四价人乳头瘤病毒疫苗在台湾地区的成本效益分析

The cost-effectiveness of a quadrivalent human papillomavirus vaccine in Taiwan.

作者信息

Dasbach Erik J, Insinga Ralph P, Yang Yuh Cheng, Pwu Raoh-Fang, Lac Christina, Elbasha Elamin H

机构信息

Health Economic Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, North Wales, PA 19454-1099, USA.

出版信息

Asian Pac J Cancer Prev. 2008 Jul-Sep;9(3):459-66.

PMID:18990021

Abstract

BACKGROUND

A quadrivalent human papillomavirus (HPV 6/11/16/18) vaccine has recently received regulatory approval in Taiwan for the prevention of cervical carcinoma, high-grade cervical dysplasia (cervical intraepithelial neoplasia 2/3 [CIN 2/3]), low-grade cervical dysplasia (CIN 1), high-grade vulvar and vaginal dysplasia, and external genital warts.

OBJECTIVE

To examine the potential long-term epidemiologic and economic consequences of a quadrivalent HPV (6/11/16/18) vaccination program in Taiwan.

METHODS

A transmission dynamic model was used to estimate the long-term epidemiologic and economic consequences of quadrivalent HPV vaccination. Two vaccination strategies were evaluated in conjunction with current cervical cancer screening: 1) vaccination of 12-year-old girls and 2) vaccination of 12-year-old girls with a temporary 5-year catch-up vaccination of females aged 12-24 years (catch-up).

RESULTS

From an epidemiologic perspective, both vaccination strategies reduce the overall incidence of HPV 16/18-related cervical cancer relative to no vaccination by 91% during year 100 following vaccine introduction. Likewise, both vaccination strategies reduce the incidence of CIN 2/3, CIN 1, and genital warts by approximately 90%, 86%, and 94%, respectively, at this time point. However, the catch-up program consistently achieves greater benefit earlier than the 12-year-old program. The catch-up strategy is both more effective and efficient than the strategy that vaccinates 12-year-old girls only, with an incremental cost-effectiveness ratio of New Taiwan dollars (NT$) 410,477 per quality-adjusted life-year gained.

CONCLUSIONS

The results from this model suggest that in Taiwan, prophylactic HPV 6/11/16/18 vaccination of females can: 1) substantially reduce genital warts, CIN, and cervical cancer; 2) improve quality of life and survival; and 3) be cost-effective when implemented as a vaccination strategy that includes a temporary catch-up program.

摘要

背景

一种四价人乳头瘤病毒（HPV 6/11/16/18）疫苗最近在台湾获得监管批准，用于预防宫颈癌、高级别宫颈发育异常（宫颈上皮内瘤变2/3级[CIN 2/3]）、低级别宫颈发育异常（CIN 1）、高级别外阴和阴道发育异常以及外生殖器疣。

目的

研究台湾四价HPV（6/11/16/18）疫苗接种计划可能产生的长期流行病学和经济后果。

方法

使用传播动力学模型来估计四价HPV疫苗接种的长期流行病学和经济后果。结合当前的宫颈癌筛查评估了两种接种策略：1）对12岁女孩进行接种；2）对12岁女孩进行接种，并对12至24岁女性进行为期5年的临时补种（补种）。

结果

从流行病学角度来看，相对于不接种疫苗，在引入疫苗后的第100年，两种接种策略均使HPV 16/18相关宫颈癌的总体发病率降低了91%。同样，在这一时间点，两种接种策略分别使CIN 2/3、CIN 1和生殖器疣的发病率降低了约90%、86%和94%。然而，补种计划始终比仅对12岁女孩进行接种的计划更早地实现更大的效益。补种策略比仅对12岁女孩进行接种的策略更有效且更具成本效益，每获得一个质量调整生命年的增量成本效益比为新台币410,477元。