Wednesday, October 21, 2009

Gardasil Optional, Not Recommended, for Boys--Will You Pay for It?

It’s up to you now. The Advisory Committee on Immunization Practices voted almost unanimously to tell doctors that they’re free to give boys the Gardasil vaccine as a way of avoiding future bouts with genital warts—which affect about one percent of the population—but they’re not going to recommend it as a routine vaccination.

Nor do they plan to recommend it as an “anti-cancer” vaccine, which is the way it’s been sold to many millions of girls. Although the HPV virus can cause esophageal, anal, testicular, penile and perineal cancer in boys, such cancers are very rare, and even then a large percentage aren’t associated with the human papillomavirus. The only real advantage would be to protect future partners.

Merck, with billions on the line, had determined that the vaccine would be very cost-effective for boys by assuming that the vaccine would be 100 percent effective in preventing cancer and that the vaccine would cost $400 per child—at $360 for the cost of the shots alone, that doesn’t leave much to pay the cost of three visits to the doctor.

A Harvard study, however, went on the assumption that the vaccine would be 75 percent effective and cost $500 per child, and found that the cost of vaccinating boys would be spectacularly cost-ineffective.

The Advisory Committee apparently agreed with Harvard.
There is certainly no reason to assume that Gardasil will be 100 percent effective. Merck’s own study of more than 4,000 boys didn’t even find that, and Gardasil trials have shown the HPV vaccine to be just 17-45 percent effective in preventing cervical abnormalities in girls thus far. Gardasil has also been associated anecdotally with a number of rare, but serious, side effects, including autoimmune diseases and a form of ALS.

Meanwhile, it’s doubtful that many insurance companies will now pay for Gardasil for boys, although government programs may do so for those on Medicaid. Parents might prefer to be sure that their children understand the importance of getting annual exams as adults and of eating fruits and vegetables, avoiding smoking, being circumcised, getting sufficient sleep, and limiting the number of sexual partners—all factors that are known to substantially cut the risk of getting a persistent HPV infection.

So are you willing to fork over the cash yourself? Do you think Gardasil’s worth it?


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Kristin Johns said...

Note: the removed comments were actually spam ads, not genuine comments whether for or agin'.

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