Cost-effectiveness of human papillomavirus vaccination and cervical cancer screening in women older than 30 years in the United States.
BACKGROUND
Women older than 30 years are the main beneficiaries of improved cervical cancer screening with human papillomavirus (HPV) DNA testing. The role of vaccination against HPV types 16 and 18, which is recommended routinely for preadolescent girls, is unclear in this age group.


OBJECTIVE
To assess the health and economic outcomes of HPV vaccination in older U.S. women.


METHODS
Cost-effectiveness analysis with an empirically calibrated model.


METHODS
Published literature.


METHODS
U.S. women aged 35 to 45 years.


METHODS
Lifetime.


CONCLUSIONS
Societal.


METHODS
HPV vaccination added to screening strategies that differ by test (cytology or HPV DNA testing), frequency, and start age versus screening alone.


METHODS
Incremental cost-effectiveness ratios (2006 U.S. dollars per quality-adjusted life-year [QALY] gained).


RESULTS
In the context of annual or biennial screening, HPV vaccination of women aged 35 to 45 years ranged from $116 950 to $272 350 per QALY for cytology with HPV DNA testing for triage of equivocal results and from $193 690 to $381 590 per QALY for combined cytology and HPV DNA testing, depending on age and screening frequency.


RESULTS
The probability of HPV vaccination being cost-effective for women aged 35 to 45 years was 0% with annual or biennial screening and less than 5% with triennial screening, at thresholds considered good value for money.


CONCLUSIONS
The natural history of the disease and the efficacy of the vaccine in older women are uncertain.


CONCLUSIONS
Given currently available information, the effectiveness of HPV vaccination for women older than 30 years who are screened seems to be small. Compared with current screening that uses sensitive HPV DNA testing, HPV vaccination is associated with less attractive cost-effectiveness ratios in this population than those for other, well-accepted interventions in the United States.
Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115, USA.
Jane J
JJ
Kim
Jesse
J
Ortendahl
Sue J
SJ
Goldie
D000328:Adult; D000367:Age Factors; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000032:analysis; D003663:Decision Trees; D055088:Early Detection of Cancer; D005260:Female; D052162:Human papillomavirus 16; D052161:Human papillomavirus 18; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009010:Monte Carlo Method; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000821:virology; D014611:Vaccination / Q000191:economics*
D004279:DNA, Viral; D053918:Papillomavirus Vaccines