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HPV Vaccine: Cost-effective Way to Prevent Anal Cancer

Study Shows Benefits of HPV Vaccine in Men Who Have Sex With Men
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Nov. 2, 2010 --The human papillomarvirus (HPV) shot is a cost-effective way to prevent genital warts and anal cancer in men who have sex with men. This is the finding of a new study that appears in The Lancet.

In 2010, there will be about 5,260 new cases of anal cancer diagnosed in the U.S, and about 720 people will die from this disease, according to the American Cancer Society. There are no routine prevention programs or screening tests for anal cancer.

HPV vaccines protect against certain types of HPV that are linked to cervical cancer and anal cancer. A sexually transmitted disease, HPV or genital warts can be transmitted through vaginal, anal, and oral sex. Nearly 80% of cases of anal cancer are linked to two of the types of HPV that the vaccine targets.

Vaccines for High-Risk Men

Jane J Kim, PhD, an assistant professor of health decision science in the department of health policy and management at the Harvard School of Public Health in Boston, constructed models to assess the cost-effectiveness of the HPV shot across a range of potential scenarios involving men who have sex with men. The scenarios were based on age, previous exposure to the types of warts that are targeted by the vaccine, and HIV status. Men who test positive for HIV, the virus that causes AIDS, are at higher risk for HPV and anal cancer.

Researchers used measurements called “QALY.” QALY -- which stands for “quality adjusted life year” -- is a measurement of both quality and length of life. In the study, a cost-effectiveness ratio of less than $50,000 per QALY gained is considered a "good value for money."

Vaccinating men who have sex with other men against HPV between the ages of 12 to 26 is a cost-effective strategy, Kim concludes. If further study shows that this vaccine is also effective against HPV-related cancers it may be an even more cost-effective intervention.

Who Should Get the HPV Shot?

Casting a wide net -- routine vaccination of all men and boys -- may not be the best way to prevent anal cancer and genital warts in this high-risk group, Kim writes. Instead, targeting men who have sex with men between the ages of 12 and 26 may be the way to go, she says.

"Such a strategy is very likely to be a valuable health investment for a high-risk population that otherwise relies on no other organized prevention strategy against an illness with a high disease burden," she writes.

Younger men may not be aware of their sexual identity or willing to disclose it, and this is one of the reasons some experts were calling for routine vaccination of all boys.

"Programs targeting HPV vaccination of males who have sex with other males at older ages -- when more men have established and are willing to disclose their sexual identity -- might be a good approach to reach this high-risk group," she says.

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