Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia.
School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia.
PLoS One. 2019 Oct 9;14(10):e0223658. doi: 10.1371/journal.pone.0223658. eCollection 2019.
Cervical cancer imposes a substantial health burden worldwide including in Australia and is caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. The objective of this study was to assess the cost-effectiveness of adding a nonavalent new Gardasil-9® (9vHPV) vaccine to the national immunisation schedule in Australia across three different delivery strategies.
The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model was used to examine the cost-effectiveness of 9vHPV vaccine introduction to prevent HPV infection. Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, and vaccine delivery costs. The incremental cost-effectiveness ratios (ICERs) were measured per disability-adjusted life years (DALYs) averted, using the heuristic cost-effectiveness threshold defined by the World Health Organisation (WHO). Analyses and data from international agencies were used in scenario analysis from the health system and societal perspectives.
The 9vHPV vaccination was estimated to prevent 113 new cases of cervical cancer (discounted) during a 20-year period. From the health system and societal perspectives, the 9vHPV vaccination was very cost-effective in comparison with the status quo, with an ICER of A$47,008 and A$44,678 per DALY averted, respectively, using the heuristic cost-effectiveness threshold level. Considering delivery strategies, the ICERs per DALY averted were A$47,605, A$46,682, and A$46,738 for school, health facilities, and outreach-based vaccination programs from the health system perspective, wherein, from the societal perspective, the ICERs per DALY averted were A$46,378, A$43,729, A$43,930, respectively. All estimates of ICERs fell below the threshold level (A$73,267).
This cost-effectiveness evaluation suggests that the routine two-dose 9vHPV vaccination strategy of preadolescent girls against HPV is very cost-effective in Australia from both the health system and societal perspectives. If equally priced, the 9vHPV option is the most economically viable vaccine. Overall, this analysis seeks to contribute to an evidence-based recommendation about the new 9vHPV vaccination in the national immunisation program in Australia.
宫颈癌在全球范围内造成了巨大的健康负担，包括在澳大利亚。它是由持续感染 13 种性传播的高危型人乳头瘤病毒（HPV）中的一种引起的。本研究的目的是评估在澳大利亚通过三种不同的接种策略在国家免疫计划中增加九价人乳头瘤病毒（HPV）疫苗（九价 Gardasil-9®[9vHPV]）的成本效益。
使用 Papillomavirus Rapid Interface for Modelling and Economics（PRIME）模型来研究引入九价 HPV 疫苗以预防 HPV 感染的成本效益。关于人口统计学变量、宫颈癌发病率和死亡率、治疗成本和疫苗接种成本的学术文献和传闻证据都被纳入了研究。使用世界卫生组织（WHO）定义的启发式成本效益阈值，每避免一个残疾调整生命年（DALY）来衡量增量成本效益比（ICER）。从卫生系统和社会角度，分析和使用国际机构的数据进行情景分析。
九价 HPV 疫苗接种预计在 20 年内预防 113 例新的宫颈癌病例（折现）。从卫生系统和社会角度来看，与现状相比，九价 HPV 疫苗接种非常具有成本效益，其健康系统视角下的 ICER 分别为每 DALY 避免 47,008 澳元和 44,678 澳元，而在社会视角下，ICER 分别为每 DALY 避免 46,378 澳元、43,729 澳元和 43,930 澳元，使用启发式成本效益阈值。考虑到接种策略，从卫生系统的角度来看，学校、卫生设施和外展接种计划的每 DALY 避免的 ICER 分别为 47,605 澳元、46,682 澳元和 46,738 澳元，而从社会角度来看，每 DALY 避免的 ICER 分别为 46,378 澳元、43,729 澳元和 43,930 澳元。所有 ICER 估计都低于阈值水平（73,267 澳元）。
这项成本效益评估表明，在澳大利亚，针对 HPV 的青春期前少女常规接种两剂九价 HPV 疫苗从卫生系统和社会角度来看都是非常具有成本效益的。如果价格相同，那么九价 HPV 疫苗是最具经济可行性的疫苗。总的来说，这项分析旨在为澳大利亚国家免疫计划中的新九价 HPV 疫苗接种提供基于证据的建议。
