveness of Male Human Papillomavirus (HPV) Vaccination in the United States

Background: In addition to the direct benefits to vaccinated men, male HPV vaccination can reduce the overall burden of vaccine-type HPV in the population.

Objectives: To examine the cost-effectiveness of adding quadrivalent HPV vaccination of 12-year-old males to an existing HPV vaccination program for females aged 12-26 years in the United States.

Methods: We expanded a previously-published, spreadsheet-based model of HPV vaccination to account for indirect effects of vaccination.  The medical costs averted and quality-adjusted life years (QALYs) saved by vaccination were calculated based on inputs such as the incidence of disease attributable to the HPV vaccine types in the absence of vaccination, the cost and QALY loss associated with each HPV-related health outcome (cervical and other cancers, genital warts, and recurrent respiratory papillomatosis), and reductions in these adverse health outcomes due to vaccination.  We examined three coverage scenarios (high, base case, and low), which corresponded to coverage rates of 80%, 50%, and 20%, respectively, for 12-year-old males and females and to annual probabilities of catch-up vaccination for females of 25%, 15%, and 5%, respectively.

Results: Although female vaccination cost less than $25,000 per QALY, adding male vaccination cost more than $100,000 per QALY in the base case. The cost-effectiveness estimates varied substantially depending on factors such as vaccine coverage and the health outcomes considered in the analysis.  Male vaccination cost less than $50,000 per QALY when considering all potential health outcomes in the low coverage scenario, but more than $500,000 per QALY when considering only cervical disease and genital warts in the high coverage scenario.

Conclusions: The cost per QALY of male vaccination generally exceeded $50,000 except when assuming low vaccine coverage or when assuming that catch-up vaccination of females was temporary (5 years) rather than permanent.

Implications for Programs, Policy, and/or Research: Expanded vaccination of females may be more cost-effective than male vaccination.