HIQA advises changing to a more effective HPV vaccine and extending the vaccine to boys

Date of publication:

The Health Information and Quality Authority (HIQA) has today published recommendations from its health technology assessment (HTA) on the clinical and cost-effectiveness of extending the HPV vaccine to boys.

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive, Dr Máirín Ryan, said: “The burden of HPV-related disease is substantial, with HPV responsible for approximately 1 in every 20 cases of cancer across the world. This assessment demonstrates that the HPV vaccine provides effective primary prevention against HPV infection and HPV-related disease, and that the vaccine is safe.”

Girls in their first year of secondary school are currently offered the 4-valent vaccine, which protects against four types of HPV. HIQA has advised that the National Immunisation Schedule switches from the 4-valent vaccine to the 9-valent vaccine, which protects against an additional five types of HPV, and that the vaccine is extended to boys of the same age.  

Dr Máirín Ryan continued: “Vaccinating girls with the 9-valent vaccine is estimated to be cost saving and more effective than the existing girls-only 4-valent programme. A gender-neutral 9-valent vaccination programme, where both boys and girls are vaccinated, is estimated to be more effective than the girls-only alternative. It is likely that gender neutral 9-valent vaccination would also be cost-effective in light of the conservative assumptions used with regard to final cost, uptake rate and protection provided against all types of cancers.”

HIQA’s HTA also considered the ethical and organisational issues for giving the vaccine to boys.

Dr Máirín Ryan continued: “Extending the HPV vaccine to boys provides direct protection against HPV-related disease to boys, indirect protection to girls who have not been vaccinated and would reduce HPV-related disease and mortality in Ireland. Over 20 years, a gender-neutral 9-valent programme will prevent an estimated 101 additional cases of cervical cancer compared with the current girls-only 4-valent programme.”

The final report and recommendations have been informed by four systematic reviews, an economic evaluation, an ethical and organisational analysis, intensive engagement with an expert advisory group and a six-week public consultation which received 242 submissions.

The HTA was approved by the Board of HIQA on 4 December 2018 and has been submitted as advice to the Minister for Health, the National Immunisation Office, the National Immunisation Advisory Committee and the Health Service Executive (HSE) to inform decision-making about the vaccination programme.

The Health technology assessment (HTA) of extending the national immunisation schedule to include HPV vaccination of boys is available from the link below, and includes an executive summary and a plain English summary. An infographic is also available.

For further information please contact: Marty Whelan, Head of Communications and Stakeholder Engagement 01 8147480 / 086 2447623 mwhelan@hiqa.ie

Notes to the Editor:

  • Human papillomavirus (HPV) is the most common viral infection of the reproductive tract causing a number of conditions in both men and women, including a range of cancers, lesions and genital warts. Around 90% of people will be infected with HPV at some point in their lives.
  • Every year, 538 cancers associated with HPV are diagnosed in Ireland, including in the cervix, anus, penis, neck and throat. HPV infection is also responsible for genital warts, with 90% of these caused by the types of HPV the vaccine protects against.
  • HPV vaccination is a form of primary prevention to reduce HPV-related disease, including cervical cancer. Cervical screening is a form of secondary prevention. The current schools-based HPV immunisation programme established in 2010 is offered to all girls in first year of secondary school. The current programme is based on the 4-valent vaccine which offers protection against four strains of HPV.
  • The HTA found that the budget impact of switching to the 9-valent vaccine for girls will be an additional €870,000 over five years. It also found that the budget impact of providing the 9-valent vaccine to boys and girls will be an additional €11.7 million over five years.
  • HIQA’s assessment also found that the HPV vaccine was safe, with data from over 70,000 trial participants and over 20 million individuals in observational studies finding no increased rate of serious adverse events in people who received the HPV vaccines compared with placebo.
  • Following a request by the Department of Health, HIQA agreed to undertake a HTA to establish the clinical and cost-effectiveness of extending the current immunisation programme which offers HPV vaccination to all girls in their first year of second-level education (12 to 13 year olds) to a programme that also offers vaccination to boys.
  • The HPV vaccine is offered to boys and girls in a number of countries, including Austria, Australia, Canada, New Zealand and the US.