Risk-Based Prophylactic Human Papillomavirus Vaccination of Heterosexual US Men Aged 27 to 45 Years for Prevention of Oropharyngeal Cancer

Human papillomavirus (HPV) vaccination of US individuals aged 27–45 years is recommended through shared clinical decision-making. To enable shared decision-making, we used a microsimulation-based state-transition model to develop and validate a risk-prediction model to identify heterosexual men aged 27–45 years at high-risk of acquiring oral HPV-16 infections. A risk model for incident oral HPV-16 infections had good discrimination (AUC = 0.73) and calibration (ratio of expected to the observed number of incident oral HPV-16 infections through age 45 years [E/O] = 1.01) in internal cross-validation. Compared to vaccinating all men aged 27–45, vaccinating 44% of men with highest model-predicted risk would prevent 80% of incident oral HPV-16 infections through age 45 years and reduce the number needed to be vaccinated to prevent 1 infection by 45% (184 vs 100).