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Social and behavioural aspects of prevention oral session 4 - STI and HIV Risk Reduction Strategies: Considerations of cost, cost-effectiveness and potential impact
O2-S4.03 The cost-effectiveness of human papillomavirus vaccination of females over age 12 years in the USA
  1. H Chesson,
  2. L Markowitz
  1. US Centers for Disease Control and Prevention, Atlanta, USA

Abstract

Background Although the recommended age for Human Papillomavirus (HPV) vaccination of females is 11 to 12 years in the USA, catch-up" vaccination is recommended for females aged 13–26 years who have not been previously vaccinated. The objective of this study was to evaluate the cost-effectiveness of catch-up vaccination strategies for females aged 13–30 years in the USA.

Method We revised and updated a previously-published, spreadsheet-based model of HPV vaccination to estimate the costs and benefits of female HPV vaccination. The health outcomes we included were: cervical intraepithelial neoplasia, genital warts, recurrent respiratory papillomatosis, and HPV associated cancers (cervical, vaginal, vulvar, anal, oropharyngeal, and penile). We examined the cost-effectiveness of catch-up vaccination for three age groups: ages 13–21 years, ages 21–26 years, and ages 27 to 30 years. We examined a 100-year time horizon. Routine vaccination of 12 year olds was assumed to occur in all 100 years, with coverage set at 20%, 30%, or 75%. The annual probability of receiving catch-up vaccination was 5% for ages 13 to 18 years and 1.25% for ages 19 years and older. The duration of the catch-up vaccination program was varied from 1 to 20 years.

Results Catch-up vaccination generally became less cost-effective as routine coverage increased and as the duration of the catch-up program increased. When vaccine coverage and the duration of the catch-up program were varied (and all other parameters were set to their base case values), the incremental cost per QALY gained by extending the duration of catch-up vaccination ranged from $5000 to $40 000 for ages 13 to 21, from $50 000 to $85 000 for ages 21 to 26, and was >$140 000 for ages 27 to 30 years. The relatively favourable cost-effectiveness ratios for vaccination of ages 13 to 21 years and the relatively unfavourable cost-effectiveness ratios for vaccination of ages 27 to 30 years were consistent regardless of routine vaccine coverage and the duration of the catch-up vaccine program.

Conclusion Our preliminary findings support the current recommendations of the Advisory Committee on Immunisation Practices (ACIP) for female vaccination. However, although catch-up vaccination for ages 21 to 26 years might be considered cost-effective now, the cost per QALY gained by catch-up vaccination may increase as time goes by and as vaccine coverage increases.

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