Zhang Lei, Regan David G, Ong Jason J, Gambhir Manoj, Chow Eric P F, Zou Huachun, Law Matthew, Hocking Jane, Fairley Christopher K
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Research Centre for Public Health, Tsinghua University, Beijing 100084, China.
Kirby Institute, UNSW Australia, Sydney, Australia.
Vaccine. 2017 Sep 5;35(37):4923-4929. doi: 10.1016/j.vaccine.2017.07.078. Epub 2017 Aug 5.
We investigated the effectiveness and cost-effectiveness of a targeted human papillomavirus (HPV) vaccination program for young (15-26) men who have sex with men (MSM).
We developed a compartmental model to project HPV epidemic trajectories in MSM for three vaccination scenarios: a boys program, a targeted program for young MSM only and the combination of the two over 2017-2036. We assessed the gain in quality-adjusted-life-years (QALY) in 190,000 Australian MSM.
A targeted program for young MSM only that achieved 20% coverage per year, without a boys program, will prevent 49,283 (31,253-71,500) cases of anogenital warts, 191 (88-319) person-years living with anal cancer through 2017-2036 but will only stablise anal cancer incidence. In contrast, a boys program will prevent 82,056 (52,100-117,164) cases of anogenital warts, 447 (204-725) person-years living with anal cancers through 2017-2036 and see major declines in anal cancer. This can reduce 90% low- and high-risk HPV in young MSM by 2024 and 2032, respectively, but will require vaccinating ≥84% of boys. Adding a targeted program for young MSM to an existing boys program would prevent an additional 14,912 (8479-21,803) anogenital wart and 91 (42-152) person-years living with anal cancer. In combination with a boys' program, a catch-up program for young MSM will cost an additional $AUD 6788 ($4628-11,989) per QALY gained, but delaying its implementation reduced its cost-effectiveness.
A boys program that achieved coverage of about 84% will result in a 90% reduction in HPV. A targeted program for young MSM is cost-effective if timely implemented.
我们调查了针对年轻（15 - 26岁）男男性行为者（MSM）的靶向人乳头瘤病毒（HPV）疫苗接种计划的有效性和成本效益。
我们建立了一个分区模型，以预测2017 - 2036年期间三种疫苗接种方案下MSM中HPV的流行轨迹：男孩接种计划、仅针对年轻MSM的靶向接种计划以及两者的组合。我们评估了190,000名澳大利亚MSM在质量调整生命年（QALY）方面的收益。
仅针对年轻MSM的靶向接种计划，若每年覆盖率达到20%且无男孩接种计划，在2017 - 2036年期间将预防49,283例（31,253 - 71,500例）肛门生殖器疣，191人年（88 - 319人年）的肛门癌存活病例，但只会稳定肛门癌发病率。相比之下，男孩接种计划在2017 - 2036年期间将预防82,056例（52,100 - 117,164例）肛门生殖器疣，447人年（204 - 725人年）的肛门癌存活病例，并使肛门癌大幅下降。到2024年和2032年，这可分别使年轻MSM中90%的低风险和高风险HPV减少，但这需要对≥84%的男孩进行接种。在现有的男孩接种计划基础上增加针对年轻MSM的靶向接种计划，将额外预防14,912例（8479 - 21,803例）肛门生殖器疣和91人年（42 - 152人年）的肛门癌存活病例。与男孩接种计划相结合，年轻MSM的补种计划每获得一个QALY将额外花费6788澳元（4628 - 11,989澳元），但推迟实施会降低其成本效益。
覆盖率达到约84%的男孩接种计划将使HPV减少90%。针对年轻MSM的靶向接种计划若及时实施具有成本效益。
