two-dose boys = $256 million over 70 years of vaccination in a population of 10 million, results not shown). Compared to no vaccination, all two- and three-dose girls-only and girls & boys HPV vaccination strategies investigated produce cost-effectiveness ratios below the $40,000/QALY-gained cost-effectiveness threshold ( Fig. 2, and see Supplementary Table 3 for detailed results). In the base-case, two-dose girls-only vaccination (vs. no vaccination) consistently produces the lowest incremental cost-effectiveness ratio with cost/QALY-gained varying between $7900 [IQR: 7000;9700] and $10,400 [IQR: 8800;13,400] ( Fig. 2b–f). The only

exception is when two-dose duration of protection is assumed to be 10 years ( Fig. 2a). In the sensitivity analysis, two-dose girls-only vaccination Selleck Autophagy Compound Library cost-effectiveness ratios remained below $40,000/QALY-gained ( Fig. 3a). The maximum cost per dose for two-dose girls-only vaccination to remain cost-effective (vs. no vaccination) is predicted to be $128, $218 and $252 assuming two-dose vaccine protection lasts 10, 20 and 30 years, PD0332991 nmr respectively (see Supplementary Fig. 4 and Table 4). The incremental cost-effectiveness ratio of

giving the third dose of vaccine to girls (i.e., of three-dose girls-only vs. two-dose girls-only) is estimated to be below $40,000/QALY-gained if: (i) three doses provide longer protection than two doses (i.e., more than 5 years), and ii) two-dose protection is less than 30 years ( Fig. 2 and Fig. 3). Under most scenarios, two-dose girls & boys vaccination (vs. two-dose girls-only) provides fewer or similar QALYs-gained and is more expensive than three-dose girls-only vaccination (i.e., is dominated; Fig. 2 and Fig. 3). The mafosfamide only exceptions are: (i) if the third dose provides little or no additional protection to two doses, (ii) when extreme scenarios for burden of HPV-disease among MSM are assumed (e.g., 7% males are MSM, the relative risk of disease among

MSM vs. male heterosexuals is 17, and girls-only vaccination is assumed to have no effect on HPV-related disease incidence in MSM) or (iii) when vaccine cost for boys is 10–40% of the cost for girls ( Fig. 3b, Supplementary Fig. 3). Finally, the incremental cost-effectiveness ratio of three-dose girls & boys vaccination (vs. three-dose girls-only) is greater than $100,000/QALY-gained under all base-case scenarios and most scenarios investigated in sensitivity analysis ( Fig. 2 and Fig. 3). In the sensitivity analysis, three-dose girls & boys vaccination is estimated to be less than $40,000/QALY-gained if the cost per dose for girls and boys is substantially reduced (Supplementary Fig. 4c).