HPV vaccination for women aged older than 30 not cost-effective

HPV vaccination for women aged older than 30 years does not appear to be effective and costs more per quality-adjusted life-year gained than other accepted health care interventions.

The probability of HPV vaccination being cost-effective for women aged 35 to 45 years was 0% for those already undergoing annual or biennial screening and was less than 5% for those who underwent triennial screening.

The researchers assessed the health and economic outcomes of HPV vaccination in women aged 35 to 45 years using a previously developed simulation model of the natural history of HPV and cervical disease, and primary and secondary preventive interventions. The women had already been participating in a specific screening strategy.

Adding HPV vaccination to screening for women in this age group increased quality-adjusted life expectancy; however, gains in quality-adjusted life-years diminished with age. Women who had received biennial cytology screening with HPV DNA testing for triage gained 0.0040 quality-adjusted life-years, or 35 hours, when vaccinated at age 35. They gained 0.0029 quality-adjusted life-years, or 26 hours, when vaccinated at age 45. The incremental benefits of screening were also lower for annual screening or when screening involved a switch to combined cytology and HPV DNA testing after age 30.

Considering different assumptions for various cervical cancer and HPV infection screening strategies, the addition of vaccination ranged from $116,950 to $381,590 per quality-adjusted life-year gained. Among women who were screened annually or biennially with cytology and HPV triage, adding vaccination resulted in gains of $116,950 to $272,350 per quality-adjusted life-year compared with screening alone. Among women who switched to combined cytology and HPV DNA testing after age 30, the incremental cost-effectiveness ratios ranged from $193,690 to $381,590 per quality-adjusted life-year.

Kim JJ. Ann Intern Med. 2009;151:538-545.