Letters Quadrivalent HPV vaccine

Wider cost benefits of vaccine

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4455 (Published 19 August 2010) Cite this as: BMJ 2010;341:c4455
  1. Colm O’Mahony, consultant in genitourinary medicine and HIV1,
  2. Peter Greenhouse2,
  3. Angela Robinson3,
  4. Chris Sonnex4
  1. 1Department of Sexual Health (GUM), Countess of Chester Hospital, Chester CH2 1UL
  2. 2Bristol Sexual Health Centre, Bristol BS2 0JD
  3. 3Mortimer Market Centre, London WC1E 6JB
  4. 4Addenbrooke’s Hospital, Cambridge CB2 2QQ
  1. colm.omahony{at}hotmail.co.uk

    The FUTURE Study Group’s results confirm the benefit to women of vaccinating against human papillomavirus (HPV) types 16 and 18 and emphasise the value of including HPV-6 and HPV-11 in any vaccine programme.1 HPV-6 and HPV-11 cause almost all condylomatas and a large proportion of cases of low grade vulval, vaginal, and cervical intraepithelial neoplasia.

    The management of genital warts in women is expensive—estimates varied from £160 (€195; $250) in one recent study to £300 in a prospective study that looked at staff and pharmacy costs only.2 3 Because the incubation period of HPV-6 and HPV-11 is about three months, a quadrivalent vaccine should give early clinical and financial benefits. In Australia, new cases of genital warts in young women were reduced by 47% within a year of completion of the vaccination programme.4 Furthermore, because juvenile and adult recurrent respiratory papillomas are almost exclusively caused by HPV-6 and HPV-11, the costs of managing this chronic condition will eventually be reduced.5

    Thus any estimate of the cost of these “benign” HPV types must take account of managing about 30% of the cases of minor cytological abnormality, minor grade vulval intraepithelial neoplasia, recurrent respiratory papilloma, and warts seen in general practice, plus the cost per case in sexual health clinics. These new data should prompt a review of the UK’s decision to choose the bivalent vaccine (Cervarix: active only against oncogenic HPV-16 and HPV-18), and we urge the use of the quadrivalent vaccine (Gardasil) in any future programme.


    Cite this as: BMJ 2010;341:c4455


    • Competing interests: All authors have consultancy agreements with Sanofi Pasteur-MSD and have lectured at educational events sponsored by both SPMSD and GlaxoSmithKline.


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