Health, Economic Outcomes of HPV Vaccine in Adolescent Girls Analysed

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Title: Health, Economic Outcomes of HPV Vaccine in Adolescent Girls Analysed
URL: http://www.pslgroup.com/dg/22996E.htm
Doctor's Guide
August 21, 2008

BOSTON -- August 21, 2008 -- The cost-effectiveness of vaccination in the United States against human papillomavirus (HPV) will be optimised by achieving universal vaccine coverage in young adolescent girls, by targeting initial "catch-up" efforts to vaccinate women younger than 21 years, and by revising current screening policies, according to a an analysis in the August 21 issue of the New England Journal of Medicine.

Jane Kim, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, led a study that involved synthesising epidemiologic, clinical, and demographic information using sophisticated computer models that simulate the US population.

The models were used to predict the health and economic outcomes of HPV vaccination of preadolescent girls aged 12 years, and catch-up vaccination over a 5-year period for girls and women aged over 12 years, in the context of routine cervical cancer screening. Strategies differed in the upper age of catch-up programs, to women aged 18, 21, or 26 years.

Researchers found that vaccination against HPV-16 and HPV-18 would lead to lower cervical cancer rates and be economically attractive if high coverage can be achieved in the most important target group of girls aged 12 years, and if vaccine protection against infection lasted for at least 20 years.

The study predicted that if most girls aged 12 years were vaccinated, their future cervical cancer screening could begin somewhat later than currently recommended and be conducted less frequently (every 3-5 years).

At an additional expense, a catch-up program for girls aged 13 to 18 years appears to offer benefits and be reasonably cost-effective compared to other vaccine programs in the United States.

The cost-effectiveness of extending the catch-up program to women aged 21 years is less certain and depends on whether the vaccine will eventually be proven to prevent other cancers caused by HPV-16 and -18.

In women aged up to 26 years, vaccination was consistently not cost-effective because the vaccine is quite expensive and is less effective in women who are already sexually active.

The authors caution that these results could change if future information shows that vaccine protection does not last, or if there is an unexpected increase in other cancer-causing HPV types not included in the vaccine.

Kim emphasises that their results "are the best prediction with the information available now, but it will be critical to update the analysis as we learn more about the long-term vaccine effects."

The authors also emphasise that it will be important to achieve high coverage among all girls aged 12 years and to ensure girls are screened for cervical cancer beginning in their early- to mid-20s, since HPV types not included in the vaccine can still cause cancer.

From a public health perspective, if women who are at continued risk for HPV infection and cervical cancer are not regularly screened, and if only some adolescents have access to the vaccine, cervical cancer rates in the United States may not change.

SOURCE: Harvard School of Public Health

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