Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Vaccine. 2013 Aug 20;31(37):3922-7. doi: 10.1016/j.vaccine.2013.06.044. Epub 2013 Jun 24.
Despite an effective screening programme, 600-700 women are still diagnosed with cervical cancer in the Netherlands each year. In 2009 a prophylactic vaccine against HPV-type 16 and 18 was implemented in the national immunisation programme to decrease the incidence of cervical cancer. There is evidence that infections with several oncogenic HPV types other than the vaccine types 16 and 18 are also prevented by vaccination, also known as cross-protection. Besides cervical cancer, HPV can also cause cancers at other sites such as the oropharynx, vulva, vagina and the anus/anal area. In this study we estimated the maximum health and economic benefits of vaccinating 12-year old girls against infection with HPV, taking cross-protection and non-cervical cancers into account. In the base-case, we found an incremental cost ratio (ICER) of €5815 per quality adjusted life year (QALY). Robustness of this result was examined in sensitivity analysis. The ICER proved to be most sensitive to vaccine price, discounting rates, costs of cervical cancer and to variation in the disutility of cervical cancer.
尽管有一项有效的筛查计划，但荷兰每年仍有 600-700 名女性被诊断出患有宫颈癌。2009 年，一种针对 HPV 型 16 和 18 的预防性疫苗被纳入国家免疫计划，以降低宫颈癌的发病率。有证据表明，接种疫苗还可以预防除疫苗类型 16 和 18 以外的几种致癌 HPV 类型的感染，这种现象也被称为交叉保护。除宫颈癌外，HPV 还可导致其他部位的癌症，如口咽、外阴、阴道和肛门/肛门周围。在这项研究中，我们估计了对 12 岁女孩进行 HPV 感染疫苗接种的最大健康和经济效益，同时考虑了交叉保护和非宫颈癌的情况。在基本情况下，我们发现每增加一个质量调整生命年（QALY）的增量成本比（ICER）为 5815 欧元。在敏感性分析中对这一结果的稳健性进行了检验。ICER 对疫苗价格、贴现率、宫颈癌成本以及宫颈癌不适的变化最为敏感。
J Natl Cancer Inst. 2009-8-5
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