Marcellusi Andrea
National Research Council (CNR), Institute for Research on Population and Social Policies (IRPPS), Via Palestro 32, 00185, Rome, Italy.
Department Accounting, Finance and Informatics, Kingston Business School Kingston University, London, UK.
Popul Health Metr. 2017 Sep 29;15(1):36. doi: 10.1186/s12963-017-0154-0.
Human papillomavirus (HPV) is the leading cause of cervical cancer and other malignant and benign neoplastic lesions. HPV vaccination has three potential goals: to prevent transmission, infection, and disease. At present, there are no available data about health consequences of HPV immunization in Italy. The aim of this study is to evaluate the effect of current HPV vaccination strategy in Italy.
A multistate morbidity-mortality model was developed to estimate the infection process in a theoretical cohort of Italian women. The Markov process considered nine health states (health, anogenital warts, grade 1 and grade 2/3 cervical intraepithelial neoplasia, cervical cancer, anal cancer, death due to cervical cancer, anal cancer and other causes), and 26 transition probabilities for each age group. The model was informed with the available data in national and international literature. Effectiveness of immunization was assumed considering a literature review pertaining to models and vaccination coverage rates observed in Italy. Life expectancy (e), Quality-Adjusted Life Years (QALYs), Disability-Adjusted Life Years (DALYs), and attributable risk (AR) were estimated for no intervention (cervical cancer screening) and vaccination strategies scenarios.
The model showed that in a cohort of 100,000 Italian women the e is equal to 83.1 years. With current HPV vaccination strategy the e achieves 83.2 (+0.1) years. When HPV-related diseases are considered altogether, the QALYs increase from 82.7 to 82.9 (+0.2 QALYs) with no intervention and vaccination strategies respectively. DALYs decrease by 0.6 due to vaccination. Finally, AR is equal to 93 and 265 cases per 100,000 women in population and not vaccinated, respectively.
When mortality due to cervical cancer is considered, HPV vaccination seems to have a low impact on health unit gains in the Italian female population. Conversely, when several HPV-related and cancer morbidity conditions are included, the effect of vaccination becomes quite remarkable.
人乳头瘤病毒（HPV）是宫颈癌及其他恶性和良性肿瘤性病变的主要病因。HPV疫苗接种有三个潜在目标：预防传播、感染和疾病。目前，意大利尚无关于HPV免疫接种对健康影响的数据。本研究旨在评估意大利当前HPV疫苗接种策略的效果。
建立了一个多状态发病-死亡模型，以估计意大利女性理论队列中的感染过程。马尔可夫过程考虑了9种健康状态（健康、肛门生殖器疣、1级和2/3级宫颈上皮内瘤变、宫颈癌、肛门癌、宫颈癌死亡、肛门癌死亡及其他原因导致的死亡），以及每个年龄组的26个转移概率。该模型依据国内和国际文献中的现有数据构建。通过对意大利观察到的模型和疫苗接种覆盖率的文献综述来假设免疫接种的有效性。针对无干预（宫颈癌筛查）和疫苗接种策略情景，估计了预期寿命（e）、质量调整生命年（QALYs）、伤残调整生命年（DALYs）和归因风险（AR）。
该模型显示，在100,000名意大利女性队列中，预期寿命为83.1岁。采用当前HPV疫苗接种策略时，预期寿命达到83.2（+0.1）岁。当将HPV相关疾病综合考虑时，无干预和疫苗接种策略下的QALYs分别从82.7增加到82.9（+0.2个QALYs）。疫苗接种使DALYs减少了0.6。最后，每100,000名女性中，接种疫苗和未接种疫苗人群的归因风险分别为93例和265例。
当考虑宫颈癌死亡率时，HPV疫苗接种对意大利女性人群健康单位收益的影响似乎较低。相反，当纳入几种HPV相关和癌症发病情况时，疫苗接种的效果就相当显著。
