Comparative and Cost-Effectiveness of Preventing HPV-Related Diseases

描述(申请人提供)：美国每年发生超过25,000例可归因于人类乳头瘤病毒(HPV)感染的浸润性癌症；近50%是宫颈癌，其余涉及口腔/口咽、肛门、外阴、阴茎和阴道。总体而言，这些导致了相当大的发病率和死亡率，造成了健康差距，并与高昂的经济成本有关。HPV相关癌症流行病学的进步，加上新技术(如HPV-16、HPV-18疫苗、HPV DNA检测)和新兴技术(如生物标记物、治疗性疫苗)，为改进癌症预防工作提供了难得的机会。然而，在临床决策和预防政策方面仍然存在关键挑战，涉及不同癌症自然历史中的知识差距和异质性、HPV-16、HPV-18疫苗接种后HPV类型分布的不确定性以及新兴技术的真实临床有效性。我们建议采用决策分析方法，开发一个灵活的建模框架，使我们能够综合最佳可用的数据；评估替代战略的健康和经济后果；探索围绕其结果的不确定性；明确量化与不同方法相关的权衡；并及时提供临床和政策问题信息。通过实现我们的目标，我们预计将对以下方面产生影响：(1)决策科学的分析方法；(2)新技术的公平分配和合理使用；(3)通过临床指南和国家政策预防癌症的战略的有效性；(4)与HPV相关的癌症结果，包括减少发病率、提高生活质量、改善生存率和缩小差异；以及(5)提供与癌症相关的健康服务的财务和经济状况。

DESCRIPTION (provided by applicant): Each year, more than 25,000 cases of invasive cancer attributable to human papillomavirus (HPV) infection occur in the United States; nearly 50% are cervical cancer, while the rest involve the oral cavity/oropharynx, anus, vulva, penis, and vagina. Collectively, these account for substantial morbidity and mortality, contribute to health disparities, and are associated with high economic costs. Advancements in HPV-related cancer epidemiology, coupled with new (e.g., HPV-16,-18 vaccines, HPV DNA testing) and emerging (e.g., biomarkers, therapeutic vaccines) technologies provide a remarkable opportunity to improve cancer prevention efforts. However, critical challenges remain with respect to clinical decision-making and prevention policy, pertaining to knowledge gaps and heterogeneities in the natural history of different cancers, uncertainties in HPV type distribution following HPV-16,-18 vaccination, and the real-world clinical effectiveness of emerging technologies. We propose to employ a decision-analytic approach, developing a flexible modeling framework that will allow us to synthesize the best available data; evaluate the health and economic consequences of alternative strategies; explore the uncertainty around their outcomes; explicitly quantify the tradeoffs associated with different approaches; and inform timely clinical and policy questions. By achieving our aims, we expect to have an impact on (1) the analytic methods of decision science; (2) the equitable distribution and rationale use of new technology; (3) the effectiveness of strategies for cancer prevention through clinical guidelines and national policies; (4) HPV-related cancer outcomes, including reduced incidence, enhanced quality of life, improved survival, and reduced disparities; and (5) the financial and economic profile of delivering cancer-related health services.