Dissertations & Theses (Open Access)

Date of Award

Spring 5-2020

Degree Name

Doctor of Philosophy (PhD)


David R Lairson Phd

Second Advisor

Wenyaw Chan Phd

Third Advisor

Linda Highfield Phd


The HPV vaccine has been proven as a safe and effective method for preventing cervical cancer. However, the HPV vaccine coverage rate in the U.S. is suboptimal. Various interventions have been implemented to improve HPV vaccine coverage. However, evidence of the cost-effectiveness of HPV vaccine promotion interventions is lacking. We conducted an economic evaluation to assess HPV vaccine promotion interventions of cervical cancer in the U.S. Firstly, a systematic review was conducted to review evidence on interventions aimed at increasing HPV vaccine coverage and to summarize the cost and effectiveness of these interventions. We included 56 HPV vaccine promotion studies in the review. Intervention approaches used to promote the HPV vaccine included patient reminder and recall systems (N=12), patient education (N=16), provider assessment and feedback (N=1), provider reminder (N=2), reducing out-of-pocket costs (N=3), school-based vaccine programs (N=4), vaccination requirements for school attendance (N=3), and intervention combinations (N=14). We also identified 7 studies that reported intervention costs. Most interventions significantly increased HPV vaccine rates using varied approaches across populations and settings, and with modest cost. The cost-effectiveness analysis is needed to determine which intervention type is the most cost-effective.

Secondly, we assessed the cost-effectiveness of several U.S. HPV vaccine promotion interventions versus current practice. Interventions of patient reminder and recall system, patient education, provider reminders, reducing patient out-of-pocket costs, school-based vaccine programs, and community-based intervention combinations were included in the evaluation. We found that patient reminder and recall system is the most cost-effective HPV vaccine promotion intervention. The cost per additional individual that completed HPV vaccine series (ICER) was $238. When the intervention effectiveness was measured as the percentage change of receiving at least one dose HPV vaccine, the ICER for the patient reminder and recall system was $107. A cost-utility analysis was conducted to assess HPV vaccine promotion interventions on cervical cancer in the U.S. The study shows that implementing patient recall and reminder system is the most cost-effective intervention for cervical cancer. Compared with current practice, patient recall and reminder system is cost saving since the cost is lower and yields a better health outcome. Decision-makers need to consider the applicability of interventions and budgets for implementing the interventions. Social and political issues need to be discussed by stakeholder groups before HPV vaccine promotion interventions are successfully implemented.