Tapsearch Com EditorOn mandatory HPV vaccinations
February 28th 2007 01:19
NOTE: Some of the links weren't working, so I removed them. The unlinked numbers are from the SEER registry.
This story has been stirring up a lot of debate. Some lawmakers are advocating a mandatory vaccine against HPV. (Oddly enough, Texas is the first state to consider it.)
The conservative response is varied -- some argue that vaccinating against an STD lowers the cost of otherwise risky sex, teaching kids it's OK, which it does to some degree. Others say parents should get to decide, which they should. An economist might point out that HPV risk varies with behavior, and it's rather dumb for someone to pay for an STD shot when they're abstinent. They're right.
But what I think the debate misses is a cost-benefit analysis. Every vaccination costs $360, plus doctor fees. For those who don't want to suffer through the painstaking math below, bottom line: For every $529,500 spent on Gardasil, the states will prevent three cancer cases. Two of these cancer cases would have been non-fatal. The dollar amount takes savings on medical bills into account.
The fact of the matter is that cervical cancer is a minimal though serious risk for American women. Some articles (including the one linked above) make a big deal about the global risk, but here (A) incidence is declining and (B) doctors often catch problems before they turn to cancer. About 8.8 in every 100,000 American women (.0088 percent) are diagnosed with cervical cancer each year.
As the San Francisco Chronicle observed:
"Cervical cancer is the second-most common cancer among women worldwide, and the third-most fatal, causing 290,000 deaths a year. It is rare in the United States, where regular screening for adult women catches most pre-cancerous cases, and about 3,700 women die of cervical cancer every year."
Browse through the government's "common cancer types," and you won't find it. In fact, of the 13 cancers that are listed, only non-melanoma skin cancer and thyroid cancer cause fewer than 7,000 deaths annually. Of all the things worth dedicating government resources to, cervical cancer should be low on the list. One wonders if the governments are more concerned about making sex risk-free than with saving lives -- but let's look strictly at the financial aspect.
One shot is only guaranteed to work for five years, but cervical cancer can take 20 years to develop (that's a high-end, see 7 to 12 for HPV 16 here), so lets say that no one vaccinated at 12 would end up with cervical cancer before 45 (20 years for incubation, 5 years of guaranteed immunity and we'll be generous and say 8 years of average extra immunity that's not guaranteed). And let's assume that Gardasil eliminates the 70 percent of cervical cancer thought caused by HPV. It is, after all, almost 100 percent effective.
A woman has a .233 percent chance of developing cervical cancer at any point between ages 0 and 45. That means .163 women in every 100 vaccinated will be saved from HPV-caused cervical cancer (.233 * .7). Divide the $36,000 spent vaccinating those 100 girls (we'll ignore doctor costs) by this and every cancer case avoided cost $220,859.
In spending this $221,000 (mind if I round?), insurance companies, patients and government programs will save $24,000 to $44,500 (2000 dollars converted to 2007 ones and rounded) in medical costs. Using the higher number (again, I'm a generous guy), the total cost of preventing the cancer was $176,500.
Also, in the end, about 33 percent of women who get cervical cancer die from it. (The lifetime risk of ever having cervical cancer is three times the risk of dying from it.) So as I summarized above, $529,500, three cases, one of them fatal, prevented.
Is that worth it? Of course we'd all agree a life -- plus two cancer ordeals, with the pain and lost work that implies -- is worth $529,000, but one important question to ask is whether state governments could have done more good by putting that money elsewhere. Even assuming the liberal model where encouraging protected-but-promiscuous sex is the best way to deal with the issue, $529,000 would buy a lot of condoms (which protect against HPV to some degree, and, of course, against pregnancy and most other STDs). That amount of money can put more cops on the street, keep dangerous criminals in jail longer, support medical research, improve dangerous roads, etc. It could buy a lot of cervical cancer screenings.
Even completely discounting the cultural effects of assuming kids will have sex, this measure is probably not the best way to save lives. Either the lawmakers haven't done their research, or they really do only care about mainstreaming sexuality.
This story has been stirring up a lot of debate. Some lawmakers are advocating a mandatory vaccine against HPV. (Oddly enough, Texas is the first state to consider it.)
