Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru
Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru
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DOI：
10.1590/s1020-49892012001400006
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发表时间：
2012-12-01
期刊：
影响因子：
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通讯作者：
Mendoza Araujo, Maria Ana
中科院分区：
文献类型：
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作者：
Goldie, Sue J.;Levin, Carol;Mendoza Araujo, Maria Ana
客观的。评估将人乳头瘤病毒 (HPV) 疫苗接种纳入秘鲁宫颈癌筛查计划的益处、成本效益（即物有所值）和所需的财务成本（例如负担能力）。方法。将在秘鲁进行的 HPV 疫苗接种示范项目的证据（例如覆盖范围、交付成本）与经验校准的数学模型中的流行病学数据相结合，以评估不同成本、覆盖范围和功效假设下的筛查（一生进行 3 至 5 次 HPV DNA 检测）和 HPV 疫苗接种。模型结果包括终生癌症风险降低、癌症病例避免、生命挽救、平均预期寿命延长、短期财务成本和贴现长期经济成本。结果。与不进行筛查相比，目前低水平的筛查（例如，细胞学筛查覆盖率为 10.0%）可将终生患宫颈癌的风险降低 11.9%。在示范计划中增加对青春期前女孩的疫苗接种覆盖率（82.0%），额外减少了 46.1%，每年挽救生命 (YLS) 的费用不到 500 美元（相当于 7 美元/剂），或相当于 1 300 美元（相当于 20 美元/剂）。一年的疫苗接种费用估计约为 500 万美元（相当于每剂 5 美元），或相当于 1600 万美元（相当于每剂 20 美元），其中包括规划成本。加强成年女性筛查与青春期前疫苗接种相结合的增量成本效益比低于秘鲁 2005 年人均国内生产总值（GDP；2 852 美元，2009 年美元），因此被认为具有成本效益。结论。青春期前接种 HPV 疫苗，然后在成年女性中加强 HPV DNA 筛查，可以预防三分之二的宫颈癌死亡。如果疫苗价格较低，有几种策略将被认为对资源投入具有“良好价值”。虽然财务成本意味着大量的直接投资，但高价值的回报应该激发创新的融资机制和扩大实施计划。
Objective. To estimate the benefits, cost-effectiveness (i.e., value for money), and required financial costs (e. g., affordability) of adding human papillomavirus (HPV) vaccination to Peru's cervical cancer screening program.Methods. Evidence (e. g., coverage, delivery costs) from an HPV vaccination demonstration project conducted in Peru was combined with epidemiological data in an empirically calibrated mathematical model to assess screening (HPV DNA testing three to five times per lifetime) and HPV vaccination under different cost, coverage, and efficacy assumptions. Model outcomes included lifetime risk of cancer reduction, cancer cases averted, lives saved, average life expectancy gains, short-term financial costs, and discounted long-term economic costs.Results. Status quo low levels of screening (e. g., cytologic screening at 10.0% coverage) reduced lifetime risk of cervical cancer by 11.9%, compared to not screening. Adding vaccination of preadolescent girls at a coverage achieved in the demonstration program (82.0%) produced an additional 46.1% reduction, and would cost less than US$ 500 per year of life saved (YLS) at similar to US$ 7/dose or similar to US$ 1 300 at similar to US$ 20/dose. One year of vaccination was estimated to cost similar to US$ 5 million at similar to US$ 5/dose or similar to US$ 16 million at similar to US$ 20/dose, including programmatic costs. Enhanced screening in adult women combined with preadolescent vaccination had incremental cost-effectiveness ratios lower than Peru's 2005 per capita gross domestic product (GDP; US$ 2 852, in 2009 US$), and would be considered cost-effective.Conclusions. Preadolescent HPV vaccination, followed by enhanced HPV DNA screening in adult women, could prevent two out of three cervical cancer deaths. Several strategies would be considered "good value" for resources invested, provided vaccine prices are low. While financial costs imply substantial immediate investments, the high-value payoff should motivate creative mechanisms for financing and scale-up of delivery programs.