Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan.
BJOG. 2012 Jan;119(2):177-86. doi: 10.1111/j.1471-0528.2011.03036.x. Epub 2011 Jul 28.
To assess the cost-effectiveness of universal vaccination of 11-year-old girls against human papillomavirus (HPV) infection and increased screening coverage to prevent cervical cancer in Japan where the coverage of Papanicolaou smears is very low.
A cost-utility analysis from a societal perspective.
Japan, 2010.
The female Japanese population aged 11 years or older.
A Markov model of the natural history of cervical cancer was constructed to compare six strategies: i.e. a screening coverage rate of 20, 50 and 80% with and without routine vaccination at age 11.
Cervical cancer incidence, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratios.
Expanding the coverage of Papanicolaou smears from the current level of 20-50 and 80% yields a 45.5 and 63.1% reduction in cervical cancer incidence, respectively. Impact of combined strategies increases with coverage. Coverages of 20, 50 and 80% showed a 66.1, 80.9 and 86.8% reduction in disease, respectively. The costs of strategies with vaccination are four times higher than the cost of strategies without vaccination. Vaccinating all 11-year-old girls with bivalent vaccines with a Papanicolaou smear coverage rate of 50% is likely to be the most cost-effective option among the six strategies.
The introduction of HPV vaccination in Japan is cost-effective as in other countries. It is more cost-effective to increase the coverage of the Papanicolaou smear along with the universal administration of HPV vaccine.
评估在日本为 11 岁女童普遍接种 HPV 疫苗并提高巴氏涂片筛查覆盖率以预防宫颈癌的成本效益，因为日本巴氏涂片筛查的覆盖率非常低。
从社会角度进行的成本效益分析。
日本，2010 年。
11 岁或以上的日本女性人群。
构建了宫颈癌自然史的马尔可夫模型，以比较六种策略：即巴氏涂片筛查覆盖率为 20%、50%和 80%，以及在 11 岁时是否常规接种疫苗。
宫颈癌发病率、质量调整生命年（QALYs）、成本和增量成本效益比。
将巴氏涂片筛查的覆盖率从目前的 20-50%和 80%提高到分别为 45.5%和 63.1%，可降低宫颈癌发病率。联合策略的影响随覆盖率的增加而增加。20%、50%和 80%的覆盖率分别使疾病减少 66.1%、80.9%和 86.8%。接种疫苗的策略成本是不接种疫苗策略成本的四倍。在巴氏涂片筛查覆盖率为 50%的情况下，为所有 11 岁女童接种二价疫苗可能是这六种策略中最具成本效益的选择。
在日本引入 HPV 疫苗接种具有成本效益，与其他国家一样。提高巴氏涂片筛查的覆盖率并同时普遍接种 HPV 疫苗更为经济有效。
