School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Cancer. 2017 Sep 1;123(17):3253-3260. doi: 10.1002/cncr.30734. Epub 2017 May 4.
Introduction of human papillomavirus (HPV) vaccination for adolescent girls is being considered in the Punjab state of India. However, evidence regarding cost-effectiveness is sought by policy makers when making this decision. The current study was undertaken to evaluate the incremental cost per quality-adjusted life-years (QALYs) gained with introduction of the HPV vaccine compared with a no-vaccination scenario.
A static progression model, using a combination of decision tree and Markov models, was populated using epidemiological, cost, coverage, and effectiveness data to determine the cost-effectiveness of HPV vaccination. Using a societal perspective, lifetime costs and consequences (in terms of QALYs) among a cohort of 11-year-old adolescent girls in Punjab state were modeled in 2 alternate scenarios with and without vaccination. All costs and consequences were discounted at a rate of 3%.
Although immunizing 1 year's cohort of 11-year-old girls in Punjab state costs Indian National Rupees (INR) 135 million (US dollars [USD] 2.08 million and International dollars [Int$] 6.25 million) on an absolute basis, its net cost after accounting for treatment savings is INR 38 million (USD 0.58 million and Int$ 1.76 million). Incremental cost per QALY gained for HPV vaccination was found to be INR 73 (USD 1.12 and Int$ 3.38). Given all the data uncertainties, there is a 90% probability for the vaccination strategy to be cost-effective in Punjab state at a willingness-to-pay threshold of INR 10,000, which is less than one-tenth of the per capita gross domestic product.
HPV vaccination appears to be a very cost-effective strategy for Punjab state, and is likely to be cost-effective for other Indian states. Cancer 2017;123:3253-60. © 2017 American Cancer Society.
印度旁遮普邦正在考虑为少女接种人乳头瘤病毒（HPV）疫苗。然而，政策制定者在做出这一决定时需要考虑成本效益的证据。本研究旨在评估与不接种疫苗相比，引入 HPV 疫苗所获得的增量成本每质量调整生命年（QALY）。
使用决策树和马尔可夫模型的静态进展模型，结合流行病学、成本、覆盖率和有效性数据，确定 HPV 疫苗接种的成本效益。使用社会视角，在有无疫苗接种的两种情况下，对旁遮普邦 11 岁少女队列的终生成本和后果（以 QALY 衡量）进行建模。所有成本和后果均以 3%的贴现率贴现。
虽然在旁遮普邦为 11 岁女孩接种 1 年的疫苗接种费用为印度卢比（INR）1.35 亿（208 万美元和 6.25 百万国际美元），但在考虑到治疗节省后，其净成本为 INR 3800 万（208 万美元和 1.76 百万国际美元）。HPV 疫苗接种的增量成本每获得一个 QALY 为 INR 73（1.12 美元和 3.38 国际美元）。考虑到所有数据的不确定性，在旁遮普邦愿意支付的 10000 卢比的阈值下，疫苗接种策略有 90%的可能性具有成本效益，这不到人均国内生产总值的十分之一。
HPV 疫苗接种对旁遮普邦来说似乎是一种非常具有成本效益的策略，并且可能对其他印度邦也具有成本效益。癌症 2017;123:3253-60。©2017 美国癌症协会。
