Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Ave, 2ndFloor, Boston, MA 02117, USA; University of Oslo, Department of Health Management and Health Economics, Postboks 1089, Blindern, 0317 Oslo, Norway.
Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Ave, 2ndFloor, Boston, MA 02117, USA.
Vaccine. 2018 Aug 6;36(32 Pt A):4823-4829. doi: 10.1016/j.vaccine.2018.04.061. Epub 2018 May 26.
BACKGROUND: Although guidelines for prophylactic human papillomavirus (HPV) vaccination recommend two doses for girls ages 9-14 years, several studies have demonstrated similar protection with one dose. Our objective was to evaluate the long-term health and economic impacts of routine one-dose HPV vaccination compared to (1) no vaccination and (2) two-dose HPV vaccination in a low-income country. METHODS: We used a three-tiered hybrid modeling approach that captured HPV transmission, cervical carcinogenesis, and population demographics to project long-term health and economic outcomes associated with one-dose HPV vaccination (assuming 80% efficacy against HPV-16/18 infections under three waning scenarios) and two-dose HPV vaccination (assuming 100% efficacy over the lifetime) in Uganda. Costs included the vaccine program (dosage and delivery) costs over a 10-year period and cervical cancer costs over the lifetimes of the current population of Ugandan women. Health outcomes included number of cervical cancer cases and disability-adjusted life years (DALYs). Incremental cost-effectiveness ratios (i.e., cost per DALY averted) were calculated and compared against the Ugandan per-capita gross domestic product. RESULTS: Routine one-dose HPV vaccination of 9-year-old girls required substantial upfront investment but was cost-saving compared to no vaccination when accounting for the cost-offsets from future cancers averted. Forty years after initiating routine vaccination and depending on assumptions of vaccine waning, one-dose HPV vaccination with equivalent coverage (70%) averted 15-16% of cervical cancer cases versus 21% with two-dose vaccination but required only half the upfront economic investment. Vaccination with two doses had an attractive cost-effectiveness profile except if one-dose vaccination enabled higher coverage (90% vs. 70%) and did not wane. CONCLUSIONS: One-dose HPV vaccination resulted in cost-savings compared to no vaccination and could be cost-effective compared to two-dose vaccination if protection is longstanding and higher coverage can be achieved.
背景：尽管预防性人乳头瘤病毒（HPV）疫苗接种指南建议 9-14 岁女孩接种两剂，但多项研究表明一剂也可提供类似的保护。我们的目的是评估在低收入国家常规接种一剂 HPV 疫苗与（1）不接种疫苗和（2）接种两剂 HPV 疫苗相比，对长期健康和经济的影响。
方法：我们使用了一种三级混合建模方法，该方法捕获了 HPV 传播、宫颈癌发生和人口统计学，以预测在三种衰减情况下，一剂 HPV 疫苗接种（假设对 HPV-16/18 感染的效力为 80%）和两剂 HPV 疫苗接种（假设终身 100%有效）与乌干达相关的长期健康和经济结果。成本包括在 10 年内疫苗计划（剂量和交付）成本和当前乌干达妇女人群一生中的宫颈癌成本。健康结果包括宫颈癌病例数和残疾调整生命年（DALY）。计算了增量成本效益比（即每避免一个 DALY 的成本），并与乌干达人均国内生产总值进行了比较。
结果：对 9 岁女孩进行常规一剂 HPV 疫苗接种需要大量前期投资，但在考虑到未来预防癌症的成本节约后，与不接种疫苗相比，成本可节省。在开始常规接种 40 年后，根据疫苗衰减的假设，一剂 HPV 疫苗接种（覆盖率为 70%）可避免 15-16%的宫颈癌病例，而两剂接种可避免 21%，但仅需一半的前期经济投资。两剂接种具有有吸引力的成本效益，但如果一剂接种能够实现更高的覆盖率（90%对 70%）且不衰减，则情况并非如此。
结论：与不接种疫苗相比，一剂 HPV 疫苗接种可节省成本，如果保护作用持久且可实现更高的覆盖率，则与两剂接种相比可能具有成本效益。
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