Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa
Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa
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DOI：
10.1002/ijc.26269
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发表时间：
2012-06-01
影响因子：
6.4
通讯作者：
Goldie, Sue J.
中科院分区：
文献类型：
--
作者：
Campos, Nicole G.;Kim, Jane J.;Goldie, Sue J.
东非是世界上宫颈癌发病率和死亡率最高的地区。我们使用来自肯尼亚、莫桑比克、坦桑尼亚、乌干达和津巴布韦的流行病学数据来建立hpv相关感染和疾病的模型。对于每个国家，我们评估了12岁前女孩的HPV疫苗接种情况，然后一生（35岁、40岁、45岁）进行一次、两次或三次HPV DNA检测筛查。对于30岁以上的女性，我们只评估筛查（一生中进行三次HPV DNA检测或35岁时进行VIA检测）。假设没有免疫力下降，接种疫苗的终生癌症风险平均降低幅度为36%至45%，接种疫苗后在35岁时进行一次HPV DNA检测筛查，终生癌症风险平均降低幅度为43%至51%。对于年轻和老年妇女来说，最有效的筛查策略是每一生进行三次HPV DNA检测。如果每个接种疫苗的女孩的成本低于10美元（每剂2美元），则疫苗接种的增量成本-效果比[每年挽救生命1美元（国际美元）]低于具体国家的人均国内生产总值，这是非常具有成本效益的干预措施通常引用的启发式。如果每个接种疫苗的女孩的费用在10美元（每剂2美元）到25美元（每剂5美元）之间，那么接种疫苗后进行HPV DNA检测将挽救大多数生命，并被认为是对公共卫生资金的良好回报。这些结果应用于促进HPV疫苗交付和筛查规划的设计和评估，并有助于就资助贫穷国家的HPV疫苗接种进行对话。
Eastern Africa has the world's highest cervical cancer incidence and mortality rates. We used epidemiologic data from Kenya, Mozambique, Tanzania, Uganda, and Zimbabwe to develop models of HPV-related infection and disease. For each country, we assessed HPV vaccination of girls before age 12 followed by screening with HPV DNA testing once, twice, or three times per lifetime (at ages 35, 40, 45). For women over age 30, we assessed only screening (with HPV DNA testing up to three times per lifetime or VIA at age 35). Assuming no waning immunity, mean reduction in lifetime cancer risk associated with vaccination ranged from 36 to 45%, and vaccination followed by screening once per lifetime at age 35 with HPV DNA testing ranged from 43 to 51%. For both younger and older women, the most effective screening strategy was HPV DNA testing three times per lifetime. Provided the cost per vaccinated girl was less than I$10 (I$2 per dose), vaccination had an incremental cost-effectiveness ratio [I$ (international dollars)/year of life saved (YLS)] less than the country-specific per capita GDP, a commonly cited heuristic for very cost-effective interventions. If the cost per vaccinated girl was between I$10 (I$2 per dose) and I$25 (I$5 per dose), vaccination followed by HPV DNA testing would save the most lives and would be considered good value for public health dollars. These results should be used to catalyze design and evaluation of HPV vaccine delivery and screening programs, and contribute to a dialogue on financing HPV vaccination in poor countries.