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。 公共卫生相关性：HPV相关癌症流行病学和医疗技术领域的快速发展为美国癌症预防方法带来了革命性的机会，但已经超过了政策制定者就最佳卫生干预措施做出明智决策的能力。在这个项目中，我们建议开发一个灵活的建模框架，使我们能够综合关于HPV的最佳可用数据，洞察不同策略的比较和成本效益，并帮助制定关于预防HPV相关癌症的知情公共卫生和临床决策。

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. PUBLIC HEALTH RELEVANCE: Rapid advances in the fields of HPV-related cancer epidemiology and medical technology present opportunities to revolutionize the approach to cancer prevention in the U.S. but have outpaced the ability of policy makers to make informed decisions regarding optimal adoption of health interventions. In this project, we propose to develop a flexible modeling framework that will enable us to synthesize the best available data on HPV, provide insight into the comparative and cost-effectiveness of different strategies, and assist in informed public health and clinical decision-making with respect to prevention of HPV-related cancers.