Model for Assessing Human Papillomavirus Vaccination Strategies

TLDR

The study develops a transmission dynamic model to evaluate the epidemiologic impact and cost‑effectiveness of different quadrivalent HPV vaccination strategies within the U.S. cervical cancer screening program. The model simulates vaccination of girls before age 12, with an optional catch‑up for ages 12–24, and includes men and boys to assess reductions in genital warts, cervical intraepithelial neoplasia, and cervical cancer.

Abstract

We present a transmission dynamic model that can assess the epidemiologic consequences and cost-effectiveness of alternative strategies of administering a prophylactic quadrivalent (types 6/11/16/18) human papillomavirus (HPV) vaccine in a setting of organized cervical cancer screening in the United States. Compared with current practice, vaccinating girls before the age of 12 years would reduce the incidence of genital warts (83%) and cervical cancer (78%) due to HPV 6/11/16/18. The incremental cost-effectiveness ratio (ICER) of augmenting this strategy with a temporary catch-up program for 12- to 24-year-olds was US $4,666 per quality-adjusted life year (QALY) gained. Relative to other commonly accepted healthcare programs, vaccinating girls and women appears cost-effective. Including men and boys in the program was the most effective strategy, reducing the incidence of genital warts, cervical intraepithelial neoplasia, and cervical cancer by 97%, 91%, and 91%, respectively. The ICER of this strategy was $45,056 per QALY.