Ekwunife Obinna I, O'Mahony James F, Gerber Grote Andreas, Mosch Christoph, Paeck Tatjana, Lhachimi Stefan K
Collaborative Research Group for Evidence-Based Public Health, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, BIPS/University of Bremen, Achterstr. 30, 28359, Bremen, Germany.
Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria.
Pharmacoeconomics. 2017 Jan;35(1):65-82. doi: 10.1007/s40273-016-0451-7.
Low- and middle-income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programmes that do not apply in high-income countries.
This review assessed how context-specific challenges of implementing cervical cancer prevention strategies in LMICs were accounted for in existing cost-effectiveness analysis (CEA) models of human papillomavirus (HPV) vaccination.
The databases of MEDLINE, EMBASE, NHS Economic Evaluation Database, EconLit, Web of Science, and the Center for the Evaluation of Value and Risk in Health (CEA) Registry were searched for studies published from 2006 to 2015. A descriptive, narrative, and interpretative synthesis of data was undertaken.
Of the 33 studies included in the review, the majority acknowledged cost per vaccinated girl (CVG) (26 studies) and vaccine coverage rate (21 studies) as particular challenges for LMICs, while nine studies identified screening coverage rate as a challenge. Most of the studies estimated CVG as a composite of different cost items. However, the basis for the items within this composite cost was unclear. The majority used an assumption rather than an observed rate to represent screening and vaccination coverage rates. CVG, vaccine coverage and screening coverage were shown by some studies through sensitivity analyses to reverse the conclusions regarding cost-effectiveness, thereby significantly affecting policy recommendations.
While many studies recognized aspects of the particular challenges of HPV vaccination in LMICs, greater efforts need to be made in adapting models to account for these challenges. These include adapting costings of HPV vaccine delivery from other countries, learning from the outcomes of cervical cancer screening programmes in the same geographical region, and taking into account the country's previous experience with other vaccination programmes.
低收入和中等收入国家（LMICs）在实施宫颈癌预防项目时面临一些高收入国家不存在的挑战。
本综述评估了在人乳头瘤病毒（HPV）疫苗接种的现有成本效益分析（CEA）模型中，是如何考虑LMICs实施宫颈癌预防策略时因具体情况而异的挑战的。
检索MEDLINE、EMBASE、英国国家医疗服务体系经济评估数据库、EconLit、科学引文索引数据库以及健康价值与风险评估中心（CEA）注册库2006年至2015年发表的研究。对数据进行描述性、叙述性和解释性综合分析。
在纳入综述的33项研究中，大多数承认每个接种女孩的成本（CVG）（26项研究）和疫苗接种覆盖率（21项研究）是LMICs面临的特殊挑战，而9项研究将筛查覆盖率视为一项挑战。大多数研究将CVG估计为不同成本项目的综合指标。然而，这一综合成本中各项成本的依据并不明确。大多数研究使用假设而非观察到的比率来代表筛查和疫苗接种覆盖率。一些研究通过敏感性分析表明，CVG、疫苗接种覆盖率和筛查覆盖率会改变成本效益结论，从而显著影响政策建议。
虽然许多研究认识到LMICs中HPV疫苗接种面临的特定挑战的各个方面，但仍需做出更大努力来调整模型以应对这些挑战。这些努力包括调整来自其他国家的HPV疫苗接种成本计算方法，借鉴同一地理区域宫颈癌筛查项目的成果，并考虑该国此前其他疫苗接种项目的经验。
