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    Experts: HPV Vaccine a Preteen Priority

    Study Shows Vaccine Is Cost-Effective When 12-Year-Olds Are Vaccinated
    WebMD Health News
    Reviewed by Louise Chang, MD

    Aug. 20, 2008 -- The vaccine against human papillomavirus (HPV), the sexually transmitted virus that causes cervical cancer, will be most cost-effective in the U.S. with universal vaccination of 12-year-old girls and catch-up efforts to vaccinate girls and women ages 13 to 21, say Harvard researchers.

    "We really should be targeting and prioritizing the younger girls, 12-year-olds, prior to sexual activity," says Jane J. Kim, PhD, assistant professor of health decision science at the Harvard School of Public Health and lead author of the study.

    That, coupled with a temporary catch-up program to vaccinate girls and women ages 13 to 21, could make it possible to revise current cervical cancer screening so that women could begin screening somewhat later and undergo it a bit less frequently, she tells WebMD.

    But an editorial in the New England Journal of Medicine, raises questions about the effectiveness of the vaccine in preventing cervical cancer.

    The study, also published in the New England Journal of Medicine, is one of many investigations undertaken by Kim and her colleagues over the years on prevention of cervical cancer, which struck more than 11,000 women in the U.S. in 2007 and killed 3,600.

    Her report is meant to evaluate cost-effectiveness and guide public health policy.

    "We used mathematical models to simulate the natural history of the disease," Kim says, "then superimposed these strategies, whether they be screening, HPV vaccine, or a combination of both."

    After FDA approved the HPV vaccine Gardasil in 2006, the CDC recommended routine vaccination of girls ages 11-12 and catch-up vaccination of girls and women ages 13 to 26.

    HPV Vaccine Strategies

    Kim pooled data to predict both the health and economic outcomes of HPV vaccination of girls age 12, with catch-up vaccinations over a five-year period of girls 13 to 21 coupled with routine cervical cancer screening.

    She plugged in various strategies to include catch-up programs to ages 18, 21, or 26. The main focus was to see how well each strategy prevented cervical cancer.

    To determine the cost-effectiveness, Kim took into account the benefit of an intervention such as a vaccine in terms of the person's health and also the cost of the intervention. Experts agree that costs and health benefits at a specific threshold are a good value, while those above the threshold are not a good value, at least from a public health perspective.

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