Extending HPV Vaccination Ages Costly With Only Small Added Health Benefits

By Megan Brooks

December 11, 2019

NEW YORK (Reuters Health) - Extending human papillomavirus (HPV) vaccination to middle-aged adults would be costly and likely yield only small added health benefits, according to a health economic model.

In the United States, HPV vaccination is currently recommended at ages 11 to 12, with catch-up vaccination through age 26 for women and 21 for men. In October 2018, the U.S. Food and Drug Administration expanded the approved upper limit of the age range for the HPV vaccine through age 45 in women and men.

To help inform policy of the U.S Advisory Committee on Immunization Practices (ACIP) regarding the expanded age indication, Dr. Lauri Markowitz of U.S. Centers for Disease Control and Prevention (CDC) and colleagues evaluated the added population-level effectiveness and cost-effectiveness of extending HPV vaccination to women ages 27 to 45 and men ages 22 to 45.

Their health economic model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 by 82% and 80%, respectively, and cases of cervical cancer and noncervical HPV-associated cancer by 59% and 39%, respectively, over 100 years and is cost saving (versus no vaccination).

However, the model predicts that extending HPV vaccination to mid-adult women and men through age 45 will produce only "small additional" reductions in HPV-associated diseases and result in substantially higher incremental cost-effectiveness ratios (ICERs) than the current program, according to the Annals of Internal Medicine report.

Specifically, vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830,000, $1,843,000, and $1,471,000, respectively, per quality-adjusted life-year gained (versus current vaccination policy).

Basically, the results show that the current HPV vaccination program is "cost saving" and expanding it to age 45 would result in "relatively small health benefits and much higher costs," Dr. Markowitz noted in a phone interview with Reuters Health.

Based on this analysis, last June, ACIP did not recommend catch-up vaccination for all adults aged 27 through 45 years, but rather left it at age 26 for catch-up vaccination. http://bit.ly/2RE2s1B

At the same time, the ACIP recognized some individuals who are not adequately vaccinated might be at risk for new HPV infection and might benefit from vaccination in this age range. Therefore, ACIP recommended "shared clinical decision-making" regarding potential HPV vaccination for these individuals, Dr. Markowitz explained, "but the committee is not at all actively promoting vaccination above age 26."

The study had no commercial funding and the authors have indicated no relevant financial conflicts of interest.

SOURCE: http://bit.ly/2Py2d5u Annals of Internal Medicine, online December 9, 2019.