Walwyn Leslie, Janusz Cara Bess, Clark Andrew David, Prieto Elise, Waight Eufemia, Largaespada Natalia
Stapleton Lane Clinic, St John's, Antigua, West Indies.
Pan American Health Organization, Washington, D.C., USA.
Vaccine. 2015 May 7;33 Suppl 1:A174-81. doi: 10.1016/j.vaccine.2014.12.042.
Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule.
The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis.
In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine.
Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program.
在伯利兹女性中，宫颈癌既是主要癌症，也是癌症死亡的主要原因。四价和二价人乳头瘤病毒（HPV）疫苗在伯利兹均已获批上市。伯利兹卫生部召集了一个多学科团队，以评估在国家免疫规划中增加HPV疫苗的成本、健康效益和成本效益。
采用CERVIVAC成本效益模型（版本1.123）评估一组10岁女孩接种HPV疫苗的终生健康和经济结果。对照为未接种HPV疫苗。使用泛美卫生组织周转基金谈判达成的每剂13.79美元的价格（用于四价疫苗），并利用国家数据源确定人口统计学、宫颈癌发病率和死亡率、宫颈癌治疗成本以及疫苗接种成本。在情景分析中采用了国际机构的估计数据。
在一组追踪终生的约4000名伯利兹女孩中，估计HPV疫苗接种可预防69例新发宫颈癌（未折现）和51例宫颈癌死亡（未折现）。从社会角度考虑潜在的宫颈癌治疗成本以及家庭避免的工资损失，每避免一个伤残调整生命年（DALY）的成本估计为429美元。若分析中排除宫颈癌治疗成本和工资损失，这一数字增至1320美元。这两个估计值均远低于伯利兹的人均国内生产总值（4795美元）。女性及其家庭节省的终生医疗保健成本超过政府为该疫苗所需投资成本的60%。
在伯利兹，常规HPV疫苗接种具有很高的成本效益。如果价格可承受，应努力加快将该疫苗引入伯利兹国家免疫规划。
