Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA.
BJOG. 2012 Jan;119(2):166-76. doi: 10.1111/j.1471-0528.2011.02974.x. Epub 2011 Apr 12.
To assess the health and economic outcomes of various screening and vaccination strategies for cervical cancer prevention.
Cost-effectiveness analysis from a societal perspective.
Thailand.
Females aged 9 years and older.
Using a mathematical model of human papillomavirus (HPV) infection and cervical cancer, calibrated to epidemiological data from Thailand, we estimated the cost-effectiveness of pre-adolescent HPV vaccination, screening [visual inspection with acetic acid (VIA), HPV DNA testing, and cytology] between one and five times per lifetime in adulthood, and combined pre-adolescent vaccination and screening. Vaccine efficacy, coverage, cost, and screening frequency were varied in sensitivity analyses.
Incremental cost-effectiveness ratios, expressed as cost per year of life saved (YLS).
Assuming lifelong efficacy and 80% coverage, pre-adolescent HPV vaccination alone was projected to reduce the lifetime risk of cervical cancer by 55%, which was greater than any strategy of screening alone. When cost per vaccinated girl was I$10 (approximately $2 per dose) or less, HPV vaccination alone was cost saving. Pre-adolescent vaccination and HPV DNA testing five times per lifetime, starting at age 35 years, reduced the lifetime cervical cancer risk by 70%, and had a cost-effectiveness ratio less than Thailand's GDP per capita (I$8100), provided the cost per vaccinated girl was I$200 or less.
Low cost pre-adolescent HPV vaccination followed by HPV screening five times per lifetime is an efficient strategy for Thailand. Costs may need to be lower, however, for this strategy to be affordable. If vaccination is not feasible, HPV DNA testing five times per lifetime is efficient.
评估宫颈癌预防的各种筛查和疫苗接种策略的健康和经济效益。
从社会角度进行成本效益分析。
泰国。
9 岁及以上女性。
使用人乳头瘤病毒（HPV）感染和宫颈癌的数学模型，根据来自泰国的流行病学数据进行校准，我们估计了青少年前 HPV 疫苗接种、一生中一次或多次筛查（醋酸视觉检查[VIA]、HPV DNA 检测和细胞学）以及青少年前疫苗接种和筛查相结合的成本效益。在敏感性分析中，疫苗效力、覆盖率、成本和筛查频率有所不同。
增量成本效益比，以每挽救一年生命的成本（YLS）表示。
假设终身疗效和 80%的覆盖率，青少年前 HPV 疫苗接种单独使用预计将降低宫颈癌的终生风险 55%，这大于任何单独筛查策略。当每个接种女孩的成本为 10 美元（约合每剂 2 美元）或更低时，HPV 疫苗接种单独使用具有成本效益。从 35 岁开始，青少年前接种疫苗和一生中五次 HPV DNA 检测可将宫颈癌终生风险降低 70%，并且具有成本效益比低于泰国人均国内生产总值（8100 美元），前提是每个接种女孩的成本为 200 美元或更低。
在青少年前进行低成本 HPV 疫苗接种，然后一生中进行五次 HPV 筛查，是泰国的一种有效策略。然而，为了使这种策略具有负担能力，成本可能需要更低。如果疫苗接种不可行，一生中五次 HPV DNA 检测也是有效的。
