title: Too late to vaccinate? The incremental benefits and cost-effectiveness of a delayed catch-up program using the 4-valent human papillomavirus vaccine in Norway.
abstract: BACKGROUND
  Human papillomavirus (HPV) vaccines are ideally administered before HPV exposure; therefore, catch-up programs for girls past adolescence have not been readily funded. We evaluated the benefits and cost-effectiveness of a delayed, 1-year female catch-up vaccination program in Norway.
  
  
  METHODS
  We calibrated a dynamic HPV transmission model to Norwegian data and projected the costs and benefits associated with 8 HPV-related conditions while varying the upper vaccination age limit to 20, 22, 24, or 26 years. We explored the impact of vaccine protection in women with prior vaccine-targeted HPV infections, vaccine cost, coverage, and natural- and vaccine-induced immunity.
  
  
  RESULTS
  The incremental benefits and cost-effectiveness decreased as the upper age limit for catch-up increased. Assuming a vaccine cost of $150/dose, vaccination up to age 20 years remained below Norway's willingness-to-pay threshold (approximately $83 000/quality-adjusted life year gained); extension to age 22 years was cost-effective at a lower cost per dose ($50-$75). At high levels of vaccine protection in women with prior HPV exposure, vaccinating up to age 26 years was cost-effective. Results were stable with lower coverage.
  
  
  CONCLUSIONS
  HPV vaccination catch-up programs, 5 years after routine implementation, may be warranted; however, even at low vaccine cost per dose, the cost-effectiveness of vaccinating beyond age 22 years remains uncertain.
authors: Department of Health Management and Health Economics, University of Oslo Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.
authors: Emily A
authors: EA
authors: Burger
authors: Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.
authors: Stephen
authors: S
authors: Sy
authors: Cancer Registry of Norway, Department of Research, Oslo.
authors: Mari
authors: M
authors: Nygård
authors: Department of Health Management and Health Economics, University of Oslo.
authors: Ivar S
authors: IS
authors: Kristiansen
authors: Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.
authors: Jane J
authors: JJ
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: cost-effectiveness analysis; disease transmission models; herd immunity; human papillomavirus; vaccine