HPV Vaccination: Is It Cost-Effective?

Ann J. Davis, MD


Journal Watch. 2008;7(8) 

Immunizing preteens before sexual exposure makes economic sense; cost-effectiveness of vaccinating older teens and young-adult females is less clear.

The effects of human papillomavirus vaccination on cervical cancer rates will not be known for many years. In the absence of long-term study results, investigators used epidemiologic and demographic data to model outcomes and to evaluate the cost-effectiveness of HPV vaccination. Benefits were expressed in terms of cost per quality-adjusted life-year (QALY) gained. Models were based on the assumption that vaccination confers lifelong immunity and that HPV-16 and HPV-18 will not be replaced over time by other oncogenic HPV types. The benefits of preventing genital warts, noncervical cancers, and juvenile respiratory papillomatosis also were considered.

The cost-effectiveness ratio for immunization of 12-year-old girls was US$43,600 per QALY gained; adding a catch-up immunization program for teen girls (age range, 13-18) cost $97,300 per QALY. The cost-effectiveness ratio was $120,400 per QALY for catch-up programs that extended to age 21 and was highest — $152,700 per QALY — for programs extended to the currently recommended age of 26.

The authors concluded that HPV vaccination of 12-year-old girls is cost-effective, whereas catch-up immunization programs are not. This reflects the observation that almost 90% of U.S. women have had vaginal coitus by age 24 and that one third of these women are exposed to HPV during the first year after their sexual debut. Public health policymakers need guidance regarding HPV vaccination programs. Currently, efficacy data rely on intermediary endpoints (e.g., prevention of precancerous cervical lesions); therefore, cost-effectiveness models can aid policymakers. As an editorialist notes, however, many unanswered questions and concerns remain.

Models such as these do not take into account patient anxiety, counseling, and telephone calls that are associated with genital warts and abnormal Pap smears and their management. Nonetheless, the model clearly indicates that — if the assumptions (which, perhaps, are optimistic) are correct — immunization of preteens before sexual exposure makes the best economic sense. Vaccinating older teens and young-adult females who have not had sexual exposure would also seem to be cost-effective, although the optimal cutoff age is unclear.

— Ann J. Davis, MD

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