Clinical and Economic Impact of Human Papillomavirus Vaccination In 19- to 25-Year-Old Women Insured by Medicaid In the US

Background: Human papillomavirus (HPV) infections can lead to cervical intraepithelial neoplasia (CIN) and subsequent cervical cancer (CC).  HPV vaccination can potentially reduce cervical disease and related healthcare costs.

Objectives: To estimate lifetime medical cost offsets due to HPV vaccination in state Medicaid populations.

Methods: A cost calculator was developed to evaluate HPV vaccination versus no vaccination in 19-25-year-old US females covered under Medicaid.  Cost inputs included vaccine price, diagnostic and treatment costs for abnormal Papanicolaou (Pap) tests, CIN grades 1-3, and CC.  States were categorized as low-, medium-, or high-risk based on CC incidence obtained from the National Cancer Institute.  Lifetime cervical events for 19-25-year-old females were obtained from a Markov model of HPV and cervical disease and adjusted using weights of 0.8 for low-, 1.0 for average- and 1.2 for high-risk states.  This model evaluated an HPV vaccine with 92.9% protection against HPV 16/18 and 37.4% protection against all other high-risk types in a HPV DNA negative cohort.  Primary outcomes included net cost/vaccinated female (vaccination cost – medical cost offset) and events avoided with vaccination.  Events were discounted at 3% per annum and multiplied by their unit cost.

Results: The net cost/vaccinated female ranged from $36 in states classified as high-risk for CC to $255 in those classified as low-risk. Across states, events avoided ranged from 1,305 to 390,435 for abnormal Pap tests, 136 to 40,650 for CIN1, 184 to 55,154 for CIN2/3, 19 to 5,780 for CC cases, and 4 to 1,252 for CC-related deaths.

Conclusions: Widespread HPV vaccination has the potential to eliminate clinical and economic burden associated with HPV-related cervical disease in women insured by Medicaid.  Benefits are significant in states classified as high-risk for CC, such as Arkansas, District of Columbia, Kentucky, Louisiana, Maine, Mississippi, New Jersey, New Mexico, Rhode Island, Texas, West Virginia, and Wyoming.