Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Prev Med. 2021 Mar;144:106276. doi: 10.1016/j.ypmed.2020.106276. Epub 2021 Mar 4.
Following the global call for action by the World Health Organization to eliminate cervical cancer (CC), we evaluated how each CC policy decision in Norway influenced the timing of CC elimination, and whether introducing nonavalent human papillomavirus (HPV) vaccine would accelerate elimination timing and be cost-effective. We used a multi-modeling approach that captured HPV transmission and cervical carcinogenesis to estimate the CC incidence associated with six past and future CC prevention policy decisions compared with a pre-vaccination scenario involving 3-yearly cytology-based screening. Scenarios examined the introduction of routine HPV vaccination of 12-year-old girls with quadrivalent vaccine in 2009, a temporary catch-up program for females aged up to 26 years in 2016-2018 with bivalent vaccine, the universal switch to bivalent vaccine in 2017, expansion to include 12-year-old boys in 2018, the switch from cytology- to HPV-based screening for women aged 34-69 in 2020, and the potential switch to nonavalent vaccine in 2021. Introducing routine female vaccination in 2009 enabled elimination to be achieved by 2056 and prevented 17,300 cases. Cumulatively, subsequent policy decisions accelerated elimination to 2039. According to our modeling assumptions, switching to the nonavalent vaccine would not be considered 'good value for money' at relevant cost-effectiveness thresholds in Norway unless the incremental cost was $19 per dose or less (range: $17-24) compared to the bivalent vaccine. CC control policies implemented over the last decade in Norway may have accelerated the timeframe to elimination by more than 17 years and prevented over 23,800 cases by 2110.
在世界卫生组织（WHO）发出消除宫颈癌（CC）的全球行动呼吁后，我们评估了挪威的每一项 CC 政策决策如何影响消除 CC 的时间安排，以及引入九价人乳头瘤病毒（HPV）疫苗是否会加速消除时间并具有成本效益。我们使用了一种多模型方法，该方法捕捉了 HPV 传播和宫颈癌发生，以估计与接种疫苗前相比，六种过去和未来的 CC 预防政策决策与基于每 3 年一次细胞学筛查的情景相关的 CC 发病率。评估了以下方案：2009 年为 12 岁女孩常规接种四价疫苗；2016-2018 年为 26 岁以下女性接种二价疫苗的临时补种计划；2017 年普及接种二价疫苗；2018 年扩大到包括 12 岁男孩；2020 年将女性（34-69 岁）的细胞学筛查改为 HPV 筛查；2021 年可能改用九价疫苗。2009 年引入常规女性疫苗接种可使消除 CC 的时间提前到 2056 年，并预防 17300 例病例。随后的政策决策加速了这一进程，使消除 CC 的时间提前到 2039 年。根据我们的建模假设，如果与二价疫苗相比，九价疫苗的增量成本为每剂 19 美元或更少（范围为 17-24 美元），那么在挪威相关的成本效益阈值下，改用九价疫苗将不会被认为是“物有所值”。过去十年中在挪威实施的 CC 控制政策可能使消除 CC 的时间提前了 17 年以上，并在 2110 年之前预防了超过 23800 例病例。
