Giving Gardasil to Boys Not Worth the Cost

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Philip E. Castle, an investigator in the division of cancer epidemiology and genetics at the U.S. National Cancer Institute and co-author of an accompanying journal editorial, agreed it is more cost effective to vaccinate just girls, rather than girls and boys.

Scientific reasons do exist to vaccinate boys, Castle said. "And from a social standpoint, people want gender equality, and those are fine things, but it is not a great investment to do that."

Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, also agreed with the findings.

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"If we can vaccinate a high enough proportion of young girls, then vaccinating boys is not cost-effective," she said.

Other experts disagreed.

Anna R. Giuliano, chair of the department of cancer epidemiology and genetics at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., said more data is needed to decide the issue appropriately.

"Some of the assumptions in the study, such as low HPV attributable risk for male cancers, and the very optimistic scenario of 75 percent vaccine dissemination in both females and males in the U.S. may have led to the relatively unfavorable cost estimates provided for male vaccination in this publication," she said.

She said the study also failed to consider the reduction in the burden of male diseases if boys were vaccinated. "This is an important public health estimate, and one that is meaningful for making public policy and clinical recommendations," she said.

Dr. Erich M. Sturgis, an associate professor of head and neck surgery at the University of Texas M. D. Anderson Cancer Center in Houston, thinks Kim's group has underestimated the number of head and neck cancers attributable to HPV infection.

"We see these patients suffering every day with the treatment, and patients dying of this disease," Sturgis said. "I think the proportion of oropharyngeal cancers that are attributable to HPV is a clear underestimate in the study."

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