比利时对女孩进行宫颈癌疫苗接种的成本效益评价：性活跃前和性活跃后的影响
Incremental cost-effectiveness evaluation of vaccinating girls against cervical cancer pre- and post-sexual debut in Belgium.
机构信息
Health Economics, GlaxoSmithKline Vaccines, Rue Fleming 20, B-1300 Wavre, Belgium.
出版信息
Vaccine. 2013 Aug 20;31(37):3962-71. doi: 10.1016/j.vaccine.2013.06.008. Epub 2013 Jun 15.
BACKGROUND
Vaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The role of protection against non-HPV-16/18 was also investigated.
METHODS
A published Markov cohort model was adapted to Belgium. The model replicated the natural history of HPV infection, the effects of screening, and vaccination. Vaccine efficacy (VE) included non-HPV-16/18 protection based on the PATRICIA clinical trial data. Pre- and post-HPV exposure VE were differentiated. Lifetime vaccine protection was assumed. Input data were obtained from literature review, national databases and a Delphi panel. Costing was from a healthcare payer perspective. Costs were discounted at 3% and effects at 1.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. The specific effect of non-HPV-16/18 protection was investigated. Univariate sensitivity analysis was performed on key variables.
RESULTS
The model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of €9171/QALY. Vaccinating at age 26 would prevent 340 CC cases (40 non-HPV-16/18) with an ICER of €17,348/QALY and vaccinating at age 40 would prevent 146 CC cases (17 non-HPV-16/18) with an ICER of €42,847/QALY. The ICER remained under the highly cost-effective threshold (1×GDP/capita) until age 33 years and under the cost-effective threshold (3×GDP/capita) beyond age 40.
CONCLUSION
Extending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.
背景
接种人乳头瘤病毒（HPV）疫苗以预防宫颈癌（CC）主要针对性行为前的年轻女孩，具有成本效益。我们评估了在比利时，与单独筛查相比，在性行为后接种 HPV-16/18 AS04 佐剂疫苗加筛查是否仍然具有成本效益。还研究了对非 HPV-16/18 的保护作用。
方法
我们改编了发表的 HPV 疫苗接种模型，以适应比利时的情况。该模型复制了 HPV 感染的自然史、筛查的效果以及疫苗接种的效果。疫苗效力（VE）包括基于 PATRICIA 临床试验数据的非 HPV-16/18 保护作用。区分了 HPV 暴露前和暴露后的 VE。假设了终生疫苗保护。输入数据来自文献综述、国家数据库和德尔菲小组。成本来自医疗保健支付者的角度。成本贴现率为 3%，效果贴现率为 1.5%。从 12 岁到 40 岁，每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）和预防的病变数量进行了评估。还研究了非 HPV-16/18 保护的具体效果。对关键变量进行了单变量敏感性分析。
结果
该模型估计，在 12 岁时为 10 万名女孩接种疫苗，将在一生中预防 646 例 CC 病例（102 例非 HPV-16/18），ICER 为 9171 欧元/QALY。26 岁时接种疫苗将预防 340 例 CC 病例（40 例非 HPV-16/18），ICER 为 17348 欧元/QALY；40 岁时接种疫苗将预防 146 例 CC 病例（17 例非 HPV-16/18），ICER 为 42847 欧元/QALY。在 33 岁之前，ICER 低于高成本效益阈值（1×人均 GDP），在 40 岁之后，ICER 低于成本效益阈值（3×人均 GDP）。
结论
将 HPV 疫苗接种扩展到性行为后的女性中，可能会大大降低与 CC 相关的负担，并且在比利时具有成本效益。
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