Should boys have HPV vaccination?

3rd February saw the publication of the results of a 4 year study to ascertain the efficacy of HPV vaccine for boys against HPV strains 6, 11, 16 and 18 . The sponsors were Merck, producers of the HPV vaccine, Gardasil. The double-blind study included 4,065 healthy men aged 16-26 in 18 countries. Efficacy was 90.5 % against external lesions when offered before exposure, and 65.5% when offered regardless of prior exposure
HPV vaccination of girls is widely practised. The question is: should we be vaccinating boys? The authors stress the potential benefits of preventing HPV transmission to women, especially in the light of the low take-up of teenage girls in the US. They also emphasise reduction of transmission from men to men.
Recent independent studies of the cost-effectiveness of HPV vaccination favour vaccination of pre-adolescent females, but not males www.bmj.com/content/339/bmj.b4127.extract . According to J.J. Kim & S.J. Goldie www.nature.com/bjc/journal/v97/n9/abs/6604023a.html, “only under the most favourable assumptions for the benefits … did the cost per quality adjusted life year fall below $100,000 per QALY”. On one issue at least Kim and Goldie concur with Giuliano and Palefsky: that male HPV vaccination may be cost-effective in situations where the take-up by girls is sufficiently low.
Anna R. Giuliano & Joel M. Palefsky, “Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males”, New England Journal of Medicine, February 2011
http://www.nejm.org

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