Long-Term Outcomes of Adding HPV Vaccine to the Anal Intraepithelial Neoplasia Treatment Regimen in HIV-Positive Men Who Have Sex With Men. Clin Infect Dis 2015 Nov 15;61(10):1527-35
Date
08/01/2015Pubmed ID
26223993Pubmed Central ID
PMC4614412DOI
10.1093/cid/civ628Scopus ID
2-s2.0-84947737632 (requires institutional sign-in at Scopus site) 41 CitationsAbstract
BACKGROUND: 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.
METHODS: 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.
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.
CONCLUSIONS: 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.
Author List
Deshmukh AA, Chhatwal J, Chiao EY, Nyitray AG, Das P, Cantor SBAuthor
Alan Nyitray PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged, 80 and over
Anus Neoplasms
Carcinoma in Situ
Costs and Cost Analysis
HIV Infections
Homosexuality, Male
Humans
Male
Middle Aged
Papillomavirus Infections
Papillomavirus Vaccines
Treatment Outcome
