美国 HPV 疫苗接种在 45 岁及以上人群中的有效性和成本效益
Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States.
机构信息
Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada (J.L., M.D., D.M., É.B.).
Centers for Disease Control and Prevention, Atlanta, Georgia (H.W.C., L.E.M.).
出版信息
Ann Intern Med. 2020 Jan 7;172(1):22-29. doi: 10.7326/M19-1182. Epub 2019 Dec 10.
BACKGROUND
In the United States, the routine age for human papillomavirus (HPV) vaccination is 11 to 12 years, with catch-up vaccination through age 26 years for women and 21 years for men. U.S. vaccination policy on use of the 9-valent HPV vaccine in adult women and men is being reviewed.
OBJECTIVE
To evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women aged 27 to 45 years and men aged 22 to 45 years.
DESIGN
The analysis used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data.
DATA SOURCES
Published data.
TARGET POPULATION
Women aged 27 to 45 years and men aged 22 to 45 years in the United States.
TIME HORIZON
100 years.
PERSPECTIVE
Health care sector.
INTERVENTION
9-valent HPV vaccination.
OUTCOME MEASURES
HPV-associated outcomes prevented and cost-effectiveness ratios.
RESULTS OF BASE-CASE ANALYSIS: The model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years and is cost saving (vs. no vaccination). In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830 000, $1 843 000, and $1 471 000, respectively, per quality-adjusted life-year gained (vs. current vaccination).
RESULTS OF SENSITIVITY ANALYSIS
Results were most sensitive to assumptions about natural immunity and progression rates after infection, historical vaccination coverage, and vaccine efficacy.
LIMITATION
Uncertainty about the proportion of HPV-associated disease due to infections after age 26 years and about the level of herd effects from the current HPV vaccination program.
CONCLUSION
The current HPV vaccination program is predicted to be cost saving. Extending vaccination to older ages is predicted to produce small additional health benefits and result in substantially higher incremental cost-effectiveness ratios than the current recommendation.
PRIMARY FUNDING SOURCE
Centers for Disease Control and Prevention.
背景
在美国，人乳头瘤病毒（HPV）疫苗的常规接种年龄为 11 至 12 岁，对于女性，可补种至 26 岁，对于男性，可补种至 21 岁。目前，美国正在审查成人女性和男性使用九价 HPV 疫苗的接种政策。
目的
评估将目前美国 HPV 疫苗接种计划扩大到 27 至 45 岁女性和 22 至 45 岁男性中的效果和成本效益。
设计
分析使用了 HPV-ADVISE（基于代理的 HPV 疫苗接种和筛查评估动态模型），这是一种 HPV 感染和相关疾病的个体传播动态模型，经过了特定年龄段的美国数据校准。
数据来源
已发表的数据。
目标人群
27 至 45 岁的女性和 22 至 45 岁的男性，居住在美国。
时间范围
100 年。
视角
医疗保健部门。
干预措施
九价 HPV 疫苗接种。
结局指标
预防 HPV 相关疾病的数量和成本效益比。
基础案例分析结果
该模型预测，目前美国的 HPV 疫苗接种计划将在 100 年内减少 82%、80%、59%和 39%的肛门生殖器疣、宫颈上皮内瘤变 2 或 3 级和宫颈癌以及非宫颈癌 HPV 相关癌症的诊断病例数，并且具有成本效益（与不接种疫苗相比）。相比之下，扩大到 45 岁女性和男性的疫苗接种预计会使这些结果分别额外减少 0.4、0.4、0.2 和 0.2 个百分点。预测为 27 至 45 岁的女性和 22 至 45 岁的男性接种疫苗的成本分别为 83 万美元、184 万美元和 147 万美元，每获得一个质量调整生命年（与当前的疫苗接种相比）。
敏感性分析结果
结果对自然免疫和感染后进展率、历史疫苗接种率和疫苗效力的假设最为敏感。
局限性
对于 26 岁以后 HPV 相关疾病的比例以及当前 HPV 疫苗接种计划产生的群体免疫效应水平的不确定性。
结论
目前的 HPV 疫苗接种计划预计具有成本效益。扩大接种年龄预计会带来较小的额外健康益处，并导致比当前建议更高的增量成本效益比。
主要资金来源
疾病控制与预防中心。
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