Germar Maria Julieta, Purugganan Carrie, Bernardino Ma Socorro, Cuenca Benjamin, Chen Y-Chen, Li Xiao, Van Kriekinge Georges, Lee I-Heng
a University of the Philippines College of Medicine, Philippine General Hospital, Metro , Manila , Philippines.
b St Martin De Porres Charity Hospital , San Juan, Mandaluyong City , Philippines.
Hum Vaccin Immunother. 2017 May 4;13(5):1158-1166. doi: 10.1080/21645515.2016.1269991. Epub 2017 Jan 11.
Cervical cancer (CC) is the second leading cause of cancer death among Filipino women. Human papillomavirus (HPV) vaccination protects against CC. Two vaccines (AS04-HPV-16/18 and 4vHPV) are approved in the Philippines; they were originally developed for a 3-dose (3D) administration and have recently been approved in a 2-dose schedule (2D). This study aims to evaluate the cost-effectiveness of HPV vaccination of 13-year-old Filipino girls, in addition to current screening, in the new 2D schedule. An existing static lifetime, one-year cycle Markov cohort model was adapted to the Philippine settings to simulate the natural history of low-risk and oncogenic HPV infection, the effects of screening and vaccination of a 13-year-old girls cohort vaccinated with either the 2D-AS04-HPV-16/18 or 2D-4vHPV assuming a 100% vaccination coverage. Incremental cost, quality-adjusted life year (QALY) and cost-effectiveness were derived from these estimates. Input data were obtained from published sources and Delphi panel, using country-specific data where possible. Sensitivity analyses were performed to assess the robustness of the model. The model estimated that 2D-AS04-HPV-16/18 prevented 986 additional CC cases and 399 CC deaths (undiscounted), as well as 555 increased QALY (discounted), and save 228.1 million Philippine pesos (PHP) compared with the 2D-4vHPV. In conclusion, AS04-HPV-16/18 is shown to be dominant over 4vHPV in the Philippines, with greater estimated health benefits and lower costs.
宫颈癌(CC)是菲律宾女性癌症死亡的第二大主要原因。人乳头瘤病毒(HPV)疫苗接种可预防宫颈癌。两种疫苗(AS04-HPV-16/18和4价HPV)在菲律宾已获批准;它们最初是为3剂次(3D)接种方案研发的,最近已获批2剂次接种方案(2D)。本研究旨在评估在新的2剂次接种方案下,除现行筛查外,对13岁菲律宾女孩进行HPV疫苗接种的成本效益。将现有的静态终生、一年周期马尔可夫队列模型应用于菲律宾的情况,以模拟低风险和致癌性HPV感染的自然史,以及假设接种覆盖率为100%的情况下,对13岁女孩队列接种2D-AS04-HPV-16/18或2D-4价HPV进行筛查和疫苗接种的效果。从这些估计中得出增量成本、质量调整生命年(QALY)和成本效益。输入数据尽可能使用特定国家的数据,从已发表的资料和德尔菲小组获得。进行敏感性分析以评估模型的稳健性。该模型估计,与2D-4价HPV相比,2D-AS04-HPV-16/18预防了986例额外的宫颈癌病例和399例宫颈癌死亡(未贴现),以及555个增加的QALY(贴现),并节省了2.281亿菲律宾比索(PHP)。总之,在菲律宾,AS04-HPV-16/18被证明优于4价HPV,估计健康效益更大且成本更低。