Department of Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
Vaccine. 2012 Feb 27;30(10):1813-22. doi: 10.1016/j.vaccine.2012.01.001. Epub 2012 Jan 10.
Cross-protection against non-HPV16/18 types and the emergence of broad spectrum vaccines protecting against multiple HPV types will influence the cost-effectiveness of future screening. To assess this influence we used an individual-based simulation model describing the relation between 14 HPV types and cervical disease, allowing the occurrence of multiple type infections. Screening scenarios for vaccinated women were evaluated, firstly for HPV16/18 vaccination with partial cross-protection against HPV 31, 33, 45 and 58 and secondly, for broad spectrum vaccination against 5-13 HPV types. The vaccine-induced incidence reduction of type-specific infection was varied from 0 to 95% in the cross-protection setting and set at 100% in the setting of broad spectrum vaccines. Scenarios of either cytology or HPV DNA screening were considered under varying lifetime number of screening rounds. At a cost-effectiveness threshold of €20,000/QALY, four times HPV DNA screening between 30 and 60 years was the selected scenario in addition to HPV16/18 vaccination, whether or not cross-protection was conferred (€6707 and €9994/QALY, respectively). In the absence of cross-protection, a fifth screening round might be considered (ICER €22,967/QALY). In addition to broad spectrum vaccination, one screen during lifetime was cost-effective up to an 11-valent vaccine. If the vaccine-induced type-specific incidence reduction was lowered to 99%, one screen during lifetime was cost-effective even in addition to 13-valent vaccination. In conclusion, in a cohort of HPV16/18 vaccinated women, four rounds of HPV DNA screening is cost-effective. One screen during lifetime remains cost-effective in addition to broad spectrum vaccination offering protection against many high-risk HPV types.
交叉保护非 HPV16/18 型和广谱疫苗预防多种 HPV 型别的出现将影响未来筛查的成本效益。为了评估这种影响，我们使用了一种基于个体的模拟模型，描述了 14 种 HPV 型别与宫颈疾病之间的关系，允许发生多种型别的感染。评估了针对接种疫苗女性的筛查方案，首先是 HPV16/18 疫苗接种，对 HPV31、33、45 和 58 具有部分交叉保护作用，其次是针对 5-13 种 HPV 型别的广谱疫苗接种。在交叉保护设置中，疫苗诱导的特定型别感染发生率从 0%到 95%不等，而在广谱疫苗设置中则设定为 100%。在不同的终生筛查轮数下，考虑了细胞学或 HPV DNA 筛查的方案。在成本效益阈值为 20,000 欧元/QALY 的情况下，除了 HPV16/18 疫苗接种外，HPV DNA 筛查还可以选择在 30 至 60 岁之间进行四次筛查（分别为 6707 和 9994/QALY），无论是否存在交叉保护作用。在没有交叉保护的情况下，可能会考虑进行第五次筛查（ICER 为 22967/QALY）。除了广谱疫苗接种外，一生中进行一次筛查在 11 价疫苗的情况下具有成本效益。如果疫苗诱导的特定型别感染发生率降低到 99%，则即使在进行 13 价疫苗接种的情况下，一生中进行一次筛查也是具有成本效益的。总之，在 HPV16/18 接种疫苗的女性队列中，进行四次 HPV DNA 筛查是具有成本效益的。一生中进行一次筛查在添加广谱疫苗接种后仍然具有成本效益，可以预防多种高危 HPV 型别。
