Expanding HPV vaccines to mid-adults: Is it worth the shot?

Vaccination against human papillomavirus (HPV) among adults aged 27–45 years (mid-adults) is less cost-effective and generates a greater number needed to vaccinate (NNV) when compared with vaccination of persons aged 26 years and below, reports a study.

"However, cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are underscreened,” the investigators said.

This study examined the incremental cost-effectiveness ratios (ICERs) and NNV to prevent one HPV-related cancer case of expanding HPV vaccination to mid-adults at increased risk for HPV-related disease in the US.

Base-case analysis revealed that expanding 9-valent HPV vaccination to all mid-adults, those with more lifetime partners, and those who have just separated would produce an additional cost of $2,005,000, $763,000, and $1,164,000 per quality-adjusted life-year (QALY) gained, respectively.

The corresponding NNVs to prevent one additional HPV-related cancer case were 7,670, 3,190, and 5,150 compared with 223 for vaccination of individuals aged 9 to 26 years (vs no vaccination).

In sensitivity analysis, the mid-adult strategy with the lowest ICER and NNV was vaccination of infrequently screened mid-adult women who have just separated and have a higher number of lifetime sex partners (ICER, $86,000 per QALY gained; NNV, 470).

This study was limited by the uncertainty on the rate of new sex partners and natural history of HPV among mid-adults.