Van Kriekinge Georges, Sohn Woo-Yun, Aljunid Syed Mohamed, Soon Ruey, Yong Chee-Meng, Chen Jing, Lee I-Heng
GSK, Avenue Fleming 20, 1300 Wavre, Belgium. Email:
Asian Pac J Cancer Prev. 2018 Apr 25;19(4):933-940. doi: 10.22034/APJCP.2018.19.4.933.
Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discounted total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In one-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV- 16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for both vaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening, was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.
在马来西亚，除宫颈癌（CC）筛查外，比较评估采用含AS04佐剂的人乳头瘤病毒16/18型疫苗（AS04-HPV-16/18v）或人乳头瘤病毒6/11/16/18型疫苗（4vHPVv）的两剂次人乳头瘤病毒（HPV）疫苗接种计划的效果。方法：采用一个复制13岁女孩HPV自然史的终生马尔可夫模型，以马来西亚的情况进行调整，从马来西亚卫生部的角度评估疫苗接种对癌前病变、生殖器疣和CC病例、CC死亡、质量调整生命年（QALY）以及成本的影响。疫苗效力基于疗效和HPV型别分布。假定两种疫苗对疫苗型HPV具有同等效力，但在预防非疫苗型HPV方面有所不同。采用疫苗价格平价，并以每年3%的贴现率对健康和成本结果进行贴现。敏感性分析检验结果的稳健性。结果：该模型预测，与4vHPVv相比，AS04-HPV-16/18v将使CC病例减少361例，CC死亡减少115例，而4vHPVv在该队列的一生中可避免4241例生殖器疣病例。贴现总成本显示，采用AS04-HPV-16/18v可节省1850万马来西亚林吉特和246个QALY。在单向敏感性分析中，贴现率是对成本和QALY最具影响力的变量，但AS04-HPV-16/18v始终占主导地位。评估两种疫苗交叉保护持久性的双向敏感性分析证实了基础病例的结果。结论：在马来西亚，除筛查外，采用AS04-HPV-16/18v在模型中被证明优于4vHPVv，预计对CC的益处更大且成本更低。
