Szucs Thomas D, Largeron Nathalie, Dedes Konstantin J, Rafia Rachid, Bénard Stève
Institute for Social and Preventive Medicine, University of Zurich, Switzerland.
Curr Med Res Opin. 2008 May;24(5):1473-83. doi: 10.1185/030079908x297826. Epub 2008 Apr 14.
Based on positive safety and efficacy data, a quadrivalent Human PapillomaVirus (HPV) vaccine has been approved in Switzerland to prevent HPV types 6, 11, 16 and 18 infections. The objective of this study was to explore the cost-effectiveness of an HPV vaccination in Switzerland.
A Markov model of the natural history of HPV infection was adapted to the Swiss context and followed a hypothetical cohort of 41,200 girls aged 11 years over their lifetime. Main epidemiological and economic parameters were extracted from the literature. Two strategies were compared: conventional cytological screening only and HPV vaccination followed by conventional cytological screening. A coverage rate of 80% was used and the vaccine was assumed to provide a lifelong protection. Analyses were performed from the direct health care cost perspective including only direct medical costs.
Compared to screening only, adding a quadrivalent HPV vaccine could prevent over lifetime 62% of cervical cancers and related deaths, 19% of Cervical Intraepithelial Neoplasia (CIN 1), 43% of CIN 2, 45% of CIN 3 and 66% of genital warts per cohort. Incremental cost-effectiveness ratios (ICER) were estimated to be CHF 45,008 per Life Year Gained (LYG) and CHF 26,005 per Quality Adjusted Life Year (QALY) gained. Sensitivity analyses demonstrated that the ICER was robust to all parameters, but was most sensitive to the need for a booster and discount rates.
Compared to commonly accepted standard thresholds in Europe and other vaccination strategies implemented in Switzerland, adding a quadrivalent HPV vaccine alongside the current cervical cancer screening programme is likely to be cost-effective in Switzerland.
基于阳性安全性和有效性数据，一种四价人乳头瘤病毒（HPV）疫苗已在瑞士获批，用于预防6、11、16和18型HPV感染。本研究的目的是探讨HPV疫苗接种在瑞士的成本效益。
将HPV感染自然史的马尔可夫模型适用于瑞士情况，并跟踪一组假设的41200名11岁女孩一生的情况。主要流行病学和经济参数从文献中提取。比较了两种策略：仅进行传统细胞学筛查和HPV疫苗接种后进行传统细胞学筛查。采用80%的覆盖率，并假设疫苗提供终身保护。分析从直接医疗保健成本角度进行，仅包括直接医疗费用。
与仅进行筛查相比，添加四价HPV疫苗可在一生中预防每队列62%的宫颈癌及相关死亡、19%的宫颈上皮内瘤变（CIN 1）、43%的CIN 2、45%的CIN 3和66%的尖锐湿疣。增量成本效益比（ICER）估计为每获得一个生命年（LYG）45008瑞士法郎，每获得一个质量调整生命年（QALY）26005瑞士法郎。敏感性分析表明，ICER对所有参数都很稳健，但对加强针需求和贴现率最为敏感。
与欧洲普遍接受的标准阈值以及瑞士实施的其他疫苗接种策略相比，在当前宫颈癌筛查计划中添加四价HPV疫苗在瑞士可能具有成本效益。
