I am writing in response to the article entitled “Ignore advertising hypes” by Catie Pike Aug. 25, 2008. I’d like to take this opportunity to examine the study that questioned the cost effectiveness of Gardasil and give some facts on the safely of the vaccine.
USA Today (8/21 Szabo) quoted a study by Kim et al. of the Harvard School of Public Health that “measured the Gardasil vaccine’s value by calculating the cost of giving one person an extra healthy year of life, and balancing the expenses of vaccinations with the benefits of avoiding cancer death and related expenses.” In short, if you vaccinate a girl at age 12 the cost of extending life expectancy one year was $43,600. If you included women vaccinated as late as age 26 that figure rose to $153,000. In my view, this type of analysis is extremely limited and fails to acknowledge quality of life.
To clarify insurance coverage, the campus-sponsored Hill Chesson insurance now covers Gardasil, as do most major insurance carriers. If your insurance does not cover the vaccine at the Student Health Services they may cover it at a preferred provider location. The vaccine costs $486 at Student Health for the three required injections. Cancer aside, Gardasil prevents infection of 90 percent of the human papilloma virus types that cause external genital warts. We treat many patients with genital warts in the health center and I see first hand how difficult this diagnosis is for patients and the anxiety and distress that it causes. I don’t know how to put a dollar value on the effect of external genital warts on a person or their relationships, but I know how much treatment costs. Coming to the health center to get genital warts treated with medication applied by a health care provider costs $37 to $60 a visit. Typically, patients need to be treated for several weeks before resolution of symptoms.
Ms. Pike is correct in asserting that Gardasil doesn’t treat cervical cancer. Just like the flu vaccine is designed to prevent flu and not treat it, Gardasil is designed to prevent infection of two types of HPV that have been linked to 70 percent of cervical cancer. If patients got regular Pap smears, would precancerous cervical abnormalities be detected and treated? Hopefully, yes. But let’s look closer at what is involved and how much that costs. When a Pap comes back abnormal in someone 21 or older, the standard of care it to do a colposcopy. This procedure involves examining the cervix with a microscope-like device and taking biopsies of the cervix. At Student Health’s Women’s Health department, this costs about $317. Abnormal Paps then need to be followed up every 6 months until 2 are consecutively normal. A Pap smear only is $38 and the cost of annual exam and Pap smear is $73. Assuming that the first two follow-up Paps were both normal, the whole thing has cost $510, not to mention the cost of time out of class and work for these visits and the emotional strain of precancerous lab findings. Gardasil may not prevent all abnormal Pap work ups, but it will surely prevent some.
There have been concerns in the media recently regarding the safety of Gardasil. Like any vaccine, there are risks and benefits. Ms. Pike is correct in reporting that as of June 30, 2008 there have been 9,749 reported adverse events from Gardasil. She didn’t mention that 94 percent were non-serious and only six percent were classified as serious. Eight million females in the US have received the Gardasil vaccine. How does Gardasil compare to other vaccines? When all vaccines are considered, there is a 10 to 15 percent incidence of serious adverse events contrasted to a six percent incidence of serious adverse events with Gardasil. On July 22, 2008 the Food and Drug Administration and the Centers for Disease Control and Prevention made the following statement: “Based on ongoing assessments of vaccine safety information, the FDA and the CDC continue to find that Gardasil is a safe and effective vaccine.”
Like Ms. Pike, I too find direct-to-patient advertising frustrating. However, I encourage students to get their health care advice from health care providers and not student editorials. Like any vaccination, there are risks and benefits to Gardasil.
The vaccine isn’t perfect, but it’s the best we have at this time. We will continue to answer any questions that you may have about the vaccination. If you chose not to get the vaccination, that’s fine. In my mind, the cost effectiveness analysis of Gardasil is too narrowly focused. It ignores the emotional cost of managing a diagnosis of genital warts or a precancerous lesion of the cervix.
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