In the United States, the vaccine against human papillomavirus is usually administered to girls and boys beginning just before the start of adolescence. Studies have shown that the vaccine prevents cancer and saves money when it is given this way. The U.S. Food and Drug Administration recently approved the vaccine for use in women and men up to age 45, and this article estimates the cost-effectiveness of the vaccine in these adults.
Abstract
Background:
In the United States, the routine age for human papillomavirus (HPV) vaccination is 11 to 12 years, with catch-up vaccination through age 26 years for women and 21 years for men. U.S. vaccination policy on use of the 9-valent HPV vaccine in adult women and men is being reviewed.
Objective:
To evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women aged 27 to 45 years and men aged 22 to 45 years.
Design:
The analysis used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data.
Data Sources:
Published data.
Target Population:
Women aged 27 to 45 years and men aged 22 to 45 years in the United States.
Time Horizon:
100 years.
Perspective:
Health care sector.
Intervention:
9-valent HPV vaccination.
Outcome Measures:
HPV-associated outcomes prevented and cost-effectiveness ratios.
Results of Base-Case Analysis:
The model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years and is cost saving (vs. no vaccination). In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830 000, $1 843 000, and $1 471 000, respectively, per quality-adjusted life-year gained (vs. current vaccination).
Results of Sensitivity Analysis:
Results were most sensitive to assumptions about natural immunity and progression rates after infection, historical vaccination coverage, and vaccine efficacy.
Limitation:
Uncertainty about the proportion of HPV-associated disease due to infections after age 26 years and about the level of herd effects from the current HPV vaccination program.
Conclusion:
The current HPV vaccination program is predicted to be cost saving. Extending vaccination to older ages is predicted to produce small additional health benefits and result in substantially higher incremental cost-effectiveness ratios than the current recommendation.
Primary Funding Source:
Centers for Disease Control and Prevention.
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Author, Article, and Disclosure Information
Jean-François Laprise,
Centre de recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada (J.L., M.D., D.M., É.B.)
Centers for Disease Control and Prevention, Atlanta, Georgia (H.W.C., L.E.M.)
Centre de recherche du CHU de Québec–Université Laval and Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada and Imperial College, London, United Kingdom (M.B.)
Note: The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Financial Support: By a contract from the CDC (00HCVGEB-2018-25176), a Fonds de recherche du Québec–Santé (FRQS) Research Scholars award (to M. Brisson), and a foundation scheme grant from the Canadian Institutes of Health Research (FDN-143283). This research was enabled in part by support provided by WestGrid (www.westgrid.ca), Compute Ontario (www.computeontario.ca), and Compute Canada (www.computecanada.ca).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1182.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: A protocol was not published before initiation of the study. The article, Supplement, and technical appendix publicly available on Dr. Brisson's Web site (www.marc-brisson.net/HPVadvise-US.pdf) are designed to provide sufficient information for an interested reader to replicate the analysis. Statistical code: Not applicable. Data set: Not applicable; this study did not use an analytic data set but used simulated data generated via our model, HPV-ADVISE.
Corresponding Author: Marc Brisson, PhD, Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec G1S 4L8, Canada; e-mail, marc.
Current Author Addresses: Drs. Laprise, Drolet, Martin, and Brisson, and Ms. Bénard: Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec G1S 4L8, Canada.
Dr. Chesson: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop US12-3, 1600 Clifton Road, Atlanta, GA 30329.
Dr. Markowitz: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-5, 1600 Clifton Road, Atlanta, GA 30329.
Author Contributions: Conception and design: M. Brisson, H.W. Chesson, L.E. Markowitz.
Analysis and interpretation of the data: J.F. Laprise, H.W. Chesson, L.E. Markowitz, M. Drolet, D. Martin, É. Bénard, M. Brisson.
Drafting of the article: J.F. Laprise.
Critical revision for important intellectual content: J.F. Laprise, H.W. Chesson, L.E. Markowitz, M. Drolet, D. Martin, É. Bénard, M. Brisson.
Final approval of the article: J.F. Laprise, H.W. Chesson, L.E. Markowitz, M. Drolet, D. Martin, É. Bénard, M. Brisson.
Obtaining of funding: M. Brisson.
Administrative, technical, or logistic support: J.F. Laprise, L.E. Markowitz, M. Drolet.
Collection and assembly of data: J.F. Laprise, H.W. Chesson, L.E. Markowitz, M. Drolet, M. Brisson.
This article was published at Annals.org on 10 December 2019.
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