Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country
Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country
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DOI：
10.1016/j.vaccine.2018.04.061
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发表时间：
2018-08-01
期刊：
影响因子：
5.5
通讯作者：
Kim, Jane J.
中科院分区：
文献类型：
--
作者：
Burger, Emily A.;Campos, Nicole G.;Kim, Jane J.
背景：尽管预防性人乳头瘤病毒 (HPV) 疫苗接种指南建议 9-14 岁女孩接种两剂疫苗，但多项研究表明，一剂疫苗可提供类似的保护作用。我们的目标是评估低收入国家中常规一剂 HPV 疫苗接种与 (1) 不接种疫苗和 (2) 两剂 HPV 疫苗接种相比的长期健康和经济影响。方法：我们使用三层混合建模方法，捕捉 HPV 传播、宫颈癌发生和人口统计数据，以预测与一剂 HPV 疫苗接种相关的长期健康和经济结果（假设在三个衰弱的情况下对 HPV-16/18 感染有 80% 的功效）乌干达的两剂 HPV 疫苗接种（假设终生 100% 有效）。成本包括 10 年期间的疫苗计划（剂量和交付）成本以及当前乌干达妇女一生中的宫颈癌成本。健康结果包括宫颈癌病例数和伤残调整生命年（DALY）。计算增量成本效益比（即避免每个伤残调整生命年的成本），并与乌干达人均国内生产总值进行比较。结果：对 9 岁女孩进行常规一剂 HPV 疫苗接种需要大量的前期投资，但在考虑到避免未来癌症的成本抵消时，与不接种疫苗相比可以节省成本。在开始常规疫苗接种 40 年后，根据疫苗减弱的假设，具有同等覆盖率 (70%) 的一剂 HPV 疫苗接种可避免 15-16% 的宫颈癌病例，而两剂疫苗接种可避免 21% 的宫颈癌病例，但只需要一半的前期经济投资。两剂疫苗接种具有有吸引力的成本效益，除非一剂疫苗接种能够实现更高的覆盖率（90% 与 70%）并且没有减弱。结论：与不接种疫苗相比，一剂 HPV 疫苗接种可以节省成本，并且如果保护是长期的并且可以实现更高的覆盖率，那么与两剂疫苗接种相比可能具有成本效益。 (C) 2018 作者。由爱思唯尔有限公司出版
Background: Although guidelines for prophylactic human papillomavirus (HPV) vaccination recommend two doses for girls ages 9-14 years, several studies have demonstrated similar protection with one dose. Our objective was to evaluate the long-term health and economic impacts of routine one-dose HPV vaccination compared to (1) no vaccination and (2) two-dose HPV vaccination in a low-income country.Methods: We used a three-tiered hybrid modeling approach that captured HPV transmission, cervical carcinogenesis, and population demographics to project long-term health and economic outcomes associated with one-dose HPV vaccination (assuming 80% efficacy against HPV-16/18 infections under three waning scenarios) and two-dose HPV vaccination (assuming 100% efficacy over the lifetime) in Uganda. Costs included the vaccine program (dosage and delivery) costs over a 10-year period and cervical cancer costs over the lifetimes of the current population of Ugandan women. Health outcomes included number of cervical cancer cases and disability-adjusted life years (DALYs). Incremental cost-effectiveness ratios (i.e., cost per DALY averted) were calculated and compared against the Ugandan per-capita gross domestic product.Results: Routine one-dose HPV vaccination of 9-year-old girls required substantial upfront investment but was cost-saving compared to no vaccination when accounting for the cost-offsets from future cancers averted. Forty years after initiating routine vaccination and depending on assumptions of vaccine waning, one-dose HPV vaccination with equivalent coverage (70%) averted 15-16% of cervical cancer cases versus 21% with two-dose vaccination but required only half the upfront economic investment. Vaccination with two doses had an attractive cost-effectiveness profile except if one-dose vaccination enabled higher coverage (90% vs. 70%) and did not wane.Conclusions: One-dose HPV vaccination resulted in cost-savings compared to no vaccination and could be cost-effective compared to two-dose vaccination if protection is longstanding and higher coverage can be achieved. (C) 2018 The Authors. Published by Elsevier Ltd.