Gervais Frédéric, Dunton Kyle, Jiang Yiling, Largeron Nathalie
Amaris, The Fitzpatrick Building, 188 York Way, London, N7 9AS, UK.
Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367, Lyon, Cedex 07, France.
BMC Public Health. 2017 Mar 28;17(1):283. doi: 10.1186/s12889-017-4076-3.
Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination.
A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies.
A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness.
This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.
由于多价人乳头瘤病毒（HPV）疫苗的问世，更好地理解疫苗接种与筛查计划之间的关系变得越来越重要。本综述旨在：（1）收集已发表的关于不同HPV预防策略成本效益概况的证据，特别是那些将疫苗接种与筛查实践变化相结合的策略；（2）探索基于筛查和疫苗接种的替代预防策略的成本效益。
进行了一项系统的文献综述，以确定关于HPV感染预防策略成本效益的相关研究。对研究之间的建模方法进行了比较分析，并评估了几个因素对不同筛查策略成本效益的影响程度。
在叙述中对总共18篇论文进行了定量总结。在HPV预防策略的经济和流行病学影响评估方式方面发现了高度异质性，筛查实践和HPV疫苗接种价数的差异对成本效益有很大影响。
本综述证明了筛查和疫苗接种之间的协同作用。未来可以实施涉及多价疫苗接种、HPV DNA检测筛查、延迟开始筛查和筛查频率的新预防策略。未来实施的策略应谨慎选择，并充分了解所有可能预防策略的潜在影响。本综述强调了评估多种策略的困难。需要利用适当的建模技术来评估最具成本效益的策略。
