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Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2016 (Published 12 May 2015) Cite this as: BMJ 2015;350:h2016
  1. Johannes A Bogaards, senior researcher12,
  2. Jacco Wallinga, senior researcher2,
  3. Ruud H Brakenhoff, professor3,
  4. Chris J L M Meijer, professor4,
  5. Johannes Berkhof, associate professor1
  1. 1Department of Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
  2. 2Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands
  3. 3Department of Otolaryngology/Head and Neck Surgery, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
  4. 4Department of Pathology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
  1. Correspondence to: J A Bogaards hans.bogaards{at}rivm.nl
  • Accepted 16 March 2015

Abstract

Objective To assess the reduction in the vaccine preventable burden of cancer in men if boys are vaccinated along with girls against oncogenic human papillomavirus (HPV).

Design Bayesian evidence synthesis approach used to evaluate the impact of vaccination against HPV types 16 and 18 on the burden of anal, penile, and oropharyngeal carcinomas among heterosexual men and men who have sex with men. The reduced transmission of vaccine-type HPV from vaccination of girls was assumed to lower the risk of HPV associated cancer in all men but not to affect the excess risk of HPV associated cancers among men who have sex with men.

Setting General population in the Netherlands.

Intervention Inclusion of boys aged 12 into HPV vaccination programmes.

Main outcome measures Quality adjusted life years (QALYs) and numbers needed to vaccinate.

Results Before HPV vaccination, 14.9 (95% credible interval 12.2 to 18.1) QALYs per thousand men were lost to vaccine preventable cancers associated with HPV in the Netherlands. This burden would be reduced by 37% (28% to 48%) if the vaccine uptake among girls remains at the current level of 60%. To prevent one additional case of cancer among men, 795 boys (660 to 987) would need to be vaccinated; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2162, 3486, and 1975, respectively. The burden of HPV related cancer in men would be reduced by 66% (53% to 805) if vaccine uptake among girls increases to 90%. In that case, 1735 boys (1240 to 2900) would need to be vaccinated to prevent an additional case; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2593, 29107, and 6484, respectively.

Conclusions Men will benefit indirectly from vaccination of girls but remain at risk of cancers associated with HPV. The incremental benefit of vaccinating boys when vaccine uptake among girls is high is driven by the prevention of anal carcinomas, which underscores the relevance of HPV prevention efforts for men who have sex with men.

Footnotes

  • Contributors: JAB and JB conceived and designed the analysis. JAB performed the analysis and wrote the manuscript and supplementary annex. JB was closely involved in the writing process. JW, RHB, and CJLM contributed to interpretation of data and critical revision of the manuscript. JAB is guarantor.

  • Funding: This research was supported by the EU Seventh Framework Programme of DG Research through the PREHDICT and COHEAHR projects, which received co-funding by the Health Research and Development Council of the Netherlands Organization for Scientific Research (ZonMW 121030032). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: JB has received fees for participation in expert meetings organised by GSK and Merck, CM has received fees for participation in expert meetings organised by Merck, outside the submitted work. The other authors have no potential conflicts of interest.

  • Ethical approval: Not required.

  • Transparency: The lead author (the manuscript’s guarantor) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: Technical appendix, statistical code, and datasets are available from the corresponding author.

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