Age-Based Programs for Vaccination against HPV

作者：Elbasha Elamin H^*; Da**ach Erik J; Insinga Ralph P; Haupt Richard M; Barr Eliav

来源：Value in Health, 2009, 12(5): 697-707.

DOI：10.1111/j.1524-4733.2009.00512.x

• cervical intraepithelial neoplasia
• condylomata acuminata
• cost-effectiveness analysis
• disease transmission
• herd immunity
• human papillomavirus
• nonlinear dynamics
• theoretical models
• uterine cervical neoplasms
• vaccines

Background:
The risk of infection with human papillomavirus (HPV) increases with age. Answering the question of which age groups are appropriate to target for catch-up vaccination with the newly licensed quadrivalent HPV vaccine (types 6/11/16/18) will be important for developing vaccine policy recommendations.
Objectives:
To assess the value of varying female HPV vaccination strategies by specific age groups of a catch-up program in the United States.
Methods:
The authors used previously published mathematical population dynamic model and cost-utility analysis to evaluate the public health impact and cost-effectiveness of alternative quadrivalent HPV (6/11/16/18) vaccination strategies. The model simulates heterosexual transmission of HPV infection and occurrence of cervical intraepithelial neoplasia (CIN), cervical cancer, and external genital warts in an age-structured population stratified by sex and sexual activity groups. The cost-utility analysis estimates the cost of vaccination, screening, diagnosis, and treatment of HPV diseases, and quality-adjusted survival.
Results:
Compared with the current screening practices, vaccinating girls and women ages 12 to 24 years was the most effective strategy, reducing the number of HPV6/11/16/18-related genital warts, CIN grades 2 and 3, and cervical cancer cases among women in the next 25 years by 3,049,285, 1,399,935, and 30,021; respectively. The incremental cost-effectiveness ratio of this strategy when compared with vaccinating girls and women ages 12 to 19 years was $10,986 per quality-adjusted life-year gained.
Conclusion:
Relative to other commonly accepted health-care programs, vaccinating girls and women ages 12 to 24 years appears cost-effective.

• 出版日期2009-8