Campos Nicole G, Sharma Monisha, Clark Andrew, Lee Kyueun, Geng Fangli, Regan Catherine, Kim Jane, Resch Stephen
Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Epidemiology, School of Public Health, University of Washington Seattle, Seattle, WA, USA.
Int J Gynaecol Obstet. 2017 Jul;138 Suppl 1:47-56. doi: 10.1002/ijgo.12184.
To estimate the health impact, financial costs, and cost-effectiveness of scaling-up coverage of human papillomavirus (HPV) vaccination (young girls) and cervical cancer screening (women of screening age) for women in countries that will likely need donor assistance.
We used a model-based approach to synthesize population, demographic, and epidemiological data from 50 low- and lower-middle-income countries. Models were used to project the costs (US $), lifetime health impact (cervical cancer cases, deaths averted), and cost-effectiveness (US $ per disability adjusted life year [DALY] averted) of: (1) two-dose HPV-16/18 vaccination of girls aged 10 years; (2) once-in-a-lifetime screening, with treatment when needed, of women aged 35 years with either HPV DNA testing or visual inspection with acetic acid (VIA); and (3) cervical cancer treatment over a 10-year roll-out.
We estimated that both HPV vaccination and screening would be very cost-effective, and a comprehensive program could avert 5.2 million cases, 3.7 million deaths, and 22.0 million DALYs over the lifetimes of the intervention cohorts for a total 10-year program cost of US $3.2 billion.
Investment in HPV vaccination of young girls and cervical cancer screen-and-treat programs in low- and lower-middle-income countries could avert a substantial burden of disease while providing good value for public health dollars.
评估在可能需要捐助者援助的国家扩大人乳头瘤病毒（HPV）疫苗接种（年轻女孩）和宫颈癌筛查（筛查年龄女性）覆盖范围对女性健康的影响、财务成本及成本效益。
我们采用基于模型的方法，综合来自50个低收入和中低收入国家的人口、人口统计学和流行病学数据。模型用于预测以下各项的成本（美元）、终生健康影响（宫颈癌病例数、避免的死亡数）和成本效益（每避免一个伤残调整生命年[DALY]的美元数）：（1）对10岁女孩进行两剂HPV-16/18疫苗接种；（2）对35岁女性进行一次性终生筛查，必要时进行治疗，采用HPV DNA检测或醋酸目视检查（VIA）；（3）在10年推广期内进行宫颈癌治疗。
我们估计HPV疫苗接种和筛查都将具有很高的成本效益，一项综合计划在干预队列的终生期间可避免520万例病例、370万例死亡和2200万个DALY，10年计划总成本为32亿美元。
在低收入和中低收入国家投资于年轻女孩的HPV疫苗接种以及宫颈癌筛查与治疗计划，可避免重大疾病负担，同时为公共卫生资金提供良好价值。
