Reduced cost-effectiveness reported from HPV vaccination in mid-adults

Reduced cost-effectiveness reported from HPV vaccination in mid-adults | Image Credit: © Tobias Arhelger - © Tobias Arhelger - stock.adobe.com.

While subgroups with increased human papillomavirus (HPV) risk among adults aged 27 to 45 years may benefit from HPV vaccination programs for adults, this approach is more costly and less effective compared to vaccinating younger people, according to a recent study published in Annals of Internal Medicine.¹

HPV vaccination is vital for the prevention of cervical cancer, which has been reported as the fourth most common cancer in women worldwide.² The World Health Organization has set a goal of at least 90% completion of the HPV vaccine series among girls aged 15 years and older by 2030.

According to the Centers for Disease Control and Prevention, HPV vaccination should be included in routine vaccination among patients aged 11 or 12 years. Additionally, HPV vaccination can begin in patients aged as young as 9 years. Patients not vaccinated at a young age should receive the HPV vaccine when aged up to 26 years.²

Shared clinical decision-making toward HPV vaccination is recommended among adults aged 27 to 45 years by the US Advisory Committee on Immunization Practices.¹ The cost-effectiveness and number of people needed to vaccinate (NNV) to prevent a single HPV-related cancer was recently measured by a computer model.

The model was used by researchers from Laval University, Quebec, and performed measurements based on expanding current routine and catch-up 9-valent HPV vaccine programs used for patients aged 9 to 26 years to include those aged 27 to 45 years. Subgroups included adults with increased sexual activity and adults recently separated from their long-term intimate partner.¹

HPV transmission was modeled using HPV- Agent-based Dynamic model for Vaccination and Screening Evaluation.³ Outcomes were reported as incremental cost-effectiveness ratios (ICERs) and NNV to prevent 1 HPV-related case among mid-adults in the United States.

Significantly reduced cost-effectiveness was reported from vaccination against HPV in adults aged 27 to 45 years compared to vaccination among patients aged up to 26 years.¹ A significantly increased NNV was also reported among this population.

The cost was increased by al $2,005,000 per quality-adjusted life-year (QALY) gained when expanding 9-valent HPV vaccination to all mid-adults, $763,000 when expanding to those with more lifetime partners, and $1,164,000 when expanding to those who had recently separated.³

The NNVs to prevent an HPV-related cancer case were 7670, 3190, and 5150, respectively. In comparison, only 223 NNVs were reported to prevent 1 additional case when vaccinating patients aged 9 to 26 years.³

Mid-adult women with recent separation and an increased number of lifetime sex partners who did not vaccinate frequently had the lowest ICER and NNV when expanding HPV vaccination. The ICER in this population was $86,000 per QALY gained, while the NNV was 470 to prevent a single case of HPV-related cancer.³

These results indicated reduced cost-effectiveness and increased NNVs when vaccinating mid-adults aged 27 to 45 years against HPV vs younger adults aged 26 years and younger. However, investigators noted the potential for improved cost-effectiveness and NNV among higher risk subgroups.³

References

1. Expanding HPV vaccination to all adults aged 27-45 years unlikely to be cost-effective or efficient for HPV-related cancer prevention. EurekAlert. November 25, 2024. Accessed November 26, 2024.
2. Fitch J. US-affiliated HPV vaccination progress from 2013 to 2023. Contemporary OB/GYN. August 23, 2024. Accessed November 26, 2024. https://www.contemporaryobgyn.net/view/us-affiliated-hpv-vaccination-progress-from-2013-to-2023
3. François Laprise J, Chesson HW, Markowitz LE, Drolet M, Brisson M. Cost-effectiveness of extending human papillomavirus vaccination to population subgroups older than 26 years who are at higher risk for human papillomavirus infection in the United States. Annals of Internal Medicine. 2024. doi:10.7326/M24-0421