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Cost-effectiveness of extending the HPV vaccination to boys: a systematic review
  1. Renata Linertová1,2,
  2. Carmen Guirado-Fuentes1,2,
  3. Javier Mar Medina2,3,4,
  4. Iñaki Imaz-Iglesia2,5,
  5. Leticia Rodríguez-Rodríguez1,
  6. Montserrat Carmona-Rodríguez2,5
  1. 1 FIISC, Fundación Canaria de Investigación Sanitaria de Canarias, Santa Cruz de Tenerife, Spain
  2. 2 REDISSEC, Madrid, Spain
  3. 3 Kronikgune, Baracaldo, Spain
  4. 4 Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
  5. 5 Agencia de Evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Renata Linertová, FIISC, Fundación Canaria de Investigación Sanitaria, Las Palmas de Gran Canaria, Spain; renata.linertova{at}


Background Human papillomavirus (HPV) infection can have severe consequences both in women and men. Preadolescent girls are vaccinated against HPV worldwide but a gender-neutral vaccination is being adopted only little by little. This systematic review offers an overview of cost-effectiveness of the gender-neutral HPV vaccination.

Methods Economic evaluations of gender-neutral HPV vaccination with a two-dose schedule compared with girls-only strategy were systematically searched in Medline, Embase and WOS up to June 2020. Incremental cost-effectiveness ratios and key parameters were analysed.

Results Nine studies met the inclusion criteria. Four studies concluded in favour of the gender-neutral programme, another four found it cost-effective only in alternative scenarios. The most influential parameters are the discount rate of benefits (same as for costs vs reduced), vaccine price (listed vs publicly negotiated) and included health problems (inclusion of oropharyngeal and penile cancers). Sponsorship was not decisive for the final result, but there were differences between industry-funded and independent studies in some cost categories.

Conclusions The evidence of the cost-effectiveness of extending HPV vaccination to boys is scarce and ambiguous. Before the adoption of such a strategy, countries should carry out context-specific cost-effectiveness analyses, but the decision should also take into account other criteria, such as gender-related equality.

  • cost effective
  • systematic review
  • vaccination
  • prevention
  • sexually transmitted diseases

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  • Contributors The study was originally planned by RL and CGF. Search strategy was designed by LRR and RL, and executed by LRR. The systematic review was conducted by all authors. Quality of included studies was assessed by CGF, JMM and RL. Reporting was done by RL, CGF, JMM, III and MCR and the manuscript was reviewed and approved by all authors. RL is responsible for the overall content.

  • Funding This work was supported by the Ministry of Health of Spain.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.