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.