COST-EFFECTIVENESS OF A QUADRIVALENT (16/18/6/11) HPV VACCINE PROGRAM IN GIRLS AND WOMEN 12 TO 44 YEARS OF AGE IN THE UNITED STATES

PURPOSE:  To assess the cost-effectiveness of extending the current quadrivalent HPV vaccine recommendations to women through the age of 44 years from the healthcare system perspective in the United States
   METHODS:  We extended a previously published mathematical model of the transmission dynamics of HPV infection and HPV disease development to evaluate the public health and economic impact of a quadrivalent HPV vaccine in girls and women 12 to 44 years of age.  Model inputs were obtained from public data sources, published literature, claims data, and clinical trials.  We assumed current cervical cancer screening practices would remain unchanged with vaccination.  Vaccine coverage rates varied according to vaccinee demographic characteristics. 
   RESULTS:  Relative to vaccinating girls and women 12-24 years of age, extending HPV vaccination to women 25-44 years of age is projected to reduce in the U.S. an additional 3,600 cervical cancer cases, 190,000 cervical intraepithelial neoplasia cases, and 300,000 genital wart cases 25 years following the introduction of a 12-44 year old vaccine program. The incremental cost-effectiveness ratio (ICER) for the 12-44 vaccination strategy when compared with the current HPV vaccine recommendations was $74,060 per quality adjusted life year (QALY) gained from a US healthcare system perspective. Variables with significant influence on the public health benefits and ICERs included vaccine coverage, the quality of life weights associated with HPV-related diseases, duration of vaccine protection, and duration of natural immunity to HPV infection.    
  CONCLUSIONS:  Broadening the current HPV vaccination recommendation in the U.S. to women through the age of 44 can provide potentially additional public health benefits at a cost-effectiveness ratio within the range accepted as cost-effective for a reasonably wide range of model input values.