荷兰中性人乳头瘤病毒疫苗接种项目的成本效益分析。

Cost-effectiveness analysis of a gender-neutral human papillomavirus vaccination program in the Netherlands.

机构信息

Market Access Department, GSK, Huis ter Heideweg 62, 3705 Zeist, the Netherlands.

Value Evidence Department, GSK, Avenue Fleming 20, 1300 Wavre, Belgium.

出版信息

Vaccine. 2020 Jun 19;38(30):4687-4694. doi: 10.1016/j.vaccine.2020.05.031. Epub 2020 May 23.

DOI:10.1016/j.vaccine.2020.05.031

PMID:32451211

Abstract

BACKGROUND

Vaccinating girls against human papillomavirus (HPV) infection is a highly effective and cost-effective intervention to provide protection against HPV-induced cancers. Since vaccination coverage rates among girls is modest in the Netherlands, additional strategies should be implemented to improve the protection against HPV-related cancer. Here we assessed the benefits and cost-effectiveness of gender-neutral vaccination.

METHODS

We designed a static Markov model with a lifelong time horizon to simulate a cohort of 100,000 12-year-old Dutch boys. The model compares health and economic effects of HPV vaccination taking the current female vaccination coverage into consideration. HPV prevalence in boys was corrected for the predicted herd effects of the female programme in 2017. We extracted transition probabilities from peer-reviewed literature and previously constructed models. The robustness of the model was tested with multiple sensitivity analyses.

RESULTS

Vaccinating 30% of 100,000 12-year-old boys prevents 18, 13 and 25 cases of anal, penile, and oropharyngeal cancers in men, respectively. A total of 205 quality-adjusted life-years (QALYs) are saved by preventing cancer-related morbidity and mortality. Assuming a vaccine price of €50 per dose, the incremental cost-effectiveness ratio (ICER) is €17,907 per QALY. In addition, due to vaccine-induced herd effects, we estimated that 110 cases of cancer in females would be additionally prevented and 246 QALYs would be gained in the female cohort, bringing the total to 166 cancers prevented and 451 QALYs gained. Taking these additional benefits of boys' vaccination into account, the overall ICER was estimated at €7310 per QALY gained. The model outcomes are most sensitive to variation in vaccine price, herd immunity from females and vaccine efficacy.

CONCLUSIONS

Vaccination of boys, additional to girls, will prevent a relevant number of cancers in both boys and girls. Based on the current Dutch situation vaccination of HPV in boys is likely cost-effective. GSK Study identifier: HO-18-19169.

摘要

背景

为女孩接种人乳头瘤病毒（HPV）疫苗是一种高效且具有成本效益的干预措施，可以预防 HPV 引起的癌症。由于荷兰女孩的疫苗接种率不高，因此应实施其他策略来提高对 HPV 相关癌症的保护。在这里，我们评估了中性性别接种的收益和成本效益。

方法

我们设计了一个静态马尔可夫模型，具有终生时间范围，以模拟 100,000 名 12 岁荷兰男孩的队列。该模型考虑了当前女性疫苗接种覆盖率，比较了 HPV 疫苗接种的健康和经济效果。2017 年，根据女性计划的预测群体效应，对男孩的 HPV 流行率进行了校正。我们从经过同行评审的文献和先前构建的模型中提取了转移概率。通过多次敏感性分析测试了模型的稳健性。

结果

为 100,000 名 12 岁男孩中的 30%接种疫苗，可以分别预防男性肛门、阴茎和口咽癌 18、13 和 25 例。通过预防癌症相关发病率和死亡率，总共可以节省 205 个质量调整生命年（QALY）。假设疫苗价格为每剂 50 欧元，增量成本效益比（ICER）为每 QALY 17,907 欧元。此外，由于疫苗引起的群体免疫效应，我们估计女性中还将额外预防 110 例癌症，并在女性队列中获得 246 个 QALY，总共将预防 166 例癌症和获得 451 个 QALY。考虑到男孩接种疫苗的这些额外益处，总体 ICER 估计为每获得 1 个 QALY 花费 7310 欧元。模型结果对疫苗价格、女性群体免疫和疫苗效力的变化最为敏感。