Owusu-Edusei Kwame, Palmer Cody, Ovcinnikova Olga, Favato Giampiero, Daniels Vincent
Merck & Co., Inc.
MSD (UK) Limited.
J Health Econ Outcomes Res. 2022 Jun 6;9(1):140-150. doi: 10.36469/001c.34721. eCollection 2022.
The United Kingdom (UK) switched from using the 4-valent human papillomavirus (HPV) vaccine (Gardasil®) to the 9-valent vaccine