The conservative response is varied -- some argue that vaccinating against an STD lowers the cost of otherwise risky sex, teaching kids it's OK, which it does to some degree. Others say parents should get to decide, which they should. An economist might point out that HPV risk varies with behavior, and it's rather dumb for someone to pay for an STD shot when they're abstinent. They're right.
But what I think the debate misses is a cost-benefit analysis. Every vaccination costs $360, plus doctor fees. For those who don't want to suffer through the painstaking math below, bottom line: For every $529,500 spent on Gardasil, the states will prevent three cancer cases. Two of these cancer cases would have been non-fatal. The dollar amount takes savings on medical bills into account.
The fact of the matter is that cervical cancer is a minimal though serious risk for American women. Some articles (including the one linked above) make a big deal about the global risk, but here (A) incidence is declining and (B) doctors often catch problems before they turn to cancer. About 8.8 in every 100,000 American women (.0088 percent) are diagnosed with cervical cancer each year.
As the San Francisco Chronicle observed:
"Cervical cancer is the second-most common cancer among women worldwide, and the third-most fatal, causing 290,000 deaths a year. It is rare in the United States, where regular screening for adult women catches most pre-cancerous cases, and about 3,700 women die of cervical cancer every year."
Browse through the government's "common cancer types," and you won't find it. In fact, of the 13 cancers that are listed, only non-melanoma skin cancer and thyroid cancer cause fewer than 7,000 deaths annually. Of all the things worth dedicating government resources to, cervical cancer should be low on the list. One wonders if the governments are more concerned about making sex risk-free than with saving lives -- but let's look strictly at the financial aspect.
One shot is only guaranteed to work for five years, but cervical cancer can take 20 years to develop (that's a high-end, see 7 to 12 for HPV 16 here), so lets say that no one vaccinated at 12 would end up with cervical cancer before 45 (20 years for incubation, 5 years of guaranteed immunity and we'll be generous and say 8 years of average extra immunity that's not guaranteed). And let's assume that Gardasil eliminates the 70 percent of cervical cancer thought caused by HPV. It is, after all, almost 100 percent effective.
A woman has a .233 percent chance of developing cervical cancer at any point between ages 0 and 45. That means .163 women in every 100 vaccinated will be saved from HPV-caused cervical cancer (.233 * .7). Divide the $36,000 spent vaccinating those 100 girls (we'll ignore doctor costs) by this and every cancer case avoided cost $220,859.
In spending this $221,000 (mind if I round?), insurance companies, patients and government programs will save $24,000 to $44,500 (2000 dollars converted to 2007 ones and rounded) in medical costs. Using the higher number (again, I'm a generous guy), the total cost of preventing the cancer was $176,500.
Also, in the end, about 33 percent of women who get cervical cancer die from it. (The lifetime risk of ever having cervical cancer is three times the risk of dying from it.) So as I summarized above, $529,500, three cases, one of them fatal, prevented.
Is that worth it? Of course we'd all agree a life -- plus two cancer ordeals, with the pain and lost work that implies -- is worth $529,000, but one important question to ask is whether state governments could have done more good by putting that money elsewhere. Even assuming the liberal model where encouraging protected-but-promiscuous sex is the best way to deal with the issue, $529,000 would buy a lot of condoms (which protect against HPV to some degree, and, of course, against pregnancy and most other STDs). That amount of money can put more cops on the street, keep dangerous criminals in jail longer, support medical research, improve dangerous roads, etc. It could buy a lot of cervical cancer screenings.
Even completely discounting the cultural effects of assuming kids will have sex, this measure is probably not the best way to save lives. Either the lawmakers haven't done their research, or they really do only care about mainstreaming sexuality.
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Comment by Damo
Prior to anti biotics treating some STD's required a little tool that some people nicknamed the Umbrella.
It is a no brainer.
The vacine for polio worked.
The vaccicne for chicken pox worked.
Comment by Robert V
So to answer your question, if the vaccine didn't involve condoning adolescent sexual behavior to some degree, no, it wouldn't be so controversial!
This post in particular, though, involves the cost. If we're talking about government intervention (and we are), you can do a lot more good than to spend money on preventing a rare cancer. So it's not a matter of whether vaccinating pre-teens is right or wrong; it's a question of whether it's efficient.
Comment by Anonymous