Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands.
BMC Infect Dis. 2013 Feb 7;13:75. doi: 10.1186/1471-2334-13-75.
Infection with HPV 16 and 18, the major causative agents of cervical cancer, can be prevented through vaccination with a bivalent or quadrivalent vaccine. Both vaccines provide cross-protection against HPV-types not included in the vaccines. In particular, the bivalent vaccine provides additional protection against HPV 31, 33, and 45 and the quadrivalent vaccine against HPV31. The quadrivalent vaccine additionally protects against low-risk HPV type 6 and 11, responsible for most cases of genital warts. In this study, we made an analytical comparison of the two vaccines in terms of cost-effectiveness including the additional benefits of cross-protection and protection against genital warts in comparison with a screening-only strategy.
We used a Markov model, simulating the progression from HPV infection to cervical cancer or genital warts. The model was used to estimate the difference in future costs and health effects of both HPV-vaccines separately.
In a cohort of 100,000 women, use of the bivalent or quadrivalent vaccine (both at 50% vaccination coverage) reduces the cervical cancer incidence by 221 and 207 cases, corresponding to ICERs of €17,600/QALY and €18,900/QALY, respectively. It was estimated that the quadrivalent vaccine additionally prevents 4390 cases of genital warts, reducing the ICER to €16,300/QALY. Assuming a comparable willingness to pay for cancer and genital warts prevention, the difference in ICERs could justify a slightly higher price (~7% per dose) in favor of the quadrivalent vaccine.
Clearly, HPV vaccination has been implemented for the prevention of cervical cancer. From this perspective, use of the bivalent HPV vaccine appears to be most effective and cost-effective. Including the benefits of prevention against genital warts, the ICER of the quadrivalent HPV vaccine was found to be slightly more favourable. However, current decision-making on the introduction of HPV is driven by the primary cervical cancer outcome. New vaccine tenders could consider the benefits of cross-protection and the benefits of genital warts, which requires more balanced decision-making.
HPV 16 和 18 的感染是宫颈癌的主要致病因素，可通过接种二价或四价疫苗进行预防。这两种疫苗都能对疫苗未包含的 HPV 类型提供交叉保护。特别是，二价疫苗对 HPV 31、33 和 45 型提供额外保护，四价疫苗对 HPV31 型提供额外保护。四价疫苗还可预防低危型 HPV 6 和 11 型，这两种病毒导致了大多数生殖器疣病例。在这项研究中，我们比较了两种疫苗的成本效益，包括交叉保护和预防生殖器疣的额外益处，与仅筛查策略相比。
我们使用马尔可夫模型模拟从 HPV 感染到宫颈癌或生殖器疣的进展。该模型用于单独估计两种 HPV 疫苗的未来成本和健康效果差异。
在 10 万名女性队列中，使用二价或四价疫苗（接种率均为 50%）可分别减少 221 例和 207 例宫颈癌发病，相应的增量成本效益比（ICER）分别为 17600 欧元/QALY 和 18900 欧元/QALY。估计四价疫苗还可预防 4390 例生殖器疣，将 ICER 降低至 16300 欧元/QALY。假设对癌症和生殖器疣预防的支付意愿相当，ICER 差异可证明四价疫苗略高的价格（每剂量高 7%左右）是合理的。
显然，HPV 疫苗已用于预防宫颈癌。从这个角度来看，使用二价 HPV 疫苗似乎最有效且具有成本效益。包括预防生殖器疣的益处，四价 HPV 疫苗的 ICER 略有更有利。然而，当前 HPV 疫苗接种的决策主要基于宫颈癌的主要结果。新的疫苗招标可能会考虑交叉保护和生殖器疣的益处，这需要更平衡的决策。
