OBJECTIVES

Despite the widespread evidence on the efficacy and safety of the human papillomavirus (HPV) vaccine, only 54% of adolescents completed the vaccination series in the U.S. in 2019. Our objectives were to assess the potential health outcomes, costs, and cost-effectiveness of adding pharmacies to traditional locations (i.e. clinic offices, hospitals, and urgent care) for the delivery of HPV vaccines compared to traditional locations alone.

METHODS

We constructed a hybrid decision tree Markov model to compare the projected health outcomes and costs of HPV vaccination administered at pharmacies plus traditional locations to traditional locations alone, taking the health care system perspective. The target population was girls, 9-12 years, in the U.S. and the intervention was the 9-valent HPV vaccine. The model simulated HPV natural history and cervical cancer of a single cohort of girls starting at age 10 until age 100 or death over 1-year cycle lengths. Model inputs related to uptake in pharmacies were based on estimates from various vaccination programs. Unit costs were from the CDC price list, CMS fee schedules, and costing studies. We derived transition probabilities and utility estimates from the published literature. We conducted univariate sensitivity analyses to assess drivers of the model outcomes.

RESULTS

Assuming that expanding vaccination to pharmacies will increase the vaccination rate by 10%, this strategy was projected to be a dominant strategy, with lower mean health care costs of $15,863 per person (2020 dollars) and 0.044 QALY gained. Univariate sensitivity analyses demonstrated the robustness of this finding.

CONCLUSIONS

Utilizing pharmacies in addition to traditional locations to administer HPV vaccination is cost saving compared to traditional locations alone. Pharmacies have the potential to increase vaccine accessibility and reduce overall cervical cancer burden, but are currently underutilized. Further research on operational feasibility is needed in order to capitalize on this potential.