Expanded HPV Vaccination Schedule is Cost-Effective, But Not For Seniors 

According to a new study’s findings, the current Human Papillomavirus (HPV) vaccination program is predicted to generate a ‘cost-saving.’

But, this study published in the Annual of Internal Medicine on December 9, 2019, also concluded that ‘extending HPV vaccinations to those above 45 years of age is predicted to produce small additional health benefits.’

Furthermore, extending HPV vaccinations to ‘seniors’ would result in substantially higher incremental cost-effectiveness ratios than the current Centers for Disease Control and Prevention (CDC) recommendation.

HPV vaccination for adolescents has been routinely recommended by the CDC for females since 2006 and for males since 2011. Over 120 million doses of the HPV vaccine have been distributed in the USA since licensure.

There is no way to know which people who have HPV will develop cancer or other health problems, says the CDC.

About 14 million Americans, including teens, become infected with HPV each year.

This new study focused on the population-level effectiveness and cost-effectiveness of extending the current HPV vaccination program, as of August 15, 2019, to women aged 27 to 45 years and men aged 22 to 45 years.

The analysis for this study used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data.

This model predicted that the current HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years. 

In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. 

Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830,000, $1,843,000, and $1,471,000, respectively, per quality-adjusted life-year gained vs. the current vaccination schedule.

The primary limitations of this study were the uncertainty about the proportion of HPV-associated disease due to infections after the age of 26 and the impact of herd-immunity effects from the current HPV vaccination program.

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Previously in October 2018, using results from 4vHPV clinical trials in women aged 24 through 45 years, and bridging immunogenicity and safety data in women and men, the Food and Drug Administration (FDA) expanded the approved age range for 9vHPV use from 9 through 26 years to 9 through 45 years in women and men. 

Then, in June 2019, after reviewing evidence related to HPV vaccination of adults, the CDC’s ACIP committee updated recommendations for catch-up vaccination and for vaccination of adults older than the recommended catch-up age.

HPV infections are so common that nearly all men and women will get at least one type of HPV at some point in their lives. HPV is spread through intimate skin-to-skin contact. 

Most HPV infections (90%) go away by themselves within 2 years.

These vaccination expansions are good news since about 33,700 cancers are caused by HPV in the USA each year, including 12,900 oropharyngeal cancers among men and women, 10,800 cervical cancers among women, and 6,000 anal cancers among men and women.

Over 12 years of monitoring and research have shown that HPV vaccination is very safe. Each HPV vaccine—Gardasil® 9, Gardasil®, and Cervarix®—went through years of extensive safety testing before they were licensed by the FDA.

Since late 2016, the Gardasil 9 vaccine has been the only HPV vaccine available for use in the USA.

Furthermore, the CDC says ‘HPV vaccines do not cause HPV infection or cancer.’

Each vaccine is made from one protein from the virus and is not infectious, meaning that it cannot cause HPV infection or cancer.

Furthermore, there is no evidence to suggest that the HPV vaccine causes fertility problems, says the CDC. 

Women who develop a precancer or cancer caused by HPV could require treatment that would limit their ability to have children, such as a hysterectomy, chemotherapy, or radiation.

The CDC continues to say that all vaccination decisions should be made in consultations between patients and certified healthcare providers.

The funding source for this study was the Centers for Disease Control and Prevention. No conflicts of interest were disclosed by these researchers.

HPV Vaccine news published by Vax Before Cancer.