Too Late to Vaccinate? The Incremental Benefits and Cost-effectiveness of a Delayed Catch-up Program Using the 4-Valent Human Papillomavirus Vaccine in Norway
Too Late to Vaccinate? The Incremental Benefits and Cost-effectiveness of a Delayed Catch-up Program Using the 4-Valent Human Papillomavirus Vaccine in Norway
复制标题
DOI：
10.1093/infdis/jiu413
复制
发表时间：
2015-01-15
影响因子：
6.4
通讯作者：
Kim, Jane J.
中科院分区：
文献类型：
--
作者：
Burger, Emily A.;Sy, Stephen;Kim, Jane J.
背景人乳头瘤病毒（HPV）疫苗最好在HPV暴露前接种;因此，青春期后女孩的追赶计划尚未得到资助。我们评估了在挪威延迟1年的女性追加疫苗接种计划的效益和成本效益。我们根据挪威的数据校准了一个动态HPV传播模型，并预测了与8种HPV相关疾病相关的成本和收益，同时将疫苗接种年龄上限改为20岁，22岁，24岁或26岁。我们探讨了疫苗保护对既往有疫苗靶向HPV感染的妇女的影响、疫苗成本、覆盖率以及自然和疫苗诱导的免疫力。随着追赶年龄上限的增加，增量效益和成本效益下降。假设疫苗费用为150美元/剂，20岁以下的疫苗接种仍低于挪威的支付意愿阈值（约83 000美元/获得的质量调整生命年）;延长至22岁的疫苗接种具有成本效益，每剂费用较低（50 - 75美元）。在既往暴露于HPV的女性中，疫苗保护水平较高，接种至26岁具有成本效益。结果稳定，覆盖率较低。常规实施5年后的HPV疫苗接种追赶计划可能是必要的;然而，即使每剂疫苗的成本较低，22岁以上接种疫苗的成本效益仍然不确定。
Background. Human papillomavirus (HPV) vaccines are ideally administered before HPV exposure; therefore, catch-up programs for girls past adolescence have not been readily funded. We evaluated the benefits and cost-effectiveness of a delayed, 1-year female catch-up vaccination program in Norway.Methods. We calibrated a dynamic HPV transmission model to Norwegian data and projected the costs and benefits associated with 8 HPV-related conditions while varying the upper vaccination age limit to 20, 22, 24, or 26 years. We explored the impact of vaccine protection in women with prior vaccine-targeted HPV infections, vaccine cost, coverage, and natural-and vaccine-induced immunity.Results. The incremental benefits and cost-effectiveness decreased as the upper age limit for catch-up increased. Assuming a vaccine cost of $150/dose, vaccination up to age 20 years remained below Norway's willingness-to-pay threshold (approximately $83 000/quality-adjusted life year gained); extension to age 22 years was cost-effective at a lower cost per dose ($50-$75). At high levels of vaccine protection in women with prior HPV exposure, vaccinating up to age 26 years was cost-effective. Results were stable with lower coverage.Conclusions. HPV vaccination catch-up programs, 5 years after routine implementation, may be warranted; however, even at low vaccine cost per dose, the cost-effectiveness of vaccinating beyond age 22 years remains uncertain.