National Clinical Trial and Research Center, National Taiwan University Hospital, Taipei, Taiwan.
BMC Health Serv Res. 2010 Jan 11;10:11. doi: 10.1186/1472-6963-10-11.
Human papillomavirus (HPV) infection has been shown to be a major risk factor for cervical cancer. Vaccines against HPV-16 and HPV-18 are highly effective in preventing type-specific HPV infections and related cervical lesions. There is, however, limited data available describing the health and economic impacts of HPV vaccination in Taiwan. The objective of this study was to assess the cost-effectiveness of prophylactic HPV vaccination for the prevention of cervical cancer in Taiwan.
We developed a Markov model to compare the health and economic outcomes of vaccinating preadolescent girls (at the age of 12 years) for the prevention of cervical cancer with current practice, including cervical cytological screening. Data were synthesized from published papers or reports, and whenever possible, those specific to Taiwan were used. Sensitivity analyses were performed to account for important uncertainties and different vaccination scenarios.
Under the assumption that the HPV vaccine could provide lifelong protection, the massive vaccination among preadolescent girls in Taiwan would lead to reduction in 73.3% of the total incident cervical cancer cases and would result in a life expectancy gain of 4.9 days or 8.7 quality-adjusted life days at a cost of US$324 as compared to the current practice. The incremental cost-effectiveness ratio (ICER) was US$23,939 per life year gained or US$13,674 per quality-adjusted life year (QALY) gained given the discount rate of 3%. Sensitivity analyses showed that this ICER would remain below US$30,000 per QALY under most conditions, even when vaccine efficacy was suboptimal or when vaccine-induced immunity required booster shots every 13 years.
Although gains in life expectancy may be modest at the individual level, the results indicate that prophylactic HPV vaccination of preadolescent girls in Taiwan would result in substantial population benefits with a favorable cost-effectiveness ratio. Nevertheless, we should not overlook the urgency to improve the compliance rate of cervical screening, particularly for older individuals.
人乳头瘤病毒（HPV）感染已被证实是宫颈癌的主要危险因素。HPV-16 和 HPV-18 疫苗在预防特定类型 HPV 感染和相关宫颈病变方面非常有效。然而，关于 HPV 疫苗接种在台湾的健康和经济影响的数据有限。本研究旨在评估在台湾为预防宫颈癌而对青春期前女孩（12 岁时）进行 HPV 预防性疫苗接种的成本效益。
我们开发了一个马尔可夫模型，以比较对青春期前女孩进行 HPV 预防性疫苗接种以预防宫颈癌与目前的常规做法（包括宫颈细胞学筛查）的健康和经济结果。数据来自已发表的论文或报告，并且在可能的情况下，使用特定于台湾的数据。进行敏感性分析以考虑重要的不确定性和不同的疫苗接种方案。
假设 HPV 疫苗能提供终身保护，那么在台湾大规模为青春期前女孩接种疫苗将使宫颈癌总发病例减少 73.3%，并使预期寿命增加 4.9 天或 8.7 个质量调整生命年，成本为 324 美元，与目前的常规做法相比。增量成本效益比（ICER）为每获得 1 个生命年增加 23939 美元，或每获得 1 个质量调整生命年增加 13674 美元（鉴于 3%的贴现率）。敏感性分析表明，在大多数情况下，即使疫苗效力不佳，或者疫苗诱导的免疫力需要每 13 年加强注射一次，这种 ICER 仍将低于 30000 美元/质量调整生命年。
尽管个体层面的预期寿命增加可能有限，但结果表明，在台湾对青春期前女孩进行 HPV 预防性疫苗接种将带来显著的人群效益，并具有良好的成本效益。然而，我们不应忽视提高宫颈筛查的依从率的紧迫性，特别是对于年龄较大的人群。
