Bardach Ariel Esteban, Garay Osvaldo Ulises, Calderón María, Pichón-Riviére Andrés, Augustovski Federico, Martí Sebastián García, Cortiñas Paula, Gonzalez Marino, Naranjo Laura T, Gomez Jorge Alberto, Caporale Joaquín Enzo
IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina.
Salud Chacao, Final Av. Ávila, Edif. Salud Chacao. Urb. Bello Campo. Chacao, 1060, Caracas, D.C, Venezuela.
BMC Public Health. 2017 Feb 2;17(1):152. doi: 10.1186/s12889-017-4064-7.
Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers.
A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed.
Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs.
Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results.
宫颈癌（CC）和尖锐湿疣（GW）是委内瑞拉一个重大的公共卫生问题。我们的目标是评估二价和四价这两种现有疫苗针对委内瑞拉女孩人乳头瘤病毒（HPV）的成本效益，以便为决策者提供信息。
一个先前发表的、基于现有最佳证据的马尔可夫队列模型，针对委内瑞拉的情况进行了调整，以从医疗保健支付者的角度评估疫苗接种对264,489名11岁女孩队列的健康和医疗保健成本的影响。成本和质量调整生命年（QALYs）按5%进行贴现。分析了八个情景，以描述在不同疫苗价格、汇率和接种方案下的成本效益。进行了确定性和概率性敏感性分析。
与仅进行筛查相比，二价和四价疫苗在所有情景下均节省成本，四价疫苗分别避免了2310例和2143例死亡、4781例和4431例宫颈癌以及多达18459例尖锐湿疣，并分别获得了4486个和4395个贴现QALYs。对于这两种疫苗，在进行确定性和概率性敏感性分析后，增量成本效益比变化的主要决定因素是转移概率、疫苗和癌症治疗成本以及宫颈癌病例中HPV 16和18的分布。比较疫苗时，没有一种疫苗始终比另一种更具成本效益。在敏感性分析中，对于这些比较，主要决定因素是尖锐湿疣发病率、交叉保护水平，以及在某些情景下的疫苗成本。
在委内瑞拉，接种二价或四价HPV疫苗显示出节省成本或具有成本效益，低于每获得一个QALY人均国内生产总值（GDP）（104,404委内瑞拉玻利瓦尔）的阈值。确定性和概率性敏感性分析证实了这些结果的稳健性。
