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Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3884 (Published 08 October 2009) Cite this as: BMJ 2009;339:b3884

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HPV vaccination for girls only does not consider male specific HPV related diseases

We have read with much interest the article by Kim and Goldie1 and
the associated Editorial comment by Castle and Scarinci2 on the cost
effectiveness analysis of including preadolescent boys in a routine human
papillomavirus (HPV) vaccination programme, concluding that the best
investment is to vaccinate only females. These conclusions were made in
the context of cervical cancer, but the cost per quality adjusted life
year did fall below the threshold below which an intervention is
considered a good economic investment ($ 100 000) under the most favorable
assumptions and considering all HPV related diseases or under scenario of
lower efficacy with lower coverage or lower vaccine costs.
Considering these endpoints we agree with the conclusions of this study.

However, the Authors did not actually take into account some important
aspects:

1. By vaccination girls only it is obvious that the males remain carriers
of the virus, and therefore can transmit the virus to non vaccinated women
and men.

2. In some groups of males the percentage of HPV related diseases is very
high, and higher than in females, such as for oropharyngeal cancer,
conjunctival squamous cancer, genital warts, anal and penile cancers in
homosexual, bisexual and HIV positive subjects.

3. The presence of HPV in the male reproductive tract is well demonstrated
and we recently documented also the presence of the virus in ejaculated
sperm and its association with reduced sperm motility and therefore with
male infertility.3 Such cases of reduced sperm motility
(asthenozoospermia) are nowadays considered as idiopathic and are often
treated with assisted reproduction techniques. These procedures are very
expensive and have important psychological effects especially because they
have often to be repeated several times due to the low success rate.

4. We have a long experience in sperm cryopreservation. Recently, we have
examined for the presence of HPV 100 semen samples cryopreserved from
subjects with testicular cancer or infertility and found that HPV was
present in 6% of them. Obviously, such cryopreserved sperm are used for
assisted reproduction techniques.

For these reasons, we suggest considering these male specific HPV related
diseases in future studies regarding the cost effectiveness analysis of
HPV vaccination.

References

1. Kim JJ, Goldie SJ. Cost effectiveness analysis of including boys in a
human papillomavirus vaccination programme in the United States. BMJ. 2009
Oct 8;339:b3884.

2. Castle PE, Scarinci I. Should HPV vaccine be given to men? BMJ. 2009
Oct 8;339:b4127.

3. Foresta C, Garolla A, Zuccarello D, Pizzol D, Moretti A, Barzon L, Palù
G. Human papillomavirus found in sperm head of young adult males affects
the progressive motility. Fertil Steril. 2008 Dec 17. [Epub ahead of
print]

Carlo Foresta, MD

Alberto Ferlin, MD

Andrea Garolla, MD

University of Padova, Department of Histology, Microbiology and
Medical Biotechnologies, Section of Clinical Pathology & Centre for
Male Gamete Cryopreservation, Padova, Italy

Correspondence: Prof. Carlo Foresta, University of Padova, Department
of Histology, Microbiology and Medical Biotechnologies, Section of
Clinical Pathology & Centre for Male Gamete Cryopreservation, Via
Gabelli 63, 35121 Padova, Italy.
carlo.foresta@unipd.it

Competing interests:
None declared

Competing interests: No competing interests

15 October 2009
Carlo Foresta
Professor
Alberto Ferlin, Andrea Garolla
University of Padova, 35121 Padova, Italy