Coupé Veerle M H, van Ginkel Joost, de Melker Hester E, Snijders Peter J F, Meijer Chris J L M, Berkhof Johannes
Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
Int J Cancer. 2009 Feb 15;124(4):970-8. doi: 10.1002/ijc.24000.
We evaluated the cost-effectiveness of HPV16/18 vaccination for girls aged 12 years in The Netherlands in addition to cervical cancer screening. For this purpose, we developed a simulation model that describes the relation between each of the high-risk human papillomavirus (hrHPV) types and cervical disease, allowing the occurrence of multiple type-specific infections. Model parameters were derived from Dutch cohort studies, including a large population-based screening trial, and from the national cervical cancer registry. The model satisfactorily reproduced Dutch data on HPV infection and the presence of cervical lesions. For our base-case scenario in which 85% of the girls aged 12 years were vaccinated against types 16/18 (95% efficacy, lifelong protection), the model predicted a decrease of 60% in the number of cervical cancer cases and cervical cancer deaths indicating that substantial health benefits can be achieved. Health savings were robust against changes in the vaccine efficacy (varied from 85% to 98%) but savings showed a substantial reduction when the efficacy started waning 10 years after vaccination. The discounted costs per quality-adjusted life year (QALY) were euro 19,500/QALY (range euro 11,000 to euro 25,000/QALY) and lied near the cost-effectiveness threshold of euro 20,000/QALY used in The Netherlands. The simulations further showed that vaccination cannot replace screening because vaccination without screening was less effective than screening in preventing cancer in women over 40 years of age. In conclusion, our model results support the implementation of HPV16/18 vaccination in young women in addition to cervical cancer screening.
我们评估了在荷兰对12岁女孩接种人乳头瘤病毒16/18型（HPV16/18）疫苗并结合宫颈癌筛查的成本效益。为此，我们开发了一个模拟模型，该模型描述了每种高危型人乳头瘤病毒（hrHPV）与宫颈疾病之间的关系，允许发生多种特定类型的感染。模型参数来自荷兰队列研究，包括一项基于大规模人群的筛查试验以及国家宫颈癌登记处。该模型令人满意地再现了荷兰关于HPV感染和宫颈病变存在情况的数据。对于我们的基础情景，即85%的12岁女孩接种16/18型疫苗（效力为95%，终身保护），该模型预测宫颈癌病例数和宫颈癌死亡数将减少60%，这表明可以实现显著的健康效益。健康储蓄对疫苗效力的变化（从85%到98%不等）具有稳健性，但当接种疫苗10年后效力开始下降时，储蓄大幅减少。每质量调整生命年（QALY）的贴现成本为19,500欧元/QALY（范围为11,000欧元至25,000欧元/QALY），接近荷兰使用的20,000欧元/QALY的成本效益阈值。模拟结果还表明，接种疫苗不能替代筛查，因为在40岁以上女性中，不进行筛查的接种疫苗预防癌症的效果不如筛查。总之，我们的模型结果支持在年轻女性中实施HPV16/18疫苗接种并结合宫颈癌筛查。
