Extending the U.S. human papillomavirus (HPV) vaccination schedule to involve women and men aged 45 would produce proportionately small health benefits compared with the current immunization program.
In October 2018, the U.S. Food and Drug Administration expanded the approved age range for the use of the 9-valent HPV vaccine from 9 through 26 years to 9 through 45 in women and men. Among other considerations for policy, recommendations is the potential for population-level health benefits relative to the increased costs.
‘Advanced age is a strong determinant of post-AMI mortality in the six months after hospital discharge.’
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Researchers used publicly available data to develop a model that would evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S.
HPV vaccination program. Different strategies were compared with routine vaccination of all adolescents at age 11-12 years and vaccination through age 26 for women and 21 for men who were not vaccinated previously. The model showed that the current vaccination strategy in the U.S. will substantially reduce HPV-associated diseases and is cost saving, whereas vaccinating mid-adult women and men through age 45 years is predicted to produce small additional reductions in HPV-associated diseases and result in substantially higher cost-effectiveness ratios than the current recommendations.
These findings suggest that policies extending HPV vaccination programs to include middle-aged adults may produce relatively small population benefit.
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2. Novel risk model predicts mortality for older adults within 6 months of hospitalization for AMI
A new risk model to predict mortality for older adults within 6 months of being hospitalized for acute myocardial infarction (AMI) has been developed. The novel risk model takes into account 15 variables, including 4 that were not considered in prior models: hearing impairment, mobility impairment, weight loss, and lower patient-reported health status. Findings from a cohort study are published in Annals of Internal Medicine.
Advanced age is a strong determinant of post-AMI mortality in the 6 months after hospital discharge. Whereas older adults often have worse outcomes compared to their younger counterparts, some older patients do very well. Clinical practice guidelines endorse routine use of AMI mortality risk models to assist with decision making after AMI hospitalization, but those risk models were derived from younger cohorts and may not work as well in older adults, who tend to have different risk factors for death.
Researchers from Yale University School of Medicine studied 3,006 persons aged 75 years or older who were hospitalized with AMI and discharged alive to develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in this population. Fifteen risk factors were selected for inclusion in the prediction model, including comorbid diseases, laboratory values, in-hospital procedures, and functional impairments.
The model considered several factors relevant to older adults that had not been considered in prior AMI risk models. The researchers found that by considering factors such as mobility and sensory impairments, cachexia, and health status, their model had good discrimination, was well-calibrated, and performed better than or as well as existing risk models.