Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India.
Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India.
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HPV 16和18印度疫苗接种和宫颈癌筛查的健康和经济影响。
DOI：
10.1038/sj.bjc.6604462
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发表时间：
2008-07-22
影响因子：
8.8
通讯作者：
Goldie, S. J.
中科院分区：
文献类型：
--
作者：
Diaz, M.;Kim, J. J.;Albero, G.;de Sanjose, S.;Clifford, G.;Bosch, F. X.;Goldie, S. J.
宫颈癌是低收入国家妇女癌症死亡的主要原因，全世界约25%的病例发生在印度。我们估计了不同宫颈癌预防策略的潜在健康和经济影响。根据国家具体流行病学数据对宫颈癌模型进行实证校准后，我们预测了癌症发病率、预期寿命和终生成本（2005年），并计算了以下策略的增量成本-效果比（2005年）：12岁以下女孩的青春期前疫苗接种，30岁以上妇女的筛查，以及疫苗接种和筛查相结合。筛查因检查（细胞学、目视检查、HPV DNA检测）、临床就诊次数（1次、2次或3次）、频率（一生1次、2次、3次）和年龄范围（35-45岁）而异。在敏感性分析中，疫苗效力、覆盖率和成本各不相同。假设覆盖率为70%，单独接种HPV 16、18疫苗的终生癌症风险平均降低44%（范围28-57%），每一生筛查三次的终生癌症风险平均降低21-33%。结合疫苗接种和每一生三次筛查，平均减少56%（疫苗接种加三次常规细胞学检查）至63%（疫苗接种加两次HPV DNA检测）。以该国的人均国内生产总值（3452美元）为门槛，以每位接种疫苗的女孩的成本为10美元（每剂费用为2美元），青春期前接种疫苗，然后使用VIA或HPV DNA检测进行一生三次筛查，将被认为具有成本效益。在印度，如果能够实现提供长期保护的低成本人乳头瘤病毒疫苗对青春期前女孩的高覆盖率，那么接种疫苗之后，每一生进行三次筛查，预计将使癌症死亡人数减少一半，并且具有成本效益。
Cervical cancer is a leading cause of cancer death among women in low-income countries, with ∼25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 × , 2 × , 3 × per lifetime), and age range (35–45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with HPV 16,18 vaccination alone, and 21–33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.
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影响因子：
7
作者：
Basu, A;Mukherjee, N;Majumder, PP
通讯作者：
Majumder, PP
影响因子：
6.4
作者：
Goldie, SJ;Grima, D;Franco, E
通讯作者：
Franco, E
影响因子：
5.5
作者：
Garnett, Geoffrey P.;Kim, Jane J.;Goldie, Sue J.
通讯作者：
Goldie, Sue J.
影响因子：
6.4
作者：
Franceschi, S;Rajkumar, T;Herrero, R
通讯作者：
Herrero, R
DOI：
10.1111/j.1525-1438.2007.00827.x
发表时间：
2007-01-01
影响因子：
4.8
作者：
Laikangbam, P.;Sengupta, S.;Mukhopadhyay, S.
通讯作者：
Mukhopadhyay, S.