Agency for Care Effectiveness, Ministry of Health, Singapore.
Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Vaccine. 2021 Apr 15;39(16):2255-2263. doi: 10.1016/j.vaccine.2021.03.040. Epub 2021 Mar 18.
The nonavalent human papillomavirus (HPV) vaccine has been shown to extend protection against oncogenic HPV types 31/33/45/52/58 (HPV-OV) not covered by the bivalent and quadrivalent HPV vaccines. Besides its clinical benefit, evidence on the economic value of the nonavalent vaccine is required to inform local vaccination strategies and funding decisions. This study evaluated the cost-effectiveness of replacing the bivalent vaccine with the nonavalent vaccine in the national school-based HPV vaccination programme in Singapore.
An existing age-structured dynamic transmission model coupled with stochastic individual-based simulations was adapted to project the health and economic impact of vaccinating 13-year-old girls with two doses of the nonavalent or bivalent HPV vaccines in Singapore. Direct costs (in Singapore dollars, S$) were obtained from public healthcare institutions in Singapore, while health state utilities were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated over a lifetime horizon, from a healthcare system perspective. Probabilistic sensitivity analysis was performed to obtain the ICERs and corresponding variations across variable uncertainty. Particularly, this study tested the scenarios of lifelong and 20-year vaccine-induced protection, assumed 96.0% and 22.3% cross-protection against HPV-OV by nonavalent and bivalent vaccines respectively, and fixed vaccine prices per dose at S$188 for nonavalent and S$61.50 for bivalent vaccines.
Compared with the bivalent vaccine, the use of the nonavalent vaccine was associated with an ICER of S$61,629 per quality-adjusted life year gained in the base case. The result was robust across a range of plausible input values, and to assumptions regarding the duration of vaccine protection.
Given the high ICER, the nonavalent vaccine is unlikely to represent a cost-effective option compared with the bivalent vaccine for school-based HPV vaccination of 13-year old female students in Singapore. Substantial price reductions would be required to justify its inclusion in the school-based programme in the future.
九价人乳头瘤病毒（HPV）疫苗已被证明可延长对二价和四价 HPV 疫苗未覆盖的致癌 HPV 型 31/33/45/52/58（HPV-OV）的保护。除了其临床益处外，还需要有关九价疫苗的经济价值的证据，以告知当地的疫苗接种策略和资金决策。本研究评估了在新加坡国家学校 HPV 疫苗接种计划中用九价疫苗替代二价疫苗的成本效益。
本研究改编了一个现有的年龄结构动态传播模型，并结合随机个体模拟，以预测在新加坡为 13 岁女孩接种两剂九价或二价 HPV 疫苗的健康和经济影响。直接成本（新加坡元，S$）来自新加坡公共医疗机构，而健康状态效用则来自文献。从医疗保健系统的角度，在终生时间范围内估算增量成本效益比（ICER）。通过概率敏感性分析获得了 ICER 及其在变量不确定性下的相应变化。本研究特别测试了终生和 20 年疫苗诱导保护的情况，假设九价和二价疫苗对 HPV-OV 的交叉保护率分别为 96.0%和 22.3%，并将九价疫苗每剂的固定价格设定为 S$188，二价疫苗的固定价格设定为 S$61.50。
与二价疫苗相比，在基础情况下，使用九价疫苗每获得一个质量调整生命年的增量成本效益比为 S$61629。该结果在一系列合理的输入值范围内是稳健的，并且对疫苗保护持续时间的假设也是稳健的。
鉴于高增量成本效益比，与二价疫苗相比，九价疫苗不太可能成为新加坡为 13 岁女学生提供学校 HPV 疫苗接种的一种具有成本效益的选择。未来要将其纳入学校计划，需要大幅降低价格。
