https://immattersacp.org/weekly/archives/2019/12/10/1.htm

Little health benefit, higher costs likely with extended age limit for HPV vaccination

A modeling study examined four scenarios for extended vaccination in women and men up to ages 26, 30, 40, and 45 years.


Extending the age limit for human papillomavirus (HPV) vaccination in the U.S. would carry little additional health benefit and higher cost, a recent study predicted.

Researchers used a model of HPV infection and associated diseases calibrated to age-specific U.S. data to evaluate how extending HPV vaccination in the U.S. would affect population-level effectiveness and cost-effectiveness. Currently, HPV vaccination is recommended at ages 11 to 12 years with catchup vaccination through age 26 years for women and 21 years for men. Four extended scenarios were examined: women and men up to ages 26, 30, 40, and 45 years. The time horizon used in the study was 100 years, the perspective was the health care sector, and the intervention was the 9-valent HPV vaccine. Outcome measures were HPV-associated outcomes prevented by vaccination and cost-effectiveness ratios. The results of the study, which was funded by and included authors from the CDC, were published Dec. 10 by Annals of Internal Medicine.

According to the model, the current vaccination program is expected to decrease diagnoses of anogenital wards by 82%, cervical intraepithelial neoplasia of grade 2 or 3 by 80%, cervical cancer by 59%, and noncervical HPV-associated cancer by 39% over 100 years and saves costs compared with no vaccination. If vaccination were extended to men and woman 45 years of age, these outcomes are predicted to decrease by an additional 0.4, 0.2, 0.2, and 0.2 percentage point, respectively. Costs for extending vaccination among men and women to ages 30, 40, and 45 years are predicted to be $830,000, $1,843,000, and $1,471,000, respectively, per quality-adjusted life-year gained versus the current vaccination strategy. The cost-effectiveness results were most sensitive to natural immunity after infection, rates of progression to cervical lesions, and historical vaccination coverage and efficacy.

Limitations of the study included uncertainty about the proportion of HPV-associated disease due to infection after age 26 years, the long-term herd effects of the current HPV vaccination program, and future vaccine prices and schedules, the authors noted. However, they concluded that the current vaccination program for HPV in the U.S. is likely cost-saving and that extending the age limit will yield small additional health benefits and substantially higher costs. “Future research priorities should include estimating the herd effects produced by the current U.S. vaccination program (that is, the reduction of HPV-associated outcomes in unvaccinated mid-adult women and men) and the percentage of HPV-associated disease burden due to acquisition of infection after age 26 years, and identifying subgroups of women and men in the United States who would benefit most from mid-adult vaccination,” the authors wrote.