Abstract
BackgroundA nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines.Methods and findingsWe utilized 2 independent HPV microsimulation models to evaluate the cost-effectiveness of extending the upper age limit of HPV vaccination in women (from age 26 years) and men (from age 21 years) up to age 30, 35, 40, or 45 years. The models were empirically calibrated to reflect the burden of HPV and related cancers in the US population and used standardized inputs regarding historical and future vaccination uptake, vaccine efficacy, cervical cancer screening, and costs. Disease outcomes included cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers, as well as genital warts. Both models projected higher costs and greater health benefits as the upper age limit of HPV vaccination increased. Strategies of vaccinating females and males up to ages 30, 35, and 40 years were found to be less cost-effective than vaccinating up to age 45 years, which had an incremental cost-effectiveness ratio (ICER) greater than a commonly accepted upper threshold of $200,000 per quality-adjusted life year (QALY) gained. When including all HPV-related outcomes, the ICER for vaccinating up to age 45 years ranged from $315,700 to $440,600 per QALY gained. Assumptions regarding cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers had major impacts on the cost-effectiveness of the vaccination strategies. Key limitations of the study were related to uncertainties in the data used to inform the models, including the timing of vaccine impact on noncervical cancers and vaccine efficacy at older ages.ConclusionsOur results from 2 independent models suggest that HPV vaccination for adult women and men aged 30 to 45 years is unlikely to represent good value for money in the US.
Highlights
In the United States, routine vaccination against human papillomavirus (HPV) has been recommended for girls and young women up to age 26 years since 2006 and boys and young men up to age 21 years since 2009 [1,2]
In June 2019, the Advisory Committee on Immunization Practices (ACIP), which advises the US Centers for Disease Control and Prevention (CDC), voted to harmonize the upper age limit for catch-up HPV vaccination across genders to age 26 years but did not expand catch-up recommendations beyond age years; instead, ACIP stated that HPV vaccination between ages to 45 years be based on shared clinical decision-making [15]
Mathematical models that synthesize the best-available data while ensuring consistency with epidemiological observations can project outcomes beyond those reported in short-term clinical studies and provide insight into key drivers of impact and cost-effectiveness. In this analysis, leveraging a comparative modeling collaboration, we evaluated the cost-effectiveness of extending the upper age limit of HPV vaccination in women and men up to age 45 years to inform the deliberations of the ACIP
Summary
In the United States, routine vaccination against human papillomavirus (HPV) has been recommended for girls and young women up to age 26 years since 2006 and boys and young men up to age 21 years since 2009 [1,2]. All current HPV vaccines appear highly efficacious in preventing vaccine-targeted HPV infections and precancerous lesions in individuals not previously infected with these types [4,5,6,7,8,9,10,11,12]. A nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines
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