Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.

<h4>Background</h4>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...

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Autores principales:	Jane J Kim, Kate T Simms, James Killen, Megan A Smith, Emily A Burger, Stephen Sy, Catherine Regan, Karen Canfell
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/c7a9a728c2a34564b00d467c9944ca6f
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spelling	oai:doaj.org-article:c7a9a728c2a34564b00d467c9944ca6f2021-12-02T19:56:00ZHuman papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.1549-12771549-167610.1371/journal.pmed.1003534https://doaj.org/article/c7a9a728c2a34564b00d467c9944ca6f2021-03-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003534https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>We 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.<h4>Conclusions</h4>Our 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.Jane J KimKate T SimmsJames KillenMegan A SmithEmily A BurgerStephen SyCatherine ReganKaren CanfellPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 3, p e1003534 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Jane J Kim Kate T Simms James Killen Megan A Smith Emily A Burger Stephen Sy Catherine Regan Karen Canfell Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>We 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.<h4>Conclusions</h4>Our 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.
format	article
author	Jane J Kim Kate T Simms James Killen Megan A Smith Emily A Burger Stephen Sy Catherine Regan Karen Canfell
author_facet	Jane J Kim Kate T Simms James Killen Megan A Smith Emily A Burger Stephen Sy Catherine Regan Karen Canfell
author_sort	Jane J Kim
title	Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.
title_short	Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.
title_full	Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.
title_fullStr	Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.
title_full_unstemmed	Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.
title_sort	human papillomavirus vaccination for adults aged 30 to 45 years in the united states: a cost-effectiveness analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/c7a9a728c2a34564b00d467c9944ca6f
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Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.

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