HPV vaccination programs may benefit certain at-risk adults

Key takeaways:

• Expanding HPV vaccination to all adults aged 27 to 45 years would cost more than $2 million per QALY.
• Vaccinating those aged 9 to 26 years remains more effective and cost effective vs. expansion.

HPV vaccination programs for adults aged 27 to 45 years could benefit certain subgroups but are ultimately more costly and less effective vs. vaccination of those aged younger than 26 years, data show.

According to background information from the CDC, 13 million people in the United States are infected by types of HPV every year, while HPV annually causes around 36,000 cases of cancer.

In June 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision-making regarding possible HPV vaccination of adults aged 27 to 45 years, or “mid-adults,” Jean-François Laprise, PhD, from Laval University in Canada, and colleagues explained in Annals of Internal Medicine.

However, they pointed out that several subgroups of mid-adults may be at a greater risk for HPV infections or HPV-related cancer, like those with higher sexual activity or those who had recently separated from a long-time partner, and “could benefit substantially from HPV vaccination.”

In the analysis, the researchers used a computer model to determine the cost-effectiveness and number of people needed to vaccinate (NNV) to prevent one HPV-related cancer if the current nine-valent HPV vaccination program for those aged 9 to 26 years was expanded to include mid-adults.

They found that expanding HPV vaccination to all mid-adults, those with multiple new partners and those who had just separated was estimated to cost an additional $2,005,000, $763,000 and $1,164,000 per quality-adjusted life year gained (QALY), respectively.

Meanwhile, the NNV needed to prevent one additional HPV-related cancer was:

• 7,670 for all mid-life adults;
• 5,150 for mid-adults who had just separated;
• 3,190 for mid-adults with multiple new partners; and
• 223 for adults aged 9 to 26 years.

Laprise and colleagues noted that vaccinating mid-adult women infrequently screened for cervical cancer, who had just separated and have a higher number of multiple partners had the lowest incremental cost-effectiveness ratio ($86,000 per QALY gained) and the lowest NNV (470) of all mid-adult vaccination strategies.

They also found that vaccinating only mid-adult men with higher sexual activity had a lower incremental cost-effectiveness ratio and NNV vs. vaccinating only mid-adult women.

There were several study limitations. For example, the researchers did not consider disruptions in vaccination and cervical cancer screening due to the COVID-19 pandemic, whereas the natural history of HPV in mid-adults was not well understood.

They concluded that the cost effectiveness and NNV of mid-adult vaccination programs improve when limited to at-risk subgroups, but vaccination of adults aged 26 years or younger remains more effective and cost effective “under all scenarios investigated.”

References:

• About HPV. Available at: https://www.cdc.gov/hpv/about/index.html. Accessed Nov. 21, 2024.
• Laprise J, et al. Ann Intern Med. 2024;doi:10.7326/M24-0421.