Jane J. Kim, PhD; Jesse Ortendahl, BS; Sue J. Goldie, MD, MPH
Kim JJ, Ortendahl J, Goldie SJ. Cost-Effectiveness of Human Papillomavirus Vaccination and Cervical Cancer Screening in Women Older Than 30 Years in the United States. Ann Intern Med. 2009;151:538-545. doi: 10.7326/0003-4819-151-8-200910200-00007
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Published: Ann Intern Med. 2009;151(8):538-545.
Women older than 30 years are the main beneficiaries of improved cervical cancer screening with human papillomavirus (HPV) DNA testing. The role of vaccination against HPV types 16 and 18, which is recommended routinely for preadolescent girls, is unclear in this age group.
To assess the health and economic outcomes of HPV vaccination in older U.S. women.
Cost-effectiveness analysis with an empirically calibrated model.
U.S. women aged 35 to 45 years.
HPV vaccination added to screening strategies that differ by test (cytology or HPV DNA testing), frequency, and start age versus screening alone.
Incremental cost-effectiveness ratios (2006 U.S. dollars per quality-adjusted life-year [QALY] gained).
In the context of annual or biennial screening, HPV vaccination of women aged 35 to 45 years ranged from $116Â 950 to $272Â 350 per QALY for cytology with HPV DNA testing for triage of equivocal results and from $193Â 690 to $381Â 590 per QALY for combined cytology and HPV DNA testing, depending on age and screening frequency.
The probability of HPV vaccination being cost-effective for women aged 35 to 45 years was 0% with annual or biennial screening and less than 5% with triennial screening, at thresholds considered good value for money.
The natural history of the disease and the efficacy of the vaccine in older women are uncertain.
Given currently available information, the effectiveness of HPV vaccination for women older than 30 years who are screened seems to be small. Compared with current screening that uses sensitive HPV DNA testing, HPV vaccination is associated with less attractive cost-effectiveness ratios in this population than those for other, well-accepted interventions in the United States.
National Cancer Institute, Centers for Disease Control and Prevention, and the American Cancer Society.
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High Value Care, Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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