Researchers from the Harvard School of Public Health have reported that human papillomavirus vaccination for prevention of cervical cancer is not cost-effective in women between the ages of 35 and 45 years. The details of this report appeared in the October 20, 2009 issue of the Annals of Internal Medicine.[1]

HPV types 16 and 18 cause approximately 70% of all cases of cervical cancer. Cervical cancer can occur from two to 50 years after the onset of infection. Over 20 million Americans are infected with some type of HPV. In most developing countries, most women are already infected with HPV, making development of a vaccine paramount in controlling this disease. It is also important to point out that HPV is associated with infections and cancers of other sites such as the vulva, vagina, anus, penis, and oropharynx. It is anticipated that vaccines against cervical HPV would also be effective for HPV infections in sites other than the cervix.

The U.S. Food and Drug Administration (FDA) has approved Gardasil® and Cervarix® for routine vaccination of girls and young women for prevention of HPV infection, which will prevent cervical cancer. Gardasil has also been approved in boys for the prevention of genital warts but not for routine vaccination for prevention of transmission to females. The U.S. FDA is apparently considering extending the age of vaccination of females to older age groups.

Researchers involved in the current study sought to determine if routine vaccination of women over the age of 30 years would be cost-effective compared to existing screening with HPV DNA testing and cytology. The age group considered was between the ages of 35 and 45 years. They estimated that the cost of vaccination in this age group ranged from just over $100,000 to almost $400,000 per quality-adjusted life-year (QALY) gained based on various assumptions. For women undergoing annual screening in this age group, there was 0% chance that vaccination would be cost-effective. Less frequent screening for cervical cancer increased the probability that vaccination would be cost-effective.

Comments: These calculations are based on the prevention of cervical cancer where screening methods are relatively effective in detecting early cancers. However, we need to know more about the prevention of other HPV-related cancers before we could definitively conclude that vaccination is or is not cost-effective.

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