GARDASIL Vaccine Breaking Budgets

June 6, 2007

Merck is making a lot of $$$$$ at the risk of a young girl's life

Health Experts Ask Whether Tax Dollars Spent Too Quickly on HPV Vaccine

New Hampshire Public Radio June 4, 2007 by Diane FinchClick here for the URL:

Like many states, New Hampshire jumped quickly to offer the HPV vaccine to girls as young as 11 years old.The vaccine fights off four strains of the humanpapiloma virus - including two strains that cause 70% of cervical cancers.But it's priced higher than any vaccine to date - and already accounts for nearly 30% of the state's universal vaccine budget - just to cover the first round of inoculations.So some health experts wonder if offering the vaccine is the best way to spend limited tax dollars.NHPR's Dianne Finch reports.

New Hampshire was one of the first states to add the humanpapiloma virus vaccine to its universal immunization program.The state offers the HPV shots free to children who don't have insurance that covers it.It's on the list with polio, measles, mumps, and rubella shots.The Centers for Disease Control advises the shots for girls starting at age 9 and women up to age 26.New Hampton's Representative Fran Wendelboe was part of a task force established to evaluate the vaccine before it was approved by the FDA.That group, which included state health officials and representatives from HPV vaccine makers, recommended it. And Wendelboe applauds their decision. "I think its exciting it's a ray of hope for people who do have cancers that we've been able to look at this one and come up with what looks like a real end to the great majority of cervical cancers. And it was a real education to women to find out that practically all women have this HPV." Healthcare experts agree with Wendelboe that the vaccine is a remarkable breakthrough.But it tops the vaccine price list. Merck & Co.'s vaccine retails at about $360 for the 3-shot series. To put that in perspective, vaccinations for pneumonia cost $73 dollars. Polio runs at about $22. And to immunize children against three diseases - measles, mumps and rubella - the price is $124 dollars.And as for prevalence - most women may get HPV in their lifetime, as Wendelboe said.But a CDC study shows the cancer-causing strains that the vaccine protects against occur in less than 3% of women - far from the majority. And most strains go away on their own.Harold DeMonaco directs Massachusetts General Hospital's drug evaluation division.He analyzes costs and benefits of new drugs and vaccines for the hospital.Like most health experts, he believes the vaccine is effective in preventing some cervical cancers.But when tax dollars are limited, he says, policymakers should spend more time comparing the drug's benefits to other under-funded cancer programs.As an example, he says that if Massachusetts inoculates only its 42,000 12-year-olds against HPV, it would cost about $15 million dollars."That represents almost half of the total budget for universal immunizations in Massachusetts. Importantly, if you look at the net result of that $15 million expenditure in about 30 years you would presumably prevent about 70 cases in the 42,000 12- yr-olds and somewhere around 28 deaths from cervical cancer. That's a great deal of money for a relatively small return that could in fact be used in other scenarios."A spokesman for Merck, the company that makes the vaccine, says the company believes more than 70 cervical cancer cases would be prevented by inoculating those 42,000 girls.But he didn't provide any data to back that up.CDC studies show that direct medical costs to treat those presumed 70 cancer cases could cost as much as $2.7 million.And of course, no one wants to put a price on the 28 lives that could be saved.In comparison, mammograms, despite false readings, catch 80% of breast cancers in women without symptoms. That's according to the American Cancer Society.The ACS also reports that 9 out of 10 women survive at least five years when tumors are found in those early stages.A UNH survey says that one third of women over 40 don't get mammograms because many can't afford them.That $15 million used in the Massachusetts example could pay for at least 100,000 mammograms.And most CERVICAL cancers occur among women who don't get annual pap tests.That same $15 million could pay for at least 150,000 pap smears.But Merck spokesman Richard Haupte points out that cancer prevention isn't the only benefit."So although cancer is the worst outcome and a significant endpoint to prevent there is enormous morbidity and cost associated with the other HPV diseases as well."Diane Harper, a physician at Dartmouth Medical School, worked on Merck's clinical trials for the vaccine.And she authored the results.She speaks publicly in favor of the vaccine - and is paid by Merck to do so.But she warns that lawmakers and parents don't understand the limits of the vaccine."There has been so much information given to state legisltors because Merck has the ability to do that and with that comes some responsibility for us to understand what both the benefits of the vaccine as well as limits so that we can make educated decisions on how to spend limited resources we have on healthcare."Currently, New Hampshire's budget for all childhood immunizations is $17.5 million. Most of that money comes from insurance companies and the Medicaid program.The HPV vaccine -so far- takes up almost $5 million, or 28% of that pie. And that $5 million will inoculate only 25% of all eligible girls.For NHPR News, I'm Dianne Finch.

See what's free at AOL.com.