Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States
Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States
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DOI：
10.7326/m19-1182
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发表时间：
2020-01-07
影响因子：
39.2
通讯作者：
Brisson, Marc
中科院分区：
文献类型：
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作者：
Laprise, Jean-Francois;Chesson, Harrell W.;Brisson, Marc
背景资料：在美国，人乳头瘤病毒（HPV）疫苗接种的常规年龄为11至12岁，女性26岁，男性21岁。目的：评估将目前美国HPV疫苗接种计划扩展至27至45岁女性和22至45岁男性的人群水平有效性和成本效益。设计：分析使用HPV-ADVISE（Agent-based Dynamic model for Vaccination and Screening Evaluation），一种基于个体的HPV感染及相关疾病传播动态模型，根据美国特定年龄数据进行校准。数据来源：已发表的数据。目标人群：美国27至45岁的女性和22至45岁的男性。时间范围：100年。视角：卫生保健部门。干预措施：9价HPV疫苗接种。结果指标：预防HPV相关结果和成本效益比。基础病例分析结果：该模型预测，目前美国的HPV疫苗接种计划将使肛门生殖器疣和2级或3级宫颈上皮内瘤变的诊断数量以及宫颈癌和非宫颈HPV相关癌症的病例减少82%，80%，59%，和39%，分别超过100年，并节省成本（与没有接种疫苗）。相比之下，将疫苗接种范围扩大到45岁的女性和男性，预计这些结果将分别减少0.4、0.4、0.2和0.2个百分点。预计为30岁、40岁和45岁以下的女性和男性接种疫苗，每获得一个质量调整生命年，分别需要花费83万美元、184.3万美元和147.1万美元敏感性分析结果：结果对自然免疫和感染后进展率、历史疫苗接种覆盖率和疫苗有效性的假设最为敏感。局限性：不确定性的HPV相关疾病的比例，由于感染后的年龄26岁，从目前的HPV疫苗接种program.Conclusion的羊群效应的水平：目前的HPV疫苗接种计划预计将节省成本。预计将疫苗接种扩大到老年人将产生少量额外的健康益处，并导致比目前建议高得多的增量成本效益比。
Background: In the United States, the routine age for human papillomavirus (HPV) vaccination is 11 to 12 years, with catch-up vaccination through age 26 years for women and 21 years for men. U.S. vaccination policy on use of the 9-valent HPV vaccine in adult women and men is being reviewed.Objective: To evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women aged 27 to 45 years and men aged 22 to 45 years.Design: The analysis used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data.Data Sources: Published data.Target Population: Women aged 27 to 45 years and men aged 22 to 45 years in the United States.Time Horizon: 100 years.Perspective: Health care sector.Intervention: 9-valent HPV vaccination.Outcome Measures: HPV-associated outcomes prevented and cost-effectiveness ratios.Results of Base-Case Analysis: The model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years and is cost saving (vs. no vaccination). In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830 000, $1 843 000, and $1 471 000, respectively, per quality-adjusted life-year gained (vs. current vaccination).Results of Sensitivity Analysis: Results were most sensitive to assumptions about natural immunity and progression rates after infection, historical vaccination coverage, and vaccine efficacy.Limitation: Uncertainty about the proportion of HPV-associated disease due to infections after age 26 years and about the level of herd effects from the current HPV vaccination program.Conclusion: The current HPV vaccination program is predicted to be cost saving. Extending vaccination to older ages is predicted to produce small additional health benefits and result in substantially higher incremental cost-effectiveness ratios than the current recommendation.