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The most recent, and, we believe, the most comprehensive model to be published is the one in which vaccination is also offered to females aged 12-13 (191). In that model, vaccination of girls aged 12-13 years had very favorable cost-effectiveness, with an ICER of $1,800 per DALY averted in comparison with no vaccination; vaccine had a 90% probability of being cost-effective at a vaccine price of $50 per dose (191). For reference, the Wold study (188) indicated that vaccination of girls aged 12-13 years would be cost-effective at a vaccine price of $80 per dose (188).
Whereas these models demonstrate that vaccination of girls aged 12-13 is cost-effective, we would caution against the implementation of catch-up vaccination of girls in this age group without more evidence. In our opinion, the evidence available at present suggests that the benefits of catch-up vaccination are somewhat limited. In the 2012 Supplemental Annex to the 2013 CRHC document Vaccination: Global Immunization Vision and Strategy 2013-2020 (33), we have presented a scenario in which females aged 13-14 are vaccinated in order to achieve herd immunity at the population level (33). In that scenario, the probability of the vaccine being cost-effective is reduced significantly (40% decrease in ICER) in comparison with the scenario in which vaccination is implemented through routine programs. We have also presented a scenario in which routine vaccination of females aged 12-14 years is implemented, with catch-up vaccination of females aged 13-14 years (34). In that scenario, vaccination of females aged 13-14 years is not cost-effective (166).
It is also uncertain whether men should be vaccinated. The published models suggest that the cost-effectiveness of male vaccination is dependent on the age at vaccination and whether only partial protection is provided. A detailed review of the evidence on the cost-effectiveness of male vaccination in Canada was recently published by Hansen et al. (CMAJ 2012;184(9):1073-82).
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