Market Access, MSD France, Puteaux, France.
Market Access, MSD Vaccins, Lyon, France.
Vaccine. 2021 Jan 8;39(2):438-446. doi: 10.1016/j.vaccine.2020.10.089. Epub 2020 Nov 28.
In France, 9-valent HPV vaccination is recommended routinely for 11-14-years-old girls and as catch-up for 15-19-years-old girls. Recently, recommendation for gender-neutral vaccination (GNV) has been approved. The objectives of the study were to assess the public health impact and cost-effectiveness of a 9-valent GNV compared with girls-only vaccination program (GOV).
A published HPV disease transmission dynamic model accounting for herd protection effects with a 100-year time horizon was adapted and calibrated to French data. Epidemiological and economic outcomes included disease cases averted and quality-adjusted life years (QALY). Costs and incremental cost-effectiveness ratio (ICER) were measured in 2018 Euros (€). A coverage rate of 26.2% among girls and boys was assumed for the GNV program based on the current female coverage rate in France. The base case included genital warts, cervical, vulvar, vaginal, and anal cancers. Scenario analyses included all HPV-related diseases and considered higher vaccination coverage rate (60%). Deterministic sensitivity analyses on key inputs were performed.
Over 100 years, GNV resulted in an additional reduction of 9,519 and 3,037 cervical cancer cases and deaths; 6,901 and 1,166 additional anal cancer cases and deaths; and a reduction of additional 1,284,077 genital warts compared with current GOV and an ICER of 24,763€/QALY. When including all HPV-related diseases, the ICER was 15,184€/QALY. At a higher coverage rate (60%), GNV would prevent 17,430 and 4,334 additional anogenital cancer cases and deaths and over two million genital warts compared with GOV with an ICER of 40,401€/QALY. Results were sensitive to a higher discount rate (6% versus 4%) and a shorter duration of protection (20 years versus lifetime).
In France, GNV has a significant impact in terms of public health benefits and may be considered cost-effective compared with GOV at low and high coverage rates.
在法国，9 价 HPV 疫苗推荐为 11-14 岁女孩常规接种，并为 15-19 岁女孩补种。最近，批准了针对两性的疫苗接种（GNV）。本研究旨在评估与仅为女孩接种（GOV）相比，9 价 GNV 的公共卫生影响和成本效益。
采用已发表的 HPV 疾病传播动力学模型，该模型考虑了群体保护效应，时间范围为 100 年，并根据法国数据进行了校准。流行病学和经济结果包括预防的疾病病例和质量调整生命年（QALY）。2018 年以欧元（€）为单位衡量成本和增量成本效益比（ICER）。假设 GNV 计划在女孩和男孩中的覆盖率为 26.2%，这是基于法国目前女性的覆盖率。基础方案包括生殖器疣、宫颈癌、外阴癌、阴道癌和肛门癌。情景分析包括所有与 HPV 相关的疾病，并考虑了更高的疫苗接种覆盖率（60%）。对关键投入进行了确定性敏感性分析。
在 100 年内，GNV 可额外减少 9519 例宫颈癌病例和死亡人数，3037 例；6901 例和 1166 例额外的肛门癌病例和死亡人数；与当前 GOV 相比，生殖器疣的额外病例减少 1284077 例，ICER 为 24763€/QALY。当包括所有与 HPV 相关的疾病时，ICER 为 15184€/QALY。在更高的覆盖率（60%）下，GNV 将预防 17430 例和 4334 例额外的肛门生殖器癌病例和死亡人数以及超过两百万例生殖器疣，与 GOV 相比，ICER 为 40401€/QALY。结果对更高的贴现率（6%比 4%）和更短的保护期限（20 年比终身）敏感。
在法国，GNV 在公共卫生效益方面具有重大影响，并且在低和高覆盖率下可能被认为具有成本效益，优于 GOV。
