Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
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Bloomberg News (10.21.09) - Thursday, October 22, 2009
Tom Randall; Shannon Pettypiece
On Oct. 16, Gardasil won regulatory approval for use in males ages 9-26 to prevent genital warts. While the vaccine only received ACIP's vote for "permissive use," Gardasil will be covered under a federal program for children who are uninsured or on Medicaid. "Nobody knows what the private insurance plans will do," Harrell Chesson, a CDC economist, told the panel. "They may not distinguish between boys and girls, but we just don't know."
The federal government usually adopts ACIP's decisions.
A cost analysis by Harvard University School of Public Health researchers found it would take more than $290,000 to vaccinate enough boys and girls to save one year of life, compared to $40,000 for each year saved by focusing solely on girls. Merck put the figure at about $50,000 for both boys and girls.
A cost of less than $100,000 per quality-adjusted life year would be "a good deal," said William Schaffner, chair of preventive medicine at Vanderbilt University. Both the Merck and Harvard studies support Gardasil's use in preventing targeted HPV strains that cause cervical cancer, and CDC recommends it as a routine shot for girls ages 11-12.
The Merck and Harvard studies' widely diverging cost-benefit estimates for including boys are due to different assumptions regarding vaccine cost and age groups targeted. Merck's study assumed the Gardasil series costing $400 per person, targeting ages 9-26 with 100 percent efficacy; Harvard assumed a $500 cost, targeting 12-year-olds, and 75 percent efficacy.
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