Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys
Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys
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DOI：
10.1371/journal.pone.0089974
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发表时间：
2014-03-20
期刊：
影响因子：
3.7
通讯作者：
Kim, Jane J.
中科院分区：
文献类型：
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作者：
Burger, Emily A.;Sy, Stephen;Kim, Jane J.
背景：越来越多的国家开始为女性接种人乳头瘤病毒（HPV）疫苗，这种病毒与多种癌症和生殖器疣有因果关系，但很少有国家建议男孩接种疫苗。疫苗价格的下降以及疫苗对减少女性和男性 HPV 相关疾病的有力证据促使各国重新评估是否有必要为男孩接种 HPV 疫苗。 方法：根据挪威经验，对之前发表的 HPV 传播动态模型进行了校准。 HPV 发病率的降低，包括直接和间接的益处，被应用于宫颈癌的自然史模型以及其他非宫颈 HPV 相关疾病的基于发病率的模型。我们计算了不分性别的疫苗接种计划与仅限女性的疫苗接种计划下不同 HPV 相关疾病的健康结果和成本。结果：疫苗价格对结果具有决定性影响。例如，假设覆盖率达到 71%，疫苗功效较高，疫苗招标价格合理，每剂 75 美元，我们发现，当考虑到所有 HPV 相关疾病的疫苗效益时，在挪威，为女孩和男孩接种疫苗的成本效益阈值（每获得 83,000 美元/质量调整生命年 (QALY)）均低于该阈值。然而，按照目前的市场价格，包括男孩在内不会被认为“物有所值”。对于成本效益阈值较低（30,000 美元/QALY）的环境，将当前计划扩大到包括男孩将被认为不具有成本效益，除非疫苗价格低于 36 美元/剂。将女孩的疫苗接种覆盖率提高到 90% 比对两性进行 71% 的疫苗接种覆盖率更有效且成本更低。结论：按照预期的招标价格，将 HPV 疫苗接种计划扩大到男孩可能具有成本效益，并且可能需要改变挪威目前仅限女性的疫苗接种政策。然而，增加女孩的疫苗接种覆盖率始终比扩大男孩的疫苗接种覆盖率更有效且更具成本效益，因此应被视为优先事项。
Background: Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted.Methods: A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program.Results: Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage.Conclusions: At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.