Deshmukh Ashish A, Chhatwal Jagpreet, Chiao Elizabeth Y, Nyitray Alan G, Das Prajnan, Cantor Scott B
Department of Health Services Research Cancer Prevention Training Research Program.
Institute for Technology Assessment, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts.
Clin Infect Dis. 2015 Nov 15;61(10):1527-35. doi: 10.1093/cid/civ628. Epub 2015 Jul 29.
Recent evidence shows that quadrivalent human papillomavirus (qHPV) vaccination in men who have sex with men (MSM) who have a history of high-grade anal intraepithelial neoplasia (HGAIN) was associated with a 50% reduction in the risk of recurrent HGAIN. We evaluated the long-term clinical and economic outcomes of adding the qHPV vaccine to the treatment regimen for HGAIN in human immunodeficiency virus (HIV)-positive MSM aged ≥27 years.
We constructed a Markov model based on anal histology in HIV-positive MSM comparing qHPV vaccination with no vaccination after treatment for HGAIN, the current practice. The model parameters, including baseline prevalence, disease transitions, costs, and utilities, were either obtained from the literature or calibrated using a natural history model of anal carcinogenesis. The model outputs included lifetime costs, quality-adjusted life years, and lifetime risk of developing anal cancer. We estimated the incremental cost-effectiveness ratio of qHPV vaccination compared to no qHPV vaccination and decrease in lifetime risk of anal cancer. We also conducted deterministic and probabilistic sensitivity analyses to evaluate the robustness of the results.
Use of qHPV vaccination after treatment for HGAIN decreased the lifetime risk of anal cancer by 63% compared with no vaccination. The qHPV vaccination strategy was cost saving; it decreased lifetime costs by $419 and increased quality-adjusted life years by 0.16. Results were robust to the sensitivity analysis.
Vaccinating HIV-positive MSM aged ≥27 years with qHPV vaccine after treatment for HGAIN is a cost-saving strategy. Therefore, expansion of current vaccination guidelines to include this population should be a high priority.
近期证据表明，在有高级别肛门上皮内瘤变（HGAIN）病史的男男性行为者（MSM）中接种四价人乳头瘤病毒（qHPV）疫苗，可使HGAIN复发风险降低50%。我们评估了在年龄≥27岁的人类免疫缺陷病毒（HIV）阳性MSM中，将qHPV疫苗添加到HGAIN治疗方案中的长期临床和经济结果。
我们基于HIV阳性MSM的肛门组织学构建了一个马尔可夫模型，比较HGAIN治疗后接种qHPV疫苗与不接种疫苗（当前做法）的情况。模型参数，包括基线患病率、疾病转变、成本和效用，要么从文献中获取，要么使用肛门癌发生的自然史模型进行校准。模型输出包括终生成本、质量调整生命年和患肛门癌的终生风险。我们估计了接种qHPV疫苗与不接种qHPV疫苗相比的增量成本效益比以及肛门癌终生风险的降低情况。我们还进行了确定性和概率性敏感性分析，以评估结果的稳健性。
与不接种疫苗相比，HGAIN治疗后使用qHPV疫苗可使肛门癌终生风险降低63%。qHPV疫苗接种策略具有成本节约效益；它使终生成本降低了419美元，并使质量调整生命年增加了0.16。结果对敏感性分析具有稳健性。
在年龄≥27岁的HIV阳性MSM中，HGAIN治疗后接种qHPV疫苗是一种节约成本的策略。因此，将当前疫苗接种指南扩大到包括这一人群应成为高度优先事项。
