Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Eur J Cancer. 2011 Feb;47(3):428-35. doi: 10.1016/j.ejca.2010.09.030.
Besides cervical cancer, the human papillomavirus (HPV) is found in other cancers and may be preventable with HPV vaccination. However, these other cancers are often not accounted for in cost-effectiveness analyses of HPV vaccination. This study estimates the potential maximum effect on the cost-effectiveness ratio (CER) of HPV vaccination in preventing non-cervical HPV-positive cancers. For the Dutch situation, a mathematical equation was used to estimate the maximum impact if all cancer cases of the penis, vulva/vagina, anus, oral cavity and oro-pharynx with HPV16/18 are prevented, in terms of number of life years gained, savings and improvement in the CER of the vaccination. For other countries and for future developments, we show how the impact on the CER varies depending on the incidence of cervical/non-cervical HPV 16/18-positive cancers, vaccine costs and clinical costs. If in the Netherlands all HPV 16/18-positive cancers are prevented by vaccination in women only, compared to if only HPV 16/18-positive cervical cancer is prevented, the life years gained increase with 14%, the savings increase with 18%, and the CER decreases with 13%. If vaccination prevents HPV-positive cancers in both men and women, these figures increase to 25%, 26% and 21%, respectively. In conclusion, if HPV vaccination fully prevents all non-cervical HPV-positive cancers, this would substantially increase its cost-effectiveness. The impact of the vaccination varies depending on the incidence of cervical/non-cervical HPV16/18-positive cancers, the vaccine costs and clinical costs. Observed combinations of these parameters in different countries show a decrease in the CER between 10% and 31%.
除宫颈癌外，人乳头瘤病毒（HPV）也存在于其他癌症中，可通过 HPV 疫苗接种预防。然而，在 HPV 疫苗接种的成本效益分析中，通常不考虑这些其他癌症。本研究旨在评估 HPV 疫苗接种预防非宫颈癌 HPV 阳性癌症的潜在最大效果对成本效益比（CER）的影响。针对荷兰情况，我们使用一个数学方程来估算如果预防所有与 HPV16/18 相关的阴茎癌、外阴癌/阴道癌、肛门癌、口腔癌和口咽癌病例，在获得的生命年数、节省的费用以及 HPV 疫苗接种 CER 的改善方面，所能产生的最大影响。对于其他国家和未来的发展情况，我们展示了在不同国家和未来发展情况下，CER 受宫颈癌/非宫颈癌 HPV16/18 阳性癌症的发病率、疫苗成本和临床成本的影响如何变化。如果在荷兰，仅通过为女性接种疫苗来预防所有 HPV16/18 阳性癌症，与仅预防 HPV16/18 阳性宫颈癌相比，获得的生命年数增加 14%，节省的费用增加 18%，CER 降低 13%。如果疫苗能预防男性和女性的 HPV 阳性癌症，这些数字分别增加到 25%、26%和 21%。总之，如果 HPV 疫苗接种能完全预防所有非宫颈癌 HPV 阳性癌症，那么其成本效益将会显著提高。疫苗接种的影响取决于宫颈癌/非宫颈癌 HPV16/18 阳性癌症的发病率、疫苗成本和临床成本。不同国家观察到的这些参数组合显示 CER 降低了 10%至 31%。
