Media release from Otago University
The New Zealand Government's investment in HPV vaccination for
girls is a "good value-for-money" way to protect health, a
just-published study by the University of Otago Wellington (UOW)
Despite a modest 47% coverage rate (at the time of analysis) and
targeting young women only, there are health benefits to both men
and women from herd immunity, says Professor Tony Blakely from
UOW's Burden of Disease Epidemiology, Equity and Cost effectiveness
The vaccination programme was introduced in 2008 and has been
routinely offered through schools in year 8 or through primary care
(aged 12 to 20 years) since 2011. Since then, sentinel surveillance
clinics around the country (sexual health, family planning and
student and youth health clinics) have reported a declining number
of first presentations for genital warts, with the steepest
reductions occurring in young women aged 15-19.
Pharmaceutical data for genital warts treatment also indicates a
favourable downward trend.
Meanwhile, the BODE3 team has developed a model that shows the
vaccination programme has a cost-effectiveness of $18,800 per
quality-adjusted life-year (QALY) gained. The rule-of-thumb is that
gaining a QALY for less than a country's GDP per capita ($45,000
for New Zealand) is cost-effective, Professor Blakely says.
"Furthermore, the current vaccination programme generates more
QALYs per 12-year-old for Maori and people living in deprived
areas, so is helping to reduce health inequalities," he says.
The researchers also modelled the cost-effectiveness of moving
from the status quo to a more intensive school-based only programme
of vaccinating girls - at 73% coverage as it is in Australia. This
shift in coverage achieved more health gain and was also still
cost-effective at $34,700 per QALY.
Coverage in New Zealand is currently nudging up to about 56%
(higher for Māori and pacific), but there is scope for New Zealand
to further increase its coverage to the higher rates seen in
Australia and in the UK where coverage is 73% and 84%,
respectively, Professor Blakely says.
Part of the problem keeping rates lower in New Zealand might be
that parents are given too many options for getting free HPV
vaccination, he says.
"Having the option to either have the vaccination at school or to
delay a few years and get it from a GP is likely causing a lot of
parents to delay. One possible way to achieve higher coverage might
therefore be to have only a free school-based programme, as in
Australia, with the requirement to pay the full market price in
An additional approach is to enrich the information to school
girls and parents about the vaccination.
"Our view is that greater emphasis could be given to explain
that it will protect against multiple other cancers that affect
both men and women, and that it is best given well before the
typical age of sexual debut to maximise its benefit."
Options could also be explored for boosting the cost-effectiveness
of the vaccination even further, for example through delivery to
girls at the same time that the current
diphtheria/tetanus/pertussis boost is given to 11-year-olds at
school, Professor Blakely says.