Health and economic implications of HPV vaccination in the United States.
Health and economic implications of HPV vaccination in the United States.
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DOI：
10.1056/nejmsa0707052
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发表时间：
2008-08-21
期刊：
影响因子：
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通讯作者：
Goldie SJ
中科院分区：
文献类型：
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作者：
Kim JJ;Goldie SJ
预防性接种人乳头瘤病毒16型（HPV-16）和18型（HPV-18）的成本效益是美国免疫指南的重要考虑因素。我们使用HPV-16和HPV-18传播和宫颈癌发生模型综合流行病学和人口统计学数据，比较青春期前女孩（12岁）和年龄较大的女孩和妇女在追赶计划中接种疫苗（至18岁，21岁或26岁）的健康和经济结果。我们通过四价疫苗、免疫持续时间和未来的筛查实践，检查了避免其他HPV-16相关和HPV-18相关癌症、预防HPV-6相关和HPV-11相关生殖器疣和青少年复发性呼吸道乳头状瘤病的健康益处。假设疫苗提供终身免疫力，与现行的筛查做法相比，为12岁女孩接种疫苗的成本效益比为每获得质量调整生命年43，600美元。在基线假设下，将女孩的临时追赶计划延长至18岁的成本效益比为每QALY 97，300美元;将女孩和妇女的疫苗接种延长至21岁的成本为每QALY 120，400美元，延长至26岁的成本为每QALY 152，700美元。结果对疫苗诱导的免疫力持续时间敏感;如果10年后免疫力减弱，青春期前女孩的疫苗接种成本将超过每个QALY 140，000美元，并且追赶策略的成本效益低于单独筛查。如果包括避免其他健康状况的益处，或者如果筛查被延迟，并且以较低的间隔进行，并且使用更敏感的测试，则疫苗接种策略的成本效益比更有利;如果接种疫苗的女孩在成年后更频繁地优先进行筛查，则成本效益比不太有利。HPV疫苗接种的成本效益将取决于疫苗免疫的持续时间，并将通过在青春期前女孩中实现高覆盖率来优化，将最初的追赶努力目标定为18岁或21岁以下的妇女，并修订筛查政策。
The cost-effectiveness of prophylactic vaccination against human papillomavirus types 16 (HPV-16) and 18 (HPV-18) is an important consideration for guidelines for immunization in the United States. We synthesized epidemiologic and demographic data using models of HPV-16 and HPV-18 transmission and cervical carcinogenesis to compare the health and economic outcomes of vaccinating preadolescent girls (at 12 years of age) and vaccinating older girls and women in catch-up programs (to 18, 21, or 26 years of age). We examined the health benefits of averting other HPV-16–related and HPV-18–related cancers, the prevention of HPV-6–related and HPV-11–related genital warts and juvenile-onset recurrent respiratory papillomatosis by means of the quadrivalent vaccine, the duration of immunity, and future screening practices. On the assumption that the vaccine provided lifelong immunity, the cost-effectiveness ratio of vaccination of 12-year-old girls was $43,600 per quality-adjusted life-year (QALY) gained, as compared with the current screening practice. Under baseline assumptions, the cost-effectiveness ratio for extending a temporary catch-up program for girls to 18 years of age was $97,300 per QALY; the cost of extending vaccination of girls and women to the age of 21 years was $120,400 per QALY, and the cost for extension to the age of 26 years was $152,700 per QALY. The results were sensitive to the duration of vaccine-induced immunity; if immunity waned after 10 years, the cost of vaccination of preadolescent girls exceeded $140,000 per QALY, and catch-up strategies were less cost-effective than screening alone. The cost-effectiveness ratios for vaccination strategies were more favorable if the benefits of averting other health conditions were included or if screening was delayed and performed at less frequent intervals and with more sensitive tests; they were less favorable if vaccinated girls were preferentially screened more frequently in adulthood. The cost-effectiveness of HPV vaccination will depend on the duration of vaccine immunity and will be optimized by achieving high coverage in preadolescent girls, targeting initial catch-up efforts to women up to 18 or 21 years of age, and revising screening policies.