Welcome to the Decision Support Tool
Allocating limited resources to maximize population health impact is complex and may differ across geographies in the US. This decision support tool is designed to help decision makers identify and select interventions that can support provider-family communications to increase human papillomavirus (HPV) vaccination uptake and ultimately improve HPV cancer-related outcomes.
This interactive tool is based on real U.S. data and presents estimates of HPV-related outcomes as a result of different interventions designed to improve vaccination communication. This tool enables users to modify key assumptions and then estimate and compare the relative costs, health impacts, and cost-effectiveness of different interventions, thereby supporting data-driven decision-making to improve HPV vaccination coverage and population health outcomes.
Model Overview
This tool is powered by population-level simulation models based on real data and reflects real-world cohorts of U.S. adolescent populations which can be further filtered by state and rurality. These simulated populations reflect actual demographic characteristics of U.S. populations consistent with U.S. Census distributions. Key elements of the tool and the structure of the model are detailed below.
| Population | Adolescents living in United States from 2003-2020, ages 9-12. |
| Data distribution | Types of data included in model: 1. Intervention effect by rurality, sex, age 9-10/11-12, some states 2. Vaccination rates by rurality, sex, age, state 3. Cancer incidence by vaccination status, rurality, sex, state 4. Vaccine preventable infections by strain type, sex, cancer 5. Cancer-stage distributions by sex, state 6. Cancer deaths by cancer stage, sex, state |
| Intervention Period | 1-year period |
| Interventions simulated | Strategies to be compared to each other and to usual care: 1. Announcement Approach Training (AAT) 2. AAT + Standing orders 3. AAT+ Financial Incentives 4. AAT+ Vaccine Champions 5. AFIX 6. STOP HPV |
| Intervention implementation costs | Estimated costs of bundled interventions based on IMPACT studies or published costing studies within relevant populations and prior literature, summed by intervention |
| Intervention Level | Results are available nationwide. For some variables we will present data at the 1) state level, 2) by rurality, and 3) by sex |
| Outcomes assessed | HPV vaccine initiation rates, numbers of HPV cancers, HPV cancer deaths, short-term productivity losses, long-term productivity losses, treatment costs, costs of any intervention implementation, Quality-Adjusted Life Years, cost-effectiveness |
HPV Vaccination Interventions of Interest
This tool enables healthcare system and state-level leaders to compare the relative impact and cost-effectiveness of evidence-based strategies to increase HPV vaccine uptake. Interventions included in the model are:
- Announcement Approach Training (AAT)
- Announcement Approach Training (AAT) combined with Standing Orders
- Announcement Approach Training (AAT) combined with Financial Incentives
- Announcement Approach Training (AAT) combined with Vaccine Champions
- Assessment, Feedback Incentives, and eXchange (AFIX)
- STOP-HPV
The following table provides a brief description of each intervention, the populations and settings in which it has been studied, and the associated costs.
Interventions and Scenarios
| Intervention | Description | Population and Setting | Intervention and Implementation Costs |
|---|---|---|---|
| AAT | Training clinical staff to make presumptive announcements about HPV vaccination. | HPV- vaccine eligible adolescents ages 9-12 | Personnel/Time costs, (recruiting facilitators, planning training workshops, orientation meetings) |
| AAT+ Standing Orders | Standing orders support to promote the inclusion of the whole primary care team in HPV vaccine recommendations. | HPV- vaccine eligible adolescents ages 9-12 within 28 clinics in 4 healthcare systems across Illinois, Iowa, Missouri, Tennessee, Texas, and Utah | Personnel/Time costs, (recruiting facilitators, planning training workshops, orientation meetings); Administrative costs (EHR programming and implementation); |
| AAT+ Incentives | Clinic-level financial incentives to motivate primary care team members to recommend HPV vaccination. | HPV- vaccine eligible adolescents ages 9-12 within 29 clinics in three healthcare systems across North Carolina | Personnel/Time costs (recruiting facilitators, planning training workshops); Administrative costs (funding transfers and integrating into EHR); Material costs (financial incentives) |
| AAT+ Vaccine Champions | Engaging clinical champions to implement the AAT trainings. | HPV- vaccine eligible adolescents ages 9-12 within 47 clinics in 6 healthcare systems across Wisconsin, Michigan, and Iowa | Personnel/Time costs, (recruiting facilitators, identifying champions planning training workshops, conducting orientation meetings, champion outreach plans); Material costs (champion travel expenses, printing/posting) |
| AFIX | In person or online coaching consultations for clinicians providing education, feedback and assessment on vaccination rates and guidance on improving a clinic’s HPV vaccination rates. | Vaccine-eligible adolescents ages 13-18 years | Personnel costs (recruitment, session prep, AFIX session delivery, travel time, technical assistance) |
| STOP HPV | Asynchronous online training to improve HPV vaccination communication among primary care pediatric clinicians | HPV-vaccine eligible adolescents ages 11- to 17-year-old adolescents within 24 intervention practices (188 clinicians) and 24 control practices (177 clinicians) across the US | Personnel costs (training prep and delivery) |