新加坡基于学校的四价人乳头瘤病毒疫苗接种的临床和经济效益

The clinical and economic benefits of school-based quadrivalent HPV vaccination in Singapore.

作者信息

Tay Sun Kuie, Hsu Tun-Ying, Shcheprov Andrei, Walia Anuj, Kulkarni Amit S

机构信息

Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.

Medical Affairs, MSD Pharma (Singapore), Singapore.

出版信息

Int J Gynaecol Obstet. 2017 May;137(2):129-137. doi: 10.1002/ijgo.12126. Epub 2017 Mar 10.

DOI:10.1002/ijgo.12126

PMID:28190260

Abstract

OBJECTIVE

To investigate the clinical and economic impacts of school-based administration of the quadrivalent HPV vaccine.

METHODS

A retrospective health-economic analysis was conducted using data collected in Singapore between 2004 and 2005. A dynamic transmission model was adapted for universal vaccination that provided 80% coverage among students aged 11-12 years. Strategy 1 involved only girls, with a 5-year catch-up vaccination to provide 50% coverage among those aged 13-17 years. Strategy 2 included both girls and boys with no catch-up vaccination. Outcomes included the predicted incidence of HPV-related disease over 100 years.

RESULTS

Current coverage was assumed to be 5%. Strategy 1 would reduce cervical intraepithelial neoplasia grade 1 (CIN1) by 63.8%, cervical intraepithelial neoplasia grade 2-3 (CIN2-3) by 62.9%, cervical cancer by 50.9%, and genital warts by 78.0% (female individuals) and 73.6% (male individuals). Strategy 2 would reduce CIN1 by 64.0%, CIN2-3 by 63.1%, cervical cancer by 50.7%, and genital warts by 79.9% (female individuals) and 80.1% (male individuals). The incremental cost-effectiveness ratio was S$12 464 for strategy 1 and $27 837 for Strategy 2. These values decreased to $7477 and $22 574, respectively, if a two-dose regimen was adapted.

CONCLUSION

School-based quadrivalent HPV vaccination offered clinical and economic benefits, and is cost-effective in Singapore.

摘要

目的

探讨在校内接种四价人乳头瘤病毒（HPV）疫苗的临床及经济影响。

方法

利用2004年至2005年在新加坡收集的数据进行回顾性健康经济分析。采用动态传播模型进行普遍接种，目标是使11至12岁学生的接种覆盖率达到80%。策略1仅针对女孩，进行为期5年的补种疫苗，以使13至17岁女孩的接种覆盖率达到50%。策略2包括男孩和女孩，不进行补种疫苗。结果包括预测的100年内HPV相关疾病的发病率。

结果

假设当前接种覆盖率为5%。策略1将使1级宫颈上皮内瘤变（CIN1）减少63.8%，2至3级宫颈上皮内瘤变（CIN2 - 3）减少62.9%，宫颈癌减少50.9%，女性尖锐湿疣减少78.0%，男性尖锐湿疣减少73.6%。策略2将使CIN1减少64.0%，CIN2 - 3减少63.1%，宫颈癌减少50.7%，女性尖锐湿疣减少79.9%，男性尖锐湿疣减少80.1%。策略1的增量成本效益比为12464新加坡元，策略2为27837新加坡元。如果采用两剂接种方案，这些数值将分别降至7477新加坡元和22574新加坡元。