Graham Donna M, Isaranuwatchai Wanrudee, Habbous Steven, de Oliveira Claire, Liu Geoffrey, Siu Lillian L, Hoch Jeffrey S
Princess Margaret Cancer Center, Toronto, Ontario, Canada.
Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada.
Cancer. 2015 Jun 1;121(11):1785-92. doi: 10.1002/cncr.29111. Epub 2015 Apr 13.
Many western countries have established female human papillomavirus (HPV) vaccination programs for the prevention of cervical cancer. The quadrivalent HPV vaccine (HPV4) has proven efficacy against additional HPV-related disease in both sexes, but the cost effectiveness of male HPV vaccination remains controversial. To assess the cost effectiveness of male HPV vaccination in Canada with respect to oropharyngeal cancer (OPC), the authors performed a preliminary cost-effectiveness analysis.
After an extensive literature review regarding HPV-related OPC in Canadian males, health care costs and clinical effectiveness estimates were obtained. A Markov model was used to compare the potential costs and effectiveness of HPV4 versus no vaccination among boys aged 12 years. A theoretical cohort based on a Canadian population of 192,940 boys aged 12 years in 2012 was assumed to apply the model. A 3-month cycle length was used with a "lifetime" time horizon. The outcome of the analysis was the incremental cost per quality-adjusted life-year (QALY). Sensitivity analyses were conducted on variables, including the vaccine uptake rate and vaccine efficacy.
Assuming 99% vaccine efficacy and 70% uptake, HPV4 produced 0.05 more QALYs and saved $145 Canadian dollars (CAD) per individual compared with no vaccine (QALYs and costs were discounted at 5% per year). Assuming 50% vaccine efficacy and 50% uptake, HPV4 produced 0.023 more QALYs and saved $42 CAD. The results indicated that HPV4 in males may potentially save between $8 and $28 million CAD for the theoretical cohort of 192,940 over its lifetime.
On the basis of this model, HPV vaccination for boys aged 12 years may be a cost-effective strategy for the prevention of OPC in Canada.
许多西方国家已制定女性人乳头瘤病毒（HPV）疫苗接种计划以预防宫颈癌。四价HPV疫苗（HPV4）已被证明对两性的其他HPV相关疾病均有效，但男性HPV疫苗接种的成本效益仍存在争议。为评估在加拿大针对口咽癌（OPC）进行男性HPV疫苗接种的成本效益，作者进行了一项初步成本效益分析。
在对加拿大男性中与HPV相关的OPC进行广泛文献综述后，获得了医疗保健成本和临床效果评估。使用马尔可夫模型比较12岁男孩接种HPV4与不接种疫苗的潜在成本和效果。假设以2012年加拿大192,940名12岁男孩的人群为理论队列来应用该模型。使用3个月的周期长度和“终生”时间范围。分析结果是每质量调整生命年（QALY）的增量成本。对包括疫苗接种率和疫苗效力在内的变量进行了敏感性分析。
假设疫苗效力为99%且接种率为70%，与不接种疫苗相比，HPV4每人产生的QALY多0.05个，节省145加元（CAD）（QALY和成本按每年5%进行贴现）。假设疫苗效力为50%且接种率为50%，HPV4产生的QALY多0.023个，节省42加元CAD。结果表明，对于192,940人的理论队列，HPV4在其终生可能潜在节省800万至2800万加元CAD。
基于该模型，对12岁男孩进行HPV疫苗接种可能是加拿大预防OPC的一种具有成本效益的策略。
