Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands.
Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Lancet Public Health. 2020 Nov;5(11):e592-e603. doi: 10.1016/S2468-2667(20)30209-7.
In many European countries, human papillomavirus (HPV) vaccine uptake among girls has remained below target levels, supporting the scope for vaccination of boys. We aimed to investigate if sex-neutral HPV vaccination can be considered cost-effective compared with girls-only vaccination at uptake levels equal to those among girls and under tender-based vaccination costs achieved throughout Europe.
We investigated the cost-effectiveness of sex-neutral HPV vaccination in European tender-based settings. We applied a Bayesian synthesis framework for health economic evaluation to 11 countries (Austria, Belgium, Croatia, Estonia, Italy, Latvia, the Netherlands, Poland, Slovenia, Spain, and Sweden), accommodating country-specific information on key epidemiological and economic parameters, and on current HPV vaccination programmes. We used projections from three independently developed HPV transmission models to tailor region-specific herd effects. The main outcome measures in the comparison of sex-neutral with girls-only vaccination were cancer cases prevented and incremental cost-effectiveness ratios (ICERs), defined as the cost in international dollars (I$) per life-year gained.
The total number of cancer cases to be prevented by vaccinating girls at currently realised vaccine uptake varied from 318 (95% CI 197-405) per cohort of 200 000 preadolescents (100 000 girls plus 100 000 boys) in Croatia (under 20% uptake of the 9-valent vaccine) to 1904 (1741-2101) in Estonia (under 70% uptake of the 9-valent vaccine). Vaccinating boys at equal coverage increased these respective numbers by 168 (95% CI 121-213) in Croatia and 467 (391-587) in Estonia. Sex-neutral vaccination was likely to be cost-effective, with ICERs of sex-neutral compared with girls-only vaccination varying from I$4300 per life-year gained in Latvia (95% credibility interval 3450-5160; 40% uptake) to I$25 720 per life-year gained in Spain (21 380-30 330; 80% uptake). At uniform 80% uptake, a favourable cost-effectiveness profile was retained for most of the countries investigated (Austria, Belgium, Italy, Latvia, the Netherlands, Slovenia, Spain, and Sweden).
Sex-neutral HPV vaccination is economically attractive in European tender-based settings. However, tendering mechanisms need to ensure that vaccination of boys will remain cost-effective at high vaccine uptake rates.
European Commission 7th Framework Programme and WHO.
在许多欧洲国家，女孩的人乳头瘤病毒（HPV）疫苗接种率仍未达到目标水平，这支持了为男孩接种疫苗的范围。我们旨在研究在基于招标的疫苗接种成本达到整个欧洲的水平，并达到与女孩接种率相等的情况下，中性性别 HPV 疫苗接种是否可以被认为比仅对女孩接种更具成本效益。
我们调查了在基于招标的欧洲环境中中性性别 HPV 疫苗接种的成本效益。我们应用了一种针对健康经济评估的贝叶斯综合框架，对 11 个国家（奥地利、比利时、克罗地亚、爱沙尼亚、意大利、拉脱维亚、荷兰、波兰、斯洛文尼亚、西班牙和瑞典）进行了调查，这些国家考虑了关键的流行病学和经济参数以及当前 HPV 疫苗接种计划的具体信息。我们使用三个独立开发的 HPV 传播模型的预测来调整针对特定地区的群体效应。中性性别与仅对女孩接种疫苗的比较的主要结果衡量标准是预防的癌症病例和增量成本效益比（ICER），定义为国际美元（I$）每获得的生命年数。
在克罗地亚（9 价疫苗接种率低于 20%），为 20 万 10 岁以下儿童（10 万名女孩和 10 万名男孩）接种女孩的疫苗接种覆盖率目前已实现，预计将预防 318 例（95%CI 197-405）癌症病例，而在爱沙尼亚（9 价疫苗接种率低于 70%），这一数字为 1904 例（1741-2101）。在同等覆盖范围内接种男孩，在克罗地亚将分别增加 168 例（95%CI 121-213），在爱沙尼亚增加 467 例（391-587）。中性性别疫苗接种可能具有成本效益，中性性别与仅对女孩接种疫苗的 ICER 从拉脱维亚的每获得一个生命年 I$4300（95%置信区间 3450-5160；40%接种率）到西班牙的每获得一个生命年 I$25720（21380-30330；80%接种率）不等。在统一的 80%接种率下，大多数研究国家（奥地利、比利时、意大利、拉脱维亚、荷兰、斯洛文尼亚、西班牙和瑞典）仍保留了有利的成本效益状况。
在欧洲基于招标的环境中，中性性别 HPV 疫苗接种具有经济吸引力。然而，招标机制需要确保在高疫苗接种率下，男孩的接种仍具有成本效益。
欧盟第七框架计划和世界卫生组织。
