States mandating hpv
Specifically, we calculated the quality-adjusted life years (QALYs) gained, vaccination costs, and total societal costs across a range of scenarios.
However, as a result of migration between states, 29–84% of the long-term health benefit of a state’s vaccination will be realized beyond its borders.In 2015, the CDC recommended that females aged 11–26 y be vaccinated with any of the three available vaccines and that males aged 11–21 y receive either 4v HPV or 9v HPV (2).Although CDC contract and private sector prices vary, the new vaccine, at a per-dose cost of $126, is approximately $13 more costly than 4v HPV and $18 more costly than 2v HPV ().Switching to 9v HPV while maintaining current coverage would achieve more substantial reductions, decreasing incidence by 73% (95% CI 62–81%) and mortality by 49% (95% CI 30–62%) (Table 1).Impact through 2050 of no vaccination (solid line), 2v HPV/4v HPV continued at current adolescent coverage (long dashed line), 9v HPV at current coverage (short dashed line), 2v HPV/4v HPV at 100% coverage (dotted line), and 9v HPV at 100% coverage (dashed and dotted line) on annual HPV-associated cervical cancers ( We quantified the cost-effectiveness both of expanded coverage and of switching to 9v HPV.Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers.
However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies.
Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys.
We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity.
We find that all states will achieve greater reductions in both the incidence of and expenditure for cervical cancer if vaccination policies are coordinated among states.
Accounting for interstate migration and current heterogeneous state vaccination rates that range from 20–57% full-series coverage for girls (Fig.
Although some states have taken no action to promote HPV vaccination, others have adopted measures that range from mandating HPV vaccination as a prerequisite for school attendance to permitting vaccination in pharmacies (8–10).