Public health impact and cost-effectiveness of catch-up 9-valent HPV vaccination of individuals through age 45 years in the United States. Issue 7 (3rd July 2021)

• Record Type: Journal Article
• Authors: Daniels, Vincent; Prabhu, Vimalanand S.; Palmer, Cody; Samant, Salome; Kothari, Smita; Roberts, Craig; Elbasha, Elamin
• Is Part Of: Human vaccines & immunotherapeutics. Volume 17:Issue 7(2021)
• Page Start: 1943
• Page End: 1951
• Publication Date: 2021-07-03
• Subjects: Cost-effectiveness -- disease transmission models -- 9-valent human papillomavirus (HPV) vaccine -- adult -- United States; Vaccines -- Periodicals; 615.372
• DOI: 10.1080/21645515.2020.1852870
• Languages: English
• ISSNs: 2164-5515

Abstract

ABSTRACT: The Advisory Committee on Immunization Practices (ACIP) recommended catch-up 9-valent Human Papillomavirus (HPV) vaccination through age 26 years, and shared clinical decision-making for adults aged 27–45 years, compared with catch-up through age 26 years and 21 years for females and males, respectively (status quo; pre-June-2019 recommendations). This study assessed the public health impact and cost-effectiveness of expanded catch-up vaccination through age 45 years (expanded catch-up) compared with status quo. We used an HPV dynamic transmission infection and disease model to assess disease outcomes and incremental cost-effectiveness ratio (ICER) of expanded catch-up compared with status quo. Costs (2018 USD), calculated from a healthcare sector perspective, and quality-adjusted life years (QALY) were discounted at 3% annually. Historical vaccination coverage was estimated using NIS-TEEN survey data (NHANES data for sensitivity analysis). Alternative scenario analyses included restricting upper age of expanded catch-up through 26 years (June-2019 ACIP recommendation), 29 years, and further 5-year increments. Our results show expanded catch-up vaccination would prevent additional 37, 856 cancers, 314, 468 cervical intraepithelial neoplasia-2/3s, 1, 743, 461 genital warts, and 10, 698 deaths compared with status quo over 100 years at cost of $141, 000/QALY. With NHANES coverage, the ICER was $96, 000/QALY. The June-2019 ACIP recommendation also provided public health benefits with an ICER of $117, 000/QALY, compared with status quo. The ICER for expanded vaccination through age 34 years was $107, 000/QALY. Expanding catch-up vaccination program through age 45 years-old in the US is expected to provide public health benefits, and cost-effectiveness improves with expanding catch-up through age 34.