COST-EFFECTIVENESS OF EXPANDED ADOLESCENT HPV VACCINE COVERAGE

Purpose:

In 2014, 27% of boys and girls aged 13-15 had completed the three-dose human papillomavirus (HPV) vaccine series currently recommended in the US, leaving coverage far short of the Healthy People 2020 objective of 80% for both sexes.  We explore the cost-effectiveness of increasing HPV vaccination coverage for both sexes toward and beyond this goal.

Method:

We created a dynamic transmission model of HPV infection in the United States.  The model incorporated individuals compartmentalized by gender, age, sexual activity levels, and vaccination status.  Data from the clinical literature on HPV infection and vaccine effectiveness were used to parameterize the model.  To simplify, we assume 3 doses are needed for efficacy.  The model was calibrated to HPV prevalence in the US using NHANES data from 2003-2012 and cancer prevalence from SEER.   We assumed no costs associated with increased HPV coverage other than the costs of the additional vaccination.  The primary outcomes are HPV-related costs and HPV-related quality-adjusted life-years (QALYs) lost from various male and female cancers, genital warts, and recurrent respiratory papillomatosis.  We explored population-level outcomes for an open population of 100,000 individuals between the ages of 12 to 75 over a 50-year time horizon.  We explored the cost-effectiveness of scenarios increasing levels of adolescent vaccination from 2014 3-dose vaccination levels (27%) up to 100% 3-dose coverage with the new 9-valent HPV vaccine. We took a societal perspective.

Result:

Expanding adolescent vaccination coverage would lead to better health outcomes at higher costs.  Current HPV vaccine coverage has an incremental cost-effectiveness ratio (ICER) of $5,000/QALY when compared to no vaccination.   Expanding vaccination beyond current levels (from 27% to 28%) has an ICER of $15,000/QALY.  Expanding to 80% coverage of adolescents (from 79%) would have an ICER of $54,000/QALY mainly because the marginal benefits of increased vaccination coverage decline as vaccination coverage increases.  Increasing adolescent 3-dose vaccination coverage to 100% (from 99%) would have an ICER of $91,000/QALY.

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Conclusion:

The population-level health benefits of HPV vaccination would be substantially greater under scenarios of 80% vaccine coverage compared to current coverage levels.  Interventions to increase HPV vaccine coverage could potentially be cost-effective, particularly when coverage levels are below the Healthy People 2020 objective of 80%.