Interventions to Boost HPV Vaccine Uptake Are Cost-Effective

By Lisa Rapaport

November 17, 2020

(Reuters Health) - Interventions in schools and primary care clinics to increase human papillomavirus (HPV) vaccine uptake can be cost-effective, a new analysis suggests.

Researchers looked at three different year-long interventions to increase HPV vaccination: quality improvement visits to primary care clinics; statewide reminders for vaccine visits; and school-based vaccinations. They assessed cost-effectiveness over a period of 50 years based on a willingness-to-pay threshold of $50,000 per quality-adjusted life-year (QALY).

Quality improvement visits to primary care clinics had the lowest cost per QALY gained at $1,538 compared to no intervention. Compared to quality improvement visits, a statewide reminder and recall intervention cost $28,289 per QALY gained, and school-based HPV vaccination cost $18,337 per QALY gained, but all the interventions were found to be cost-effective, the authors report in Pediatrics.

The model was based on 5 million adults and children, the median population size of a U.S. state. Quality improvement visits could lead to an additional 3,773 HPV vaccine initiations compared to no intervention, while reminder and recall interventions could lead to an additional 6,993 vaccine initiations, and school-based vaccinations could lead to an additional 18,721 vaccinations.

Over 50 years, the reduction in total cancers from HPV in this model would be 44 cases from quality improvement visits, 76 cases for reminder and recall efforts, and 212 cases for school-based vaccinations. Nationwide, implementing all three of these interventions could prevent 3,000 to 14,000 future HPV-related cancers, researchers calculated.

At least some of the cost-effectiveness of these interventions stems from current HPV vaccine uptake rates that are suboptimal, said lead study author Jennifer Spencer of the Harvard TH Chan School of Public Health and Dana Farber Cancer Institute in Boston.

"We're not (at) the diminishing returns of trying to vaccinate only the few hard-to-reach stragglers by a long shot," Spencer said by email. "Every year in the U.S. there are almost 35,000 new cancers that are linked to HPV, so anything you can do to make a dent in that is really valuable."

The quality improvement visits at primary care clinics are designed to help providers set goals and implement best practices for increasing vaccine uptake, based on curriculum from the U.S. Centers for Disease Control and Prevention.

Centralized reminder and recall interventions would target teens or parents or guardians via phone, text, email or mail when patients are due or past due for a vaccine visit.

School-based vaccinations would involve parents providing consent to have clinicians vaccinate students at public schools and would aim to offer this at schools with and without school-based health clinics.

One limitation of the study is the potential for the cost or impact of each intervention to vary from the assumptions used by researchers to calculate the cost-effectiveness. It's also possible that state-level differences in buy-in from school districts or providers might lead to different results.

"In practice, the three interventions would target different barriers impeding uptake, and this study makes an important contribution by showing these three options are high-value interventions, especially with limited resources," said Heather Brandt, director of the HPV Cancer Prevention Program at St. Jude Children's Research Hospital in Memphis, Tennessee.

"This may be particularly valuable in areas of the U.S. with the lowest HPV vaccination rates and also the highest rates of HPV-associated disease, which includes most of the 12 states that have not expanded Medicaid," Brandt, who wasn't involved in the study, said by email.

SOURCE: Pediatrics, online November 16, 2020.