Cost-Effectiveness of an HPV Vaccination Program in the Postpartum Period.

Objective

The postpartum period represents an opportunity to increase human papillomavirus (HPV) vaccination rates for those not vaccinated previously. This study aimed to evaluate the health outcomes and cost-effectiveness of a postpartum HPV vaccination program.

Methods

A Markov model was constructed to estimate the cost-effectiveness of a postpartum HPV vaccination program. A theoretical cohort of 400,000 vaccine-eligible postpartum individuals was simulated based on the U.S. birth rates and HPV vaccination data for those aged 18-26. Simulated health outcomes included diagnoses of cervical intraepithelial neoplasia grade 1 (CIN1), CIN2+ (CIN grade 2 or 3), and early-stage cervical cancer. Inputs were derived from the literature. Cost-effectiveness was assessed in terms of healthcare costs and patient time/quality of life. The cost of the program is represented as the cost of vaccination with staff support per person in 2024 U.S. dollars. We used an incremental cost-effectiveness ratio (ICER) threshold of $100,000 per quality-adjusted life year (QALY). Sensitivity analyses were conducted to assess the impact of varying model parameters.

Results

Compared to no vaccination program, the postpartum HPV vaccination strategy resulted in 2,575 fewer CIN1 cases, 2,809 fewer CIN2+ cases, and 27 fewer cases of early-stage cervical cancer in our simulated population. The program yielded 3,476 additional QALYs at an incremental cost of $79.7 million. The ICER was $22,922/QALY and thus was cost-effective. The program remained cost-effective across 99% of probabilistic simulations.

Conclusions

A postpartum HPV vaccination program is a cost-effective strategy to reduce cervical dysplasia and cancer, meeting standards for preventative care and intervention. These results highlight the postpartum period as an opportunity to complete the HPV vaccine series.