Portnoy Allison, Sweet Steven, Desalegn Dawit, Memirie Solomon Tessema, Kim Jane J, Verguet Stéphane
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA.
Vitalant Research Institute, 270 Masonic Avenue, San Francisco, CA 94118, USA.
Health Policy Plan. 2021 Jun 25;36(6):891-899. doi: 10.1093/heapol/czab052.
High out-of-pocket (OOP) medical expenses for cervical cancer (CC) can lead to catastrophic health expenditures (CHEs) and medical impoverishment in many low-resource settings. There are 32 million women at risk for CC in Ethiopia, where CC screening is extremely limited. An evaluation of the population health and financial risk protection benefits, and their distributional consequences across socioeconomic groups, from human papillomavirus (HPV) vaccination will be critical to support CC prevention efforts in this setting. We used a static cohort model that captures the main features of HPV vaccines and population demographics to project health and economic outcomes associated with routine HPV vaccination in Ethiopia. Health outcomes included the number of CC cases, and costs included vaccination and operational costs in 2015 US dollars over the years 2019-2118 and CC treatment costs over the lifetimes of cohorts eligible for vaccination in Ethiopia. We estimated the household OOP medical expenditures averted (assuming 68% of direct medical expenditures were financed OOP) and cases of CHE averted. A case of CHE was defined as 40% of household consumption expenditures, and the cases of CHE averted depended on wealth quintile, disease incidence, healthcare use and OOP payments. Our analysis shows that, assuming 100% vaccine efficacy against HPV-16/18 and 50% vaccination coverage, routine HPV vaccination could avert up to 970 000 cases of CC between 2019 and 2118, which translates to ∼932 000 lives saved. Additionally, routine HPV vaccination could avert 33 900 cases of CHE. Approximately one-third of health benefits would accrue to the poorest wealth quintile, whereas 50% of financial risk protection benefits would accrue to this quintile. HPV vaccination can reduce disparities in CC incidence, mortality and household health expenditures. This understanding and our findings can help policymakers in decisions regarding targeted CC control efforts and investment in a routine HPV vaccination programme following an initial catch-up programme.
在许多资源匮乏地区，宫颈癌（CC）的高额自付医疗费用可能导致灾难性卫生支出（CHEs）和医疗贫困。埃塞俄比亚有3200万女性面临宫颈癌风险，而该国的宫颈癌筛查极为有限。评估人乳头瘤病毒（HPV）疫苗接种对人群健康和财务风险保护的益处及其在社会经济群体中的分配后果，对于支持该国的宫颈癌预防工作至关重要。我们使用了一个静态队列模型，该模型捕捉了HPV疫苗和人群人口统计学的主要特征，以预测埃塞俄比亚常规HPV疫苗接种相关的健康和经济结果。健康结果包括宫颈癌病例数，成本包括2019年至2118年以2015年美元计算的疫苗接种和运营成本，以及埃塞俄比亚符合疫苗接种条件队列终生的宫颈癌治疗成本。我们估计了避免的家庭自付医疗费用（假设68%的直接医疗费用由自付支付）和避免的灾难性卫生支出病例数。一例灾难性卫生支出定义为家庭消费支出的40%，避免的灾难性卫生支出病例数取决于财富五分位数、疾病发病率、医疗保健使用情况和自付费用。我们的分析表明，假设HPV-16/18疫苗效力为100%且疫苗接种覆盖率为50%，常规HPV疫苗接种在2019年至2118年期间可避免多达97万例宫颈癌病例，这相当于挽救了约93.2万人的生命。此外，常规HPV疫苗接种可避免33900例灾难性卫生支出病例。约三分之一的健康益处将归于最贫困的财富五分位数人群，而50%的财务风险保护益处将归于该五分位数人群。HPV疫苗接种可减少宫颈癌发病率、死亡率和家庭卫生支出方面的差距。这种认识和我们的研究结果有助于政策制定者在初始追赶计划之后，就有针对性的宫颈癌控制努力和常规HPV疫苗接种计划的投资做出决策。
