Cost-effectiveness of a gender-neutral vaccination against Human Papilloma Virus (HPV)

Impact Area: Pharmaceutical Industry and Health Sector

Institution: Kingston University Business School

Leading Academic: Professor Giampiero Favato



Research by Kingston University established that it is cost-effective to vaccinate males against the Human Papilloma Virus (HPV virus), overturning the outcome of previous studies and policies. HPV is the name for a group of viruses that commonly affect the moist membranes of the body. High-risk strains of HPV can cause cervical cancer. Around 3,000 new cases are diagnosed each year in the UK, which is equal to more than 8 women every day, of which 2 will eventually die. High-risk HPV infection can also lead to cancer of the anus (1,100 new cases per year) or penis (500 new cases) in men.

Since 2008, the NHS has been focusing on a single group of individuals (a cohort) to prevent HPV-induced malignancies, by offering free vaccination to all girls aged 12-13.

In 2010, Professor Giampiero Favato joined a multidisciplinary research programme (BEST), aimed to demonstrate the cost-effectiveness of a gender-neutral HPV vaccination programme including more than a single group of individuals, defined as multiple-cohort strategy. Favato’s contribution was to develop his earlier Markov simulation research into a more sophisticated Bayesian model, which then formed the core economic modelling of the cost-benefit of the HPV research programme. A secondary objective of the research was to measure the Economic Value of Information (EVI), a parameter in decision analysis which tests the robustness of results by taking into account several dimensions of uncertainty. Inputs to the model were related to Italian clinical and cost data.


The BEST study concluded that a gender neutral vaccination that includes both girls and boys aged 12 years is cost-effective, as a result of the increased clinical benefits from herd immunity. Herd immunity occurs when a critical portion of a community is immunised against a contagious disease and the spread of the disease is contained. When the combined clinical benefits for both sexes were considered, the costs per QALY (Quality Adjusted Life Years) gained were below the established cost thresholds.

Benefits and impact

Instrumental impact

In particular, the research showed the following benefits of gender-neutral vaccination:

  • Health benefits of vaccination occur faster. The clinical benefits of vaccination are expected to occur 3.8 years earlier with gender-neutral vaccination.
  • Reduced health care costs. The two-cohort strategy results in a mean net reduction in cost of €80 million to the Italian government (95% CI, h40.1–h144.7 million) as a result of the prevention of HPV-related diseases.
  • Reduced uncertainty. The EVI presented in the research (The EVI presented in the research (<€13 per patient) implies that the uncertainty that is currently present in the model parameters has a very limited impact and is more robust than previous models. This research was presented to the Italian Agency for Drug Approval (AIFA). As a result, AIFA lifted its previous restriction of vaccination to females only and approved vaccination for males.

In November 2012, Emilia-Romagna and Sicily regions introduced voluntary vaccination programmes for males under 26, with economic benefits amounting to €98.9 million. In addition, Emilia-Romagna undertook the immunisation of HIV-infected males aged up to 26 years old living in the region. This programme provides immunisation benefits to a high-risk sub-population at a relatively modest incremental total cost of €40,273 per year. The economic benefits of this policy change were estimated in collaboration with AIFA.

Based on similar health-economic evidences, gender-neutral vaccination has been recommended also in the USA, Canada, Austria, and Australia. This policy change is contributing to pressure on the NHS to extend vaccination to all adolescent boys in the UK. Aligned to the findings of the BEST study, the Royal Society for Public Health is calling for all boys aged 12 to 13 to be offered the vaccine, in order to accelerate the protective effect of herd immunity. The Joint Committee on Vaccination and Immunisation, which advises the British Government on national immunisation strategies, noted that “alternative prevention strategies such as universal male vaccination should be evaluated”.