Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective |
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| Institution: | 1. Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;2. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia;3. School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia;4. Research Centre for Public Health, Tsinghua University, Beijing 100084, China;5. Kirby Institute, UNSW Australia, Sydney, Australia;6. Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia;1. Cancer Prevention Training Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;2. Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States;3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;1. Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia;2. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia;3. Murdoch Childrens Research Institute, Parkville, VIC, Australia;4. Department of Microbiology and Infectious Diseases, The Royal Women''s Hospital, Parkville, VIC, Australia;5. Department of Obstetrics Gynaecology, University of Melbourne, Parkville, VIC, Australia;1. Stapleton Lane Clinic, St John''s, Antigua, West Indies;2. Pan American Health Organization, Washington, D.C., USA;3. London School of Hygiene & Tropical Medicine, London, UK;4. Ministry of Health, Belmopan, Belize;1. INSERM CIC 1417, F-CRIN, I REIVAC, Assistance Publique- Hôpitaux de Paris, Hôpital Cochin, Paris, France;2. INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France;3. GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France;4. AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France;5. Association Clinique et thérapeutique Infantile, du Val de Marne, Saint-Maur des Fossés, France;6. Department of Neonatology, CHI Creteil, Creteil, France;7. Université de Paris, Faculté de médecine Paris Descartes, Paris, France;1. Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States;2. Department of Medicine, University of Maryland School of Medicine, United States;3. Centre Pour Le Developpement Des Vaccins, Mali;4. Department of Biological Sciences, Old Dominion University, United States;1. Centre de recherche du CHU de Québec, Québec, Canada;2. Département de médecine sociale et préventive, Université Laval, Québec, Canada;3. Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom;4. Modelling and Economics Unit, Public Health England, United Kingdom;5. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;6. Division of Cancer Epidemiology, McGill University, Montreal, Canada |
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| Abstract: | BackgroundWe 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).MethodsWe 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.ResultsA 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.ConclusionsA 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. |
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| Keywords: | Human papillomavirus Vaccination Men who have sex with men Mathematical modelling Cost-effectiveness analysis |
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