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).