Market Access, Vaccine Advocacy & Medical Affairs, Sanofi Pasteur MSD, 8 rue Jonas Salk, 69007, Lyon, France.
Health Econ Rev. 2012 Sep 25;2(1):19. doi: 10.1186/2191-1991-2-19.
Persistent infections with human papillomavirus (HPV) are a necessary cause of cervical cancer and are responsible for important morbidity in men and women. Since 2007, HPV vaccination has been recommended and funded for all girls aged 12 to 17 in Germany. A previously published cost-effectiveness analysis, using a static model, showed that a quadrivalent HPV vaccination programme for 12-year-old girls in Germany would be cost effective. Here we present the results from a dynamic transmission model that can be used to evaluate the impact and cost-effectiveness of different vaccination schemas.
We adapted a HPV dynamic transmission model, which has been used in other countries, to the German context. The model was used to compare a cervical cancer screening only strategy with a strategy of combining vaccination of females aged 12-17 years old and cervical cancer screening, based on the current recommendations in Germany. In addition, the impact of increasing vaccination coverage in this cohort of females aged 12-17 years old was evaluated in sensitivity analysis.
The results from this analysis show that the current quadrivalent HPV vaccination programme of females ages 12 to 17 in Germany is cost-effective with an ICER of 5,525€/QALY (quality adjusted life year). The incremental cost-effectiveness ratio (ICER) increased to 10,293€/QALY when the vaccine effects on HPV6/11 diseases were excluded. At steady state, the model predicted that vaccinating girls aged 12 to 17 could reduce the number of HPV 6/11/16/18-related cervical cancers by 65% and genital warts among women and men by 70% and 48%, respectively. The impact on HPV-related disease incidence and costs avoided would occur relatively soon after initiating the vaccine programme, with much of the early impact being due to the prevention of HPV6/11-related genital warts.
These results show that the current quadrivalent HPV vaccination and cervical cancer screening programmes in Germany will substantially reduce the incidence of cervical cancer, cervical intraepithelial neoplasia (CIN) and genital warts. The evaluated vaccination strategies were all found to be cost-effective. Future analyses should include more HPV-related diseases.
人乳头瘤病毒（HPV）持续感染是宫颈癌的必要病因，也是男性和女性发生重要疾病的原因。自 2007 年以来，德国已推荐并为所有 12 至 17 岁的女孩提供 HPV 疫苗接种。此前发表的一项使用静态模型的成本效益分析表明，在德国为 12 岁女孩实施四价 HPV 疫苗接种计划具有成本效益。在此，我们介绍一种可用于评估不同疫苗接种方案的影响和成本效益的动态传播模型的结果。
我们调整了一种已在其他国家使用的 HPV 动态传播模型，使其适用于德国的情况。该模型用于比较仅进行宫颈癌筛查的策略与在德国当前建议的基础上，结合对 12-17 岁女性接种疫苗和宫颈癌筛查的策略。此外，还在敏感性分析中评估了增加该 12-17 岁女性队列中疫苗接种覆盖率的影响。
该分析的结果表明，目前在德国对 12 至 17 岁女性实施的四价 HPV 疫苗接种计划具有成本效益，增量成本效益比（ICER）为 5525 欧元/质量调整生命年（QALY）。当排除 HPV6/11 疾病的疫苗效果时，增量成本效益比（ICER）增加到 10293 欧元/QALY。在稳定状态下，该模型预测，对 12 至 17 岁女孩进行疫苗接种可以使 HPV6/11/16/18 相关宫颈癌的数量减少 65%，并分别使女性和男性的生殖器疣减少 70%和 48%。HPV 相关疾病发病率和避免成本的影响将在启动疫苗接种计划后不久出现，早期影响主要归因于 HPV6/11 相关生殖器疣的预防。
这些结果表明，目前德国的四价 HPV 疫苗接种和宫颈癌筛查计划将大大降低宫颈癌、宫颈上皮内瘤变（CIN）和生殖器疣的发病率。评估的疫苗接种策略均具有成本效益。未来的分析应包括更多的 HPV 相关疾病。
