Vaccines and Preventable Diseases:
HPV Vaccine - Cost-Effectiveness of HPV Vaccine
August 28, 2008
CDC Statement on the Cost-Effectiveness of HPV Vaccine
There has been recent media attention related to a study of the cost effectiveness of human papillomavirus (HPV) vaccination in the United States published in the New England Journal of Medicine on August 21, 2008. This study confirms the cost-effectiveness of HPV vaccination of 11and12 year old girls and is consistent with the main focus of the CDC’s recommendations which call for routine HPV vaccination of 11 and 12 year old girls in the United States. The HPV vaccine is highly effective in preventing four types of HPV in young women who have not been previously exposed to HPV. The vaccine targets HPV types that cause up to 70% of all cervical cancers and about 90% of genital warts.
It is clear that vaccinating women in their mid-to-late twenties is not as cost-effective as vaccinating 11 and 12-year-old girls. However, the majority of girls and women 13 through 26 years of age also can benefit from vaccination. Ideally, HPV vaccine should be administered before sexual debut. Females 13 through 26 years of age who are not yet sexually active can be expected to receive the full benefit of vaccination. Studies suggest that while sexually active females in this age group might have been infected with one or more vaccine HPV types, only a small percentage have been infected with all four of the HPV vaccine types. Females already infected with one or more HPV vaccine types before vaccination would be protected against disease caused by the other HPV vaccine types. Therefore, the majority of females in this age group will derive benefit from vaccination.
A number of different models have been developed to look at cost effectiveness of HPV vaccination. These models are complicated and use many assumptions. The basic structures of the models differ, and assumptions used in the models also vary, including those related to HPV epidemiology and natural history. It is expected that different models will produce different estimates of cost effectiveness.
CDC’s Advisory Committee for Immunization Practices (ACIP) considers many factors in making recommendations for use of vaccines. As part of its process for developing vaccine recommendations, the Committee reviews data about disease severity and distribution, information from clinical trials about vaccine efficacy and safety, information on vaccine acceptability (among potential vaccinees, their caregivers, and providers), and cost effectiveness. The Committee also considers issues of equity; access to vaccine and vaccine administration; impact on health care delivery systems; and logistical, social, legal and ethical concerns. In 2004, ACIP began to review a variety of data in preparation for a recommendation about the use of HPV vaccine. Cost-effectiveness data were reviewed and in June 2006 ACIP voted on recommendations for use of HPV vaccine. ACIP recently reviewed data published in the New England Journal of Medicine article during deliberations on recommendations for use of HPV vaccine in women age 27 years and older. The committee continues to review new information and data as they become available.
ACIP has not considered changing its current recommendation for catch-up vaccination of females 13 through 26 years of age.
When any new vaccine is licensed, some aspects of that vaccine are not known. Information on duration of protection is usually limited when a vaccine is first licensed. While clinical studies of HPV vaccine to date have only evaluated duration of protection through 5 and 6 years, these studies show no evidence of waning of protection. Long term evaluations are underway to assess a variety of issues such as duration of immunity, the impact of vaccination on the risk of cervical cancer with non-vaccine HPV types, the impact of vaccine on ongoing use of Pap testing and rates of genital warts, abnormal Paps, cervical precancer and cervical cancer.
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Content last reviewed on August 28, 2008
Content Source: National Center for Immunization and Respiratory Diseases