Expanding HPV vaccination to all adults aged 27-45 years unlikely to be cost-effective or efficient for HPV-related cancer prevention

Embargoed for release until 5:00 p.m. ET on Monday 25 November 2024    

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.         
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1. Expanding HPV vaccination to all adults aged 27-45 years unlikely to be cost-effective or efficient for HPV-related cancer prevention

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0421 

URL goes live when the embargo lifts          

A modeling study projected that HPV vaccination programs for adults aged 27 to 45 years could benefit subgroups at higher risk for HPV, but overall, the approach is more costly and less effective than vaccinating younger people. According to authors, this is the first study to examine the cost-effectiveness and HPV-related cancer prevention of vaccinating subgroups of adults in this age group at higher risk of HPV infection in the US. The findings are published in Annals of Internal Medicine.

In June 2019, the US Advisory Committee on Immunization Practices (ACIP) recommended shared clinical decision-making regarding potential HPV vaccination of adults aged 27 to 45 years. Researchers from Laval University, Quebec City, Quebec used a computer model to evaluate the cost effectiveness and number of people needed to vaccinate (NNV) to prevent one HPV-related cancer if the existing routine and catch-up 9-valent HPV vaccination program of people aged 9-26 years was expanded to include adults aged 27 to 45 years. The subgroups in this age group that the model explored were adults with higher sexual activity and those who recently separated from a long-term intimate partner. Under all scenarios investigated, HPV vaccination of adults aged 27-25 years was much less cost-effective than vaccinating individuals aged 26 years or younger. Additionally, the NNV was notably higher for mid-adults than for those aged 26 or younger. However, the study also projected that vaccinating infrequently screened mid-adult women with higher sexual activity and who have recently separated produced the lowest incremental cost-effectiveness ratio and lowest number needed to vaccinate to prevent 1 infection compared to other subgroups. These results suggest that the cost-effectiveness of extending HPV vaccination to older persons improve if limited to persons at higher risk for infection.  HPV vaccination of those aged 26 or younger remains significantly more cost-effective and effective than vaccinating older persons.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Marc Brisson, PhD., please email marc.brisson@crchudequebec.ulaval.ca. To speak with Jean-François Laprise, PhD, please email jean-francois.laprise@crchudequebec.ulaval.ca.

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2. Lack of control at work identified as cause for physician burnout and attrition

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00884

URL goes live when the embargo lifts   

A cross-sectional survey of U.S. physicians found that limited control over specific aspects of work, including schedule and workload, was associated with burnout and intentions to leave one’s organization. According to the authors, this is the first study to analyze specific aspects of work control and their relation to physician burnout and attrition. The findings can inform healthcare leaders’ strategies for reducing physician burnout and alleviating the physician shortage. This study is published in Annals of Internal Medicine.

Researchers from the American Medical Association (AMA) and colleagues studied data from the AMA Organizational Biopsy^TM from 2,339 physicians at 19 organizations between November 2022 and December 2023. They assessed how control over specific dimensions work (patient load, clinical team composition, hiring, schedule, workload and domains for where the physicians is accountable) affected burnout and two different career intentions: likelihood to reduce the number of hours devoted to clinical care over the next 12 months (ITR) and likelihood to leave their current organization within 2 years (ITL). The researchers found that lower levels of control were associated with higher levels of burnout, ITR and ITL. Poor control over volume of patients, clinical team composition, schedule, domains where the physician is accountable and workload were each independently associated with burnout. Lack of control over patient volume and workload were independently associated with ITR, and poor influence over hiring, lack of control over domains where the physician is responsible and lack of control over workload were each associated with ITL. With the US Health Resources and Services Administration projecting a shortage of 140,000 physicians by 2036, these findings are critical for healthcare organizations to identify opportunities to mitigate physician burnout and improve retention.  These results indicate that ensuring physicians have adequate control over their clinical work environment should be considered one component of a holistic strategy to reduce burnout and retain physicians.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Christine Sinsky, MD, please email Robert Mills at Robert.Mills@ama-assn.org or Jennifer Mathews at Jennifer.Mathews@ama-assn.org.

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