A New England Journal of Medicine study of data on cancer vaccines like Gardasil shows that what drugmaker Merck is advertising makes sense.
The study looked solely at the cost-effectiveness of the vaccine, and assumed it works as advertised. It used the Quality Adjusted Life Year (QALY) as its yardstick.
What's the value, per quality year of life gained, of the vaccine, when compared with the current practice of screening for the cancer?
- For 12-year old girls, it's dirt cheap, $43,600.
- For girls to 18, it's $97,300.
- For women to 21, $120,400.
- Extend the program to age 26 and it's $152,700.
There is an important qualification here. These figures assume the treatment gives lifelong protection. If it has to be repeated every 10 years, the cost of using it on today's 12-year olds goes to $140,00 and it's less cost-effective than screening for anyone else.
The vaccine tagets oncogenic human papillomavirus, seen as the cause of all cervical cancer, 90% of anal cancer cases, and 40% of vaginal cancer cases in the U.S.
QALY studies may be controversial, since they place an economic value on saving lives for policy purposes. But they are bound to become more common as health care costs run up against national budgets.
While there is no consensus on the QALY number that represents good value-for-resources, the authors estimated it at $50-100,000.
The study didn't ask vaccine recipients whether they had begun sexual activity, just assumed that those under 12 had not and the chances of it having started rose with age.
But it is a key question. People who are sexually active just don't get as much benefit, because it's likely they've already gotten the virus.
So while Gardasil will remain controversial, its value for girls and young women who are not yet sexually active seems established.