Comparative and Cost-Effectiveness of Preventing HPV-Related Diseases

描述（由申请人提供）：美国每年发生超过25，000例由人乳头瘤病毒（HPV）感染引起的浸润性癌症;近50%为宫颈癌，其余涉及口腔/口咽、肛门、外阴、阴茎和阴道。总的来说，这些因素造成了很高的发病率和死亡率，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展，加上新的（例如，HPV-16，-18疫苗，HPV DNA检测）和新兴（例如，生物标志物、治疗性疫苗）技术为改善癌症预防工作提供了显著的机会。然而，在临床决策和预防政策方面仍然存在重大挑战，涉及不同癌症自然史的知识差距和异质性，HPV-16，-18疫苗接种后HPV类型分布的不确定性以及新兴技术的实际临床有效性。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数据;评估替代策略的健康和经济后果;探索其结果的不确定性;明确量化与不同方法相关的权衡;并及时告知临床和政策问题。通过实现我们的目标，我们期望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策略的有效性;（4）HPV相关癌症的结果，包括降低发病率，提高生活质量，改善生存率，减少差异;以及（5）提供癌症相关卫生服务的财政和经济状况。

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.