Abstract
BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and has a significant healthcare burden and cost due to HPV-related cancers and diseases. Despite the proven safety and effectiveness of the HPV vaccine, its uptake in the U.S remains suboptimal. Furthermore, the combined influence of individual, social, and policy factors on HPV vaccination rates remains unclear. This study investigated how individual, social, and policy factors affect HPV vaccination rates, focusing on initiation and completion rates in the U.S. It also aimed to assess the potential cost savings from implementing certain recommended policy changes, aiming to boost HPV vaccination rates and subsequently lower HPV-related cancer cases. METHODS: We analyzed publicly available data on population demographics (e.g., children's public insurance coverage status, parental education, and rurality), policy, and access (e.g., Medicaid income eligibility criteria for children, state-level vaccine requirement, vaccine exemption status, access to pediatricians, access to Vaccine for Children (VFC) providers, and meningococcal conjugate vaccine uptake among adolescents) to quantify the impact of these factors on HPV vaccination coverage using a multilevel regression analysis. Using the regression results, we conducted a cost-savings analysis of higher HPV vaccine uptake and reduced HPV-related cancer incidence resulting from policy changes. RESULTS: The results revealed that meningococcal vaccination uptake, Medicaid income eligibility among children, parental education, and public insurance coverage increased HPV vaccination initiation by 0.028-0.53% points, and completion by 0.033-0.63% points. Vaccine requirements, rurality, and the COVID-19 mortality rate were negatively associated with uptake. Increasing meningococcal conjugate vaccine uptake by 1%, broadening Medicaid income eligibility criteria to 200% of the Federal Poverty Line for states below the threshold, and adding one pediatrician and VFC provider per 100,000 children could collectively reduce national direct two-year cancer treatment expenditures by $19 million to $24 million. CONCLUSIONS: The findings suggest that improving policy and access factors could significantly increase HPV vaccination coverage and generate cost savings. Future research should incorporate long-term and indirect costs to capture the full-scale cost savings related to HPV vaccination.