Recent evidence shows that quadrivalent human papillomavirus
(qHPV) vaccination in men who have sex with men (MSM) who have a history of
high-grade anal intraepithelial neoplasia (HGAIN) was associated with a 50%
reduction in the risk of recurrent HGAIN. We evaluated the long-term clinical
and economic outcomes of adding the qHPV vaccine to the treatment regimen for
HGAIN in human immunodeficiency virus (HIV)–positive MSM aged ≥27 years.
We constructed a Markov model based on anal histology in
HIV-positive MSM comparing qHPV vaccination with no vaccination after treatment
for HGAIN, the current practice. The model parameters, including baseline
prevalence, disease transitions, costs, and utilities, were either obtained
from the literature or calibrated using a natural history model of anal
carcinogenesis. The model outputs included lifetime costs, quality-adjusted
life years, and lifetime risk of developing anal cancer. We estimated the
incremental cost-effectiveness ratio of qHPV vaccination compared to no qHPV
vaccination and decrease in lifetime risk of anal cancer. We also conducted
deterministic and probabilistic sensitivity analyses to evaluate the robustness
of the results.
Use of qHPV vaccination after treatment for HGAIN decreased
the lifetime risk of anal cancer by 63% compared with no vaccination. The qHPV
vaccination strategy was cost saving; it decreased lifetime costs by $419 and
increased quality-adjusted life years by 0.16. Results were robust to the
sensitivity analysis.
Vaccinating HIV-positive MSM aged ≥27 years with qHPV
vaccine after treatment for HGAIN is a cost-saving strategy. Therefore,
expansion of current vaccination guidelines to include this population should
be a high priority.
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-Author Affiliations
4Division
of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center School of Public
Health
Correspondence: Scott B. Cantor, PhD, Department of Health
Services Research, Unit 1444, The University of Texas MD Anderson Cancer
Center, PO Box 301402, Houston, TX 77230-1402 (sbcantor@mdanderson.org).
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