Cost-effectiveness of HPV vaccination after age 26 low, varies by risk factors
A model found that human papillomavirus (HPV) vaccination of men and women ages 27 to 45 years cost $2,005,000 per quality-adjusted life-year gained. Vaccinating patients in this age range who had more partners or had recently left a relationship was more cost-effective.
Human papillomavirus (HPV) vaccination of men and women ages 27 to 45 years was not highly cost-effective, a recent analysis found.
The analysis was motivated by the June 2019 recommendation of the U.S. Advisory Committee on Immunization Practices for shared clinical decision making regarding potential HPV vaccination in this population. Researchers did dynamic modeling of HPV transmission and associated diseases based on HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation) to examine the incremental cost-effectiveness ratios (ICERs) and number needed to vaccinate (NNV) to prevent one HPV-related cancer. Results were published by Annals of Internal Medicine on Nov. 26.
The study found that expanding HPV vaccination to all in this age group would cost an additional $2,005,000 per quality-adjusted life-year (QALY) gained. Only vaccinating patients with higher sexual activity (expected to have ≥10 lifetime partners) cost $763,000 per QALY, and vaccinating only those who were leaving a stable relationship cost $1,164,000 per QALY. The NNVs were 7,670, 3,190, and 5,150, respectively, compared with 223 for vaccination during ages 9 to 26 years. The strategy with the lowest ICER and NNV in those ages 27 to 45 years was to vaccinate infrequently screened women who have just separated and have a higher number of lifetime sex partners (ICER, $86,000 per QALY; NNV, 470).
“Under all scenarios investigated, HPV vaccination of mid-adults was much less cost-effective than that of persons aged 26 years or younger,” said the study authors, adding that “cost-effectiveness and NNV of mid-adult vaccination improve when limited to mid-adult subgroups at higher risk for acquiring HPV infection.” They noted that these findings differed from those in a previous analysis by the same group because rising HPV vaccination rates among those age 26 years and younger have reduced the potential benefit of vaccinating older patients. The authors also highlighted their finding that most of the QALYs gained by extending vaccination to age 45 years come from vaccinating patients ages 27 to 35 years.
Another recent study of the HPV vaccine, published by JAMA as a research letter on Nov. 27, assessed its impact on deaths among women younger than age 25 years using data from the National Center for Health Statistics. The study found that cervical cancer mortality declined by 3.7% (95% CI, −4.8% to −2.1%) per year in this population from 1992-1994 to 2013-2015 and the rate of decline sped up to 15.2% (95% CI, −21.9% to −7.8%) per year from 2013-2015 to 2019-2021, for an overall 62% reduction. The researchers calculated that 26 additional cervical cancer deaths would have been expected to occur in 2016 to 2021 without the vaccine. They noted that after the study period, HPV vaccination rates among adolescents have been seen to decline from 79.3% in 2022 to 75.9% in 2023, according to other research. “The findings from this study highlight the urgency to improve HPV vaccination coverage,” they wrote.