Limitations
This study has several limitations. It was conducted in 1 US region within a mixed-model health care system, which both insures and provides care within and outside of Kaiser Permanente. All study participants had some form of health insurance coverage and a primary care physician, which differs from the proportions of 88% with insurance coverage and 75% with a primary care physician among US adults.In addition, the HOME trial did not collect data on HPV vaccination history, limiting our ability to inform the association of cost-effectiveness with HPV vaccine uptake. However, the lack of such data was reasonable given that participants were women aged 30 to 64 years, most of whom would have been ineligible for HPV vaccination before the age of first sexual intercourse. The HPV vaccines were first available in the US in 2006 and were only recommended through age of 26 years before 2019.