Tay Sun Kuie, Lee Bee-Wah, Sohn Woo Yun, Lee I-Heng, Mathur Gaurav, Sanicas Melvin, Van Kriekinge Georges
Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
Duke-NUS Medical School, Singapore.
Singapore Med J. 2018 Jul;59(7):370-382. doi: 10.11622/smedj.2017085. Epub 2017 Oct 6.
Cervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer.
A lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore.
Introduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV.
AS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.
宫颈癌是新加坡女性中第十大常见癌症，也是第八大常见死因。由于人乳头瘤病毒（HPV）感染是宫颈癌的必要病因，通过接种疫苗可大幅降低宫颈癌风险。本研究从医疗保健支付方的角度，评估两剂HPV疫苗接种作为新加坡针对12岁女孩的国家疫苗接种计划一部分的成本效益。
采用终身马尔可夫队列模型，评估将含AS04佐剂的HPV-16/18疫苗（AS04-HPV-16/18v）引入新加坡当前宫颈癌筛查计划的成本效益。此外，将AS04-HPV-16/18v的成本效益与HPV-6/11/16/18疫苗（4vHPV）进行比较。模型输入尽可能源自本地数据，并经新加坡临床专家验证。
与仅进行筛查相比，在新加坡引入AS04-HPV-16/18v可预防137例宫颈癌病例和48例宫颈癌死亡。这导致每获得一个质量调整生命年（QALY）的增量成本效益比为12,645新元，根据世界卫生组织对新加坡设定的阈值，这具有成本效益。按3%贴现时，AS04-HPV-16/18v相对于4vHPV具有优势，节省成本80,559新元，并多获得28个QALY。在单向敏感性分析中，与仅进行筛查相比，AS04-HPV-16/18v仍具有成本效益，与4vHPV相比具有优势。
对于新加坡12岁女孩通过普遍大规模接种疫苗减轻宫颈癌负担而言，AS04-HPV-16/18v是最具成本效益的选择。
