Novaes Hillegonda Maria Dutilh, de Soárez Patrícia Coelho, Silva Gulnar Azevedo, Ayres Andreia, Itria Alexander, Rama Cristina Helena, Sartori Ana Marli Christovam, Clark Andrew D, Resch Stephen
Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455 - 2(o) andar Cerqueira César, 01246-903 São Paulo, SP, Brazil.
Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455 - 2(o) andar Cerqueira César, 01246-903 São Paulo, SP, Brazil.
Vaccine. 2015 May 7;33 Suppl 1:A135-42. doi: 10.1016/j.vaccine.2014.12.031.
To evaluate the impact and cost-effectiveness of introducing universal human papillomavirus (HPV) vaccination into the National Immunization Program (NIP) in Brazil.
The Excel-based CERVIVAC decision support model was used to compare two strategies: (1) status quo (with current screening program) and (2) vaccination of a cohort of 11-year-old girls. National parameters for the epidemiology and costs of cervical cancer were estimated in depth. The estimates were based on data from the health information systems of the public health system, the PNAD 2008 national household survey, and relevant scientific literature on Brazil. Costs are expressed in 2008 United States dollars (US$), and a 5% discount rate is applied to both future costs and future health benefits.
Introducing the HPV vaccine would reduce the burden of disease. The model estimated there would be 229 deaths avoided and 6677 disability-adjusted life years (DALYs) averted in the vaccinated cohort. The incremental cost-effectiveness ratios (ICERs) per DALY averted from the perspectives of the government (US$ 7663), health system (US$ 7412), and society (US$ 7298) would be considered cost-effective, according to the parameters adopted by the World Health Organization. In the sensitivity analysis, the ICERs were most sensitive to variations in discount rate, disease burden, vaccine efficacy, and proportion of cervical cancer caused by types 16 and 18. However, universal HPV vaccination remained a cost-effective strategy in most variations of the key estimates.
Vaccine introduction could contribute additional benefits in controlling cervical cancer, but it requires large investments by the NIP. Among the essential conditions for attaining the expected favorable results are immunization program sustainability, equity in a population perspective, improvement of the screening program, and development of a surveillance system.
评估在巴西国家免疫规划（NIP）中引入人乳头瘤病毒（HPV）普遍接种疫苗的影响和成本效益。
基于Excel的CERVIVAC决策支持模型用于比较两种策略：（1）现状（采用当前的筛查计划）和（2）为一组11岁女孩接种疫苗。深入估计了巴西宫颈癌流行病学和成本的国家参数。这些估计基于公共卫生系统健康信息系统的数据、2008年全国住户抽样调查（PNAD）以及巴西的相关科学文献。成本以2008年美元（US$）表示，对未来成本和未来健康效益均采用5%的贴现率。
引入HPV疫苗将减轻疾病负担。该模型估计，接种疫苗的队列中将避免229例死亡，避免6677个伤残调整生命年（DALY）。根据世界卫生组织采用的参数，从政府（7663美元/ DALY）、卫生系统（7412美元/ DALY）和社会（7298美元/ DALY）角度来看，每避免一个DALY的增量成本效益比（ICER）将被视为具有成本效益。在敏感性分析中，ICER对贴现率、疾病负担、疫苗效力以及16型和18型引起的宫颈癌比例的变化最为敏感。然而，在关键估计的大多数变化中，HPV普遍接种仍然是一种具有成本效益的策略。
引入疫苗在控制宫颈癌方面可能带来额外益处，但这需要国家免疫规划进行大量投资。实现预期良好结果的基本条件包括免疫规划的可持续性、从人群角度看的公平性、筛查计划的改进以及监测系统的发展。
