Cost-effectiveness of nonavalent HPV vaccination among males aged 22 through 26?years in the United States |
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| Institution: | 1. Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA;2. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA;3. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA;1. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia;2. Tartu University Hospital, Women''s Clinic, Tartu, Estonia;3. Institute of Social Studies, University of Tartu, Tartu, Estonia;1. Cancer Prevention Training Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;2. Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States;3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;1. Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA;2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA;3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia;4. Emory Vaccine Center, 954 Gatewood Road, Atlanta, GA 30329, USA;1. Department of Health Services Research, Management and Policy, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA;2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;3. ICON Health Economics & Epidemiology, Oxford, UK;4. Department of Medicine, Section of Infectious Disease, Baylor College of Medicine, Houston, TX, USA;5. Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, TX, USA;6. Department of Obstetrics and Gynecology, Boston University Medical Center, Boston, MA, USA;7. Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA;8. Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA;9. Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;1. Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317, Oslo, Norway;2. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA;3. Department of Research, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304, Oslo, Norway;1. Stapleton Lane Clinic, St John''s, Antigua, West Indies;2. Pan American Health Organization, Washington, D.C., USA;3. London School of Hygiene & Tropical Medicine, London, UK;4. Ministry of Health, Belmopan, Belize |
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| Abstract: | IntroductionIn the United States, routine human papillomavirus (HPV) vaccination is recommended for females and males at age 11 or 12 years; the series can be started at age 9 years. Vaccination is also recommended for females through age 26 years and males through age 21 years. The objective of this study was to assess the health impact and cost-effectiveness of harmonizing female and male vaccination recommendations by increasing the upper recommended catch-up age of HPV vaccination for males from age 21 to age 26 years.MethodsWe updated a published model of the health impact and cost-effectiveness of 9-valent human papillomavirus vaccine (9vHPV). We examined the cost-effectiveness of (1) 9vHPV for females aged 12 through 26 years and males aged 12 through 21 years, and (2) an expanded program including males through age 26 years.ResultsCompared to no vaccination, providing 9vHPV for females aged 12 through 26 years and males aged 12 through 21 years cost an estimated $16,600 (in 2016 U.S. dollars) per quality-adjusted life year (QALY) gained. The estimated cost per QALY gained by expanding male vaccination through age 26 years was $228,800 and ranged from $137,900 to $367,300 in multi-way sensitivity analyses.ConclusionsThe cost-effectiveness ratios we estimated are not so favorable as to make a strong economic case for recommending expanding male vaccination, yet are not so unfavorable as to preclude consideration of expanding male vaccination. The wide range of plausible results we obtained may underestimate the true degree of uncertainty, due to model limitations. For example, the cost per QALY might be less than our lower bound estimate of $137,900 had our model allowed for vaccine protection against re-infection. Models that specifically incorporate men who have sex with men (MSM) are needed to provide a more comprehensive assessment of male HPV vaccination strategies. |
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| Keywords: | Human papillomavirus Nonavalent HPV vaccine Cost-effectiveness Cost-utility Disease transmission models Vaccines |
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