Age-based programs for vaccination against HPV.
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.


OBJECTIVE
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.
Elbasha
Elamin H
EH
Merck Research Laboratories, Merck & Co., Inc., NorthWales, PA, USA. elamin_elbasha@merck.com
Dasbach
Erik J
EJ
Insinga
Ralph P
RP
Haupt
Richard M
RM
Barr
Eliav
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003218:Condylomata Acuminata / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D032541:Mass Vaccination / Q000191:economics*; D008875:Middle Aged; D017059:Models, Econometric; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control; D055815:Young Adult
D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines