Researchers analyzed the expansion of HPV vaccination for mid-adults defined as people 26 years or older with increased HPV risk.
For mid-adults over 26 with increased risk of HPV-related diseases, the cost-effectiveness was less and number needed to vaccinate (NNV) to prevent 1 HPV-related cancer case higher compared with individuals aged 9 to 26—the main population currently approved for HPV vaccination. However, researchers predicted that cost-effectiveness and NNV will improve as more vaccinated individuals enter the mid-adult population.
“In 2006, the U.S. Advisory Committee on Immunization Practices recommended routine human papillomavirus (HPV) vaccination for [women] aged 11 and 12 years (series can be started at age 9 years) with catch-up vaccination through age 26 years,” wrote authors of a study published in the Annals of Internal Medicine.1 Five years later, boys 11 and 12 were given approval for HPV vaccination with catch-up vaccination through the age of 21. In 2019, approvals were expanded even further to all men and women through the age of 26.
Even more important to the context of this study, the most recent expansion in 2019 presented the exploration of HPV vaccination for the mid-adult population of individuals 27 to 45.
The HPV vaccine was first approved in 2006 for girls 11 and 12. | image credit: triocean / stock.adobe.com
“However, at the individual level, mid-adults who are at higher risk for acquiring new infections (for example, adults with multiple new partners or who are separated after long-term relationships) or for developing HPV-related cancer (for example, women who participate less in cervical cancer screening) could benefit substantially from HPV vaccination,” continued the authors. “In this context, more information on the cost-effectiveness of vaccinating mid-adult subgroups at higher risk for HPV infection and the [NNV] to prevent 1 additional HPV-related cancer case can help inform shared clinical decision making about potential HPV vaccination.”
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Researchers’ main goal was to identify the overall cost-effectiveness and NNV to better inform the potential expansion of HPV vaccination for the mid-adult population.
For their data collection, researchers utilized the HPV Agent-based Dynamic model for Vaccination and Screening Evaluation (HPV-ADVISE). The model focuses on integrating a variety of patient data and components, including demographic characteristics, sexual behavior, economic health outcomes, and more.
“Because HPV-ADVISE is an individual-based model, it allows the specific modeling of vaccination scenarios within subgroups of the modeled population based on individual risk factors, such as sexual behavior. The comparator scenario is based on the existing 9-valent HPV vaccination program of persons aged 9 to 26 years in the United States,” they wrote.1
With the help of HPV-ADVISE, researchers created a framework that allowed them to model the expansion of HPV vaccination programming specifically for mid-adults with higher sexual activity or those who have just separated. For individuals representing a high sexual activity, they were assigned 1 of 4 determinants for the extent of their sexual activity (L0, L1, L2, and L3), while individuals that were separated received a vaccine immediately after the completion of their stable relationship.
Regarding the overall costs of expanding HPV vaccination, researchers estimated that expanding to mid-adults would be $2,005,000. If expanded solely for recently separated mid-adults, however, costs would be $1,164,000. And if expanded solely for mid-adults with high sexual activity, overall costs were even lower at $763,000.
“In this analysis, we examined the cost-effectiveness of expanding HPV vaccination to subgroups of the mid-adult U.S. population that may be at higher risk for acquiring HPV infection. Under all scenarios investigated, HPV vaccination of mid-adults was much less cost-effective than that of persons aged 26 years or younger,” wrote the authors.1
Furthermore, mid-adults also fell behind in NNV compared with previously approved vaccine beneficiaries aged 9 to 26. Indeed, for the entire mid-adult population—including individuals with high sexual activity or who had separated—NNV was 7670. Further reinforcing the vaccine’s inability in this population, NNV for mid-adults was 7447 higher than individuals 9 to 26.
While researchers’ findings did not explicitly support the expansion of HPV vaccination approvals and programming, they will certainly be used to inform future studies regarding HPV vaccination uptake. As time passes and HPV-vaccinated individuals move from adolescence to mid-adult ages, NNV and cost-effectiveness is projected to improve.
“Cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are under screened,” concluded authors of the study.1
READ MORE: Immunization Resource Center
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