, Volume 36, Issue 8, pp 929–939 | Cite as

Cost Effectiveness of Human Papillomavirus Vaccination for Men Who have Sex with Men; Reviewing the Available Evidence

  • Didik Setiawan
  • Abrham WondimuEmail author
  • KohJun Ong
  • Albert Jan van Hoek
  • Maarten J. Postma
Systematic Review



Men who have sex with men require special attention for human papillomavirus vaccination given elevated infection risks and the development of, in particular, anal cancer.


Our purpose was to review the cost effectiveness of human papillomavirus vaccination for both currently vaccine-eligible and non-eligible individuals, particularly the men-who-have-sex-with-men population, and synthesize the available evidence.


We systematically searched for published articles in two main databases (PubMed and EMBASE). Screening and data extraction were performed by two independent reviewers. The risk of bias was assessed using a validated instrument (Bias in Economic Evaluation, ECOBIAS). Methodological aspects, study results, and sensitivity analyses were extracted and synthesized to generate a consistent overview of the cost effectiveness of human papillomavirus vaccination in the men-who-have-sex-with-men population.


From 770 identified articles, four met the inclusion criteria. Across the studies, human papillomavirus vaccination showed incremental cost-effectiveness ratios ranging from dominant to US$96,146 and US$14,000 to US$18,200 for tertiary prevention and primary prevention, respectively. The incremental cost-effectiveness ratio seemed most sensitive to vaccine efficacy, vaccine costs, and the incidence of anal cancer in the selected target populations.


This review presents the human papillomavirus vaccine, both as a primary and adjuvant (tertiary) vaccination, as a potentially cost-effective strategy for preventing mainly—but not limited to only—anal cancer in men-who-have-sex-with-men populations.


Author contributions

DS, AW, and MJP developed the research question and methodology, DS and AW performed the search term development, screening, and data extraction, and conducted the analysis. All authors contributed to the manuscript.

Compliance with Ethical Standards


These findings are the result of work supported by the University of Groningen and Directorate General of Higher Education (DIKTI) Scholarship, Ministry of National Education, Indonesia. The views expressed in this study are solely those of the authors and no official endorsement by both institutions is intended or inferred.

Conflict of interest

Didik Setiawan, Abrham Wondimu, KohJun Ong, Albert Jan van Hoek, and Maarten J. Postma received no financial compensation for their contributions to this work; however, Maarten J. Postma received grants and honoraria from various pharmaceutical companies, including those developing, producing, and marketing human papillomavirus vaccines.

Data availability statement

The data, particularly the included articles, that mainly support the findings of this review are publicly available.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of PharmacyUniversity of GroningenGroningenThe Netherlands
  2. 2.Faculty of PharmacyUniversity of Muhammadiyah PurwokertoPurwokertoIndonesia
  3. 3.Department of Health SciencesUniversity of Groningen, University Medical Center Groningen (UMCG)GroningenThe Netherlands
  4. 4.Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health EnglandLondonUK
  5. 5.Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
  6. 6.Department of Economics, Econometrics & Finance; Faculty of Economics & BusinessUniversity of GroningenGroningenThe Netherlands

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