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. 2025 Oct 24:65:127798.
doi: 10.1016/j.vaccine.2025.127798. Epub 2025 Oct 6.

HPV vaccination among gay, bisexual, and other men who have sex with men aged 27-45 years in the United States is potentially Cost-saving

Patrick A Clay  1 , Lauri E Markowitz  2 , Sameer V Gopalani  3 , Arden Baxter  4 , Julia W Gargano  2 , Carla L DeSisto  2 , Virginia Senkomago  5 , Donatus U Ekwueme  5 , Md Hafizul Islam  4 , Harrell W Chesson  1
Affiliations

HPV vaccination among gay, bisexual, and other men who have sex with men aged 27-45 years in the United States is potentially Cost-saving

Patrick A Clay et al. Vaccine. .

Abstract

Background: The Advisory Committee on Immunization Practices (ACIP) recommends routine human papillomavirus (HPV) vaccination at age 11 or 12 years (vaccination can be given starting at age 9 years), with catch-up vaccination for all persons through age 26 years. ACIP recommends shared clinical decision-making for HPV vaccination of persons aged 27 through 45 years, although modeling indicated that broadly vaccinating persons in this age group would not be cost-effective. To help inform clinical decision-making, the objective of this study was to estimate the cost-effectiveness of HPV vaccination among gay, bisexual, and other men who have sex with men (GBMSM) aged 27 through 45 years in the United States.

Method: We used an age-specific, compartmental, susceptible-infectious-susceptible (SIS) model of HPV transmission and disease among GBMSM to estimate changes in HPV, anogenital wart, and HPV-attributable cancer incidence when the upper age for vaccination among GBMSM was raised to age 30, 35, 40, or 45 years. We then estimated changes in quality adjusted life years (QALYs), costs (vaccination costs and direct medical costs of HPV disease), and the incremental cost-effectiveness ratio under each of these scenarios.

Results: Our estimates showed that HPV vaccination of GBMSM was cost-saving through age 45 years, i.e., the costs of vaccination are more than offset by decreases in the direct medical costs of HPV disease. Vaccination of GBMSM through at least age 40 years was cost-saving across most sensitivity analyses.

Conclusions: Vaccination of GBMSM through age 45 years is likely a cost-saving use of public health resources.

Keywords: Anal Cancer; Anogenital warts; HPV; MSM; Vaccination.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Additional number of cases of disease averted over time for different upper age for vaccination scenarios. Y-axis shows the cumulative number of HPV-associated cancers, or anogenital warts averted over time on the X-axis, compared to the baseline scenario where the upper age for vaccination is 26 years. Values are medians across posterior parameter sets. These values were not discounted.
Fig. 2.
Fig. 2.
Y-axis shows estimated dollars spent per QALY gained (i.e. ICER) of raising the upper age for vaccination. Negative values indicate that the cost of vaccination was less than the treatment costs averted due to vaccination. Boxplots indicate median, interquartile, and full ranges of ICERs across all fit parameter sets at the end of our 100-year timeline.
See this image and copyright information in PMC

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