The United States has been working on increasing human papillomavirus (HPV) vaccine coverage, with many potential interventions suggested. Are these interventions both effective and cost-effective?
As other countries come close to getting human papillomavirus (HPV) vaccine coverage that covers a large portion of their populations, the United States has continued to struggle to meet the coverage goals that organizations have set. A number of interventions have been recommended to increase coverage, but the cost-effectiveness hasn’t been looked at. A report in Pediatrics offers some much needed information.1
The researchers created a dynamic simulation model that had been scaled to a medium-sized state in the United States with a population of 5 million people to look at HPV transmission and progression. They modeled outcomes over the course of 50 years and compared using no intervention to a 1-year implementation of a number of interventions including: centralized reminder and recall for HPV vaccination, school-located HPV vaccination, or quality improvement visits to primary care clinics. The cost-effectiveness of the interventions was assessed relative to a conservative willingness-to-pay threshold; $50,000 per quality-adjusted life-year.
They found that when compared to no intervention, every intervention they looked at was cost-effective. Overall, the quality improvement visits had the lowest cost as well as cost per quality-adjusted life-year ($1538 versus no intervention). In comparison to the quality improvement visit intervention, the statewide implementation of centralized reminder and recall cost $28,289 per quality-adjusted life-year. The school-located HPV vaccination program had the highest cost, but remained cost-effective at $18,337 per quality-adjusted life-year gained versus quality improvement visits. When the model was scaled to the US population, the interventions could avert between 3000 and 14,000 future cancers linked to HPV.
The investigators concluded that all 3 of the interventions were both cost-effective and could result in significant health benefits. For policy makers who want to make increased HPV vaccination coverage a key policy point, they should at the very least earmark additional money for quality improvement visits, which were found to be effective as well as low cost. The other interventions can be considered if more intervention types are required and resources are available.
1. Spencer J, Brewer N, Trogdon J, Weinberger M, Coyne-Beasley T, Wheeler S. Cost-effectiveness of interventions to increase HPV vaccine uptake. Pediatrics. November 16, 2020. Epub ahead of print. doi:10.1542/peds.2020-0395