Reply #38: What is irrational about waiting for all the data on a new vaccine with

[mhatrw]

no proven safety or efficacy track record and no proven clinical benefits against cervical cancer contraction rates that was only clinically tested on a couple hundred preteens -- its targeted population for three mandatory injections?

Both GARDASIL and annual HPV screenings are very expensive on a cost per year of life gained basis. However, there is a big difference between annual HPV screenings and GARDASIL and that is that annual HPV screenings have actually been DEMONSTRATED to reduce cervical cancer contraction and mortality rates. In contrast, medical cost vs. benefit models that consider GARDASIL plus biennial or triennial HPV screenings are based on a slew of currently unproven hopeful assumptions about GARDASIL.

So we are confronted with a dilemma:

1) If we cross our fingers about GARDASIL, rush to make GARDASIL vaccination mandatory and back off to biennial or triennial HPV screenings, we may be able to save a little on costs overall while reducing the already low US cervical cancer cancer contraction and death rates very slightly.

2) Alternatively, we can keep doing HPV screen tests annually for every US woman with a first class health plan and extend these tests to uninsured women as well, resulting in a definite further decrease in US cervical cancer rates. In this case, GARDASIL's cost per year of life gained (even with all assumptions tweaked to the best case for GARDASIL) becomes stratospherically high. Thus, we offer GARDASIL only to those who wish to pay for it then further study this population. When all the data are actually in on GARDASIL, we could then act appropriately in terms of backing off on HPV screenings among the population of women with proven cervical cancer protection from GARDASIL.

Now, which of these strategies would be most optimal in terms of Merck's projected profits? And which other strategy would be most circumspect in terms protecting US women's health?

The bottom line is that this vaccine is ridiculously overpriced unless it offers lifetime protection against HPV 16 and 18 (unproven), this actually translates to 70% protection against cervical cancer (unproven), it has no associated long term risks (unproven), and we back off to biennial or triennial HPV screening tests (proving we weren't actually serious about eliminating cervical cancer to begin with).