Modeling Cervical Cancer Prevention in Developed Countries
Modeling Cervical Cancer Prevention in Developed Countries
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DOI：
10.1016/j.vaccine.2008.06.009
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发表时间：
2008-08-19
期刊：
影响因子：
5.5
通讯作者：
Goldie, Sue J.
中科院分区：
文献类型：
--
作者：
Kim, Jane J.;Brisson, Marc;Goldie, Sue J.
在能够实施、维持和资助有组织的方案以实现广泛覆盖的国家，基于细胞学的筛查降低了宫颈癌死亡率。这些正在进行的二级预防工作使是否应该引入针对人乳头瘤病毒（HPV）16型和18型的疫苗接种的问题变得相当复杂。政策问题主要集中在疫苗接种的目标年龄，临时“追赶”计划的适当年龄，筛查政策的可能修订以优化疫苗接种的协同作用，包括增加HPV DNA检测的使用，以及将男孩纳入疫苗接种计划。正在越来越多地开发决策分析模型，以模拟不同环境下的疾病负担和干预措施，从而评估初级和二级干预措施的效益和成本效益，以便作出知情决策。本文是对现有数学模型的重点审查，这些模型已被用于在发达国家现有筛查计划的背景下评估HPV疫苗接种。尽管模型假设存在差异，现有数据存在不确定性，但在目前的筛查实践中，青春期前女孩接种疫苗一直被认为是有吸引力的，前提是有完整的终身疫苗保护和广泛的疫苗接种覆盖率。与追加疫苗接种计划、其他非宫颈癌结局的潜在益处以及纳入男孩相关的问题受到更多不确定性的影响，这些分析的结果得出了相互矛盾的结论。大多数分析发现，有必要进行一些追赶疫苗接种，但随着追赶年龄的延长，这种接种越来越没有吸引力，如果女孩的接种率达到合理水平，或者女孩的接种率可以提高，那么男孩的接种不太可能具有成本效益。本综述的目的是突出共识和定性主题，讨论不同的发现领域，并提供与宫颈癌预防相关的关键决策的见解。(C)2008爱思唯尔有限公司保留所有权利。
Cytology-based screening has reduced cervical cancer mortality in countries able to implement, sustain and financially support organized programs that achieve broad coverage. These ongoing secondary prevention efforts considerably complicate the question of whether vaccination against human papillomavirus (HPV) types 16 and 18 should be introduced. Policy questions focus primarily on the target ages of vaccination, appropriate ages for a temporary "catch-up" program, possible revisions in screening policies to optimize synergies with vaccination, including the increased used of HPV DNA testing, and the inclusion of boys in the vaccination program. Decision-analytic models are increasingly being developed to simulate disease burden and interventions in different settings in order to evaluate the benefits and cost-effectiveness of primary and secondary interventions for informed decision-making. This article is a focused review on existing mathematical models that have been used to evaluate HPV vaccination in the context of developed countries with existing screening programs. Despite variations in model assumptions and uncertainty in existing data, pre-adolescent vaccination of girls has been consistently found to be attractive in the context of current screening practices, provided there is complete and lifelong vaccine protection and widespread vaccination coverage. Questions related to catch-up vaccination programs, potential benefits of other non-cervical cancer outcomes and inclusion of boys are subject to far more uncertainty, and results from these analyses have reached conflicting conclusions. Most analyses find that some catch-up vaccination is warranted but becomes increasingly unattractive as the catch-up age is extended, and vaccination of boys is unlikely to be cost-effective if reasonable levels of coverage are achieved in girls or coverage among girls can be improved. The objective of this review is to highlight points of consensus and qualitative themes, to discuss the areas of divergent findings, and to provide insight into critical decisions related to cervical cancer prevention. (C) 2008 Elsevier Ltd. All rights reserved.