Journal of Infectious Diseases
Volume 204 Issue 3 August 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Philip E. Castle and Fang-Hui Zhao
Editor’s Choice: Population Effectiveness, Not Efficacy, Should Decide Who Gets Vaccinated Against Human Papillomavirus via Publicly Funded Programs
J Infect Dis. (2011) 204(3): 335-337 doi:10.1093/infdis/jir287

No abstract; Final paragraph
“…From a comparative and cost-effectiveness perspective, based on current information, it is probably a better health care investment of public or insurer dollars to maximize vaccination coverage in young women rather than widely targeting both men and women. As shown in Australia, men benefit soon after implementation of a high-coverage, female-only HPV vaccination program [16]. Because MSM may not benefit from the “herd immunity” of vaccinating women, targeted vaccination of MSM for the prevention of genital warts and anal cancer may be appropriate and desirable [17], as well as cost-effective, provided that enough men self-identify as MSM at an age when HPV vaccination will provide substantial benefit. Thus, for publicly financed programs or insurers, the most rational, cost-effective vaccination strategy is comprehensive coverage in HPV-naive girls (ages 11–12) and targeted vaccination in selected male subpopulations, rather than widespread vaccination of both sexes. Other potential recipients who are willing to pay out of pocket should make a decision informed by the potential benefits and costs. As more data become available to address the uncertainties regarding the benefits of HPV vaccination and/or costs decrease, the most cost-effective use of HPV vaccines may need to be revisited.