A study has claimed that including preadolescent boys in routine vaccination programmes against human papillomavirus does not seem to be cost-effective, at a time when Merck & Co’s Gardasil is under review for boys.

The analysis, carried out by researchers at the Harvard School of Public Health and published in the British Medical Journal, said that routine HPV vaccination of 12 year-old girls was consistently less than $50,000 per quality adjusted life year (QALY) gained, compared with screening alone. However, including preadolescent boys into the programme resulted in higher costs and benefits “and generally had cost-effectiveness ratios that exceeded $100,000 per QALY across a range of HPV related outcomes”.

However lead researcher Jane Kim notes that the analysis assumes 75% vaccination coverage for girls “and complete, lifelong vaccine efficacy”, so if less girls are vaccinated, the financial rationale for vaccinating boys becomes much more attractive.

The study concludes that “given currently available information”, including boys in an HPV vaccination programme “generally exceeds conventional thresholds of good value for money, even under favourable conditions of vaccine protection and health benefits”. However it acknowledges that “uncertainty still exists in many areas that can either strengthen or attenuate our findings”.

The US Food and Drug Administration is reviewing Gardasil for use in boys and men aged nine to 26 to protect them from genital warts and prevent them from spreading the virus to sexual partners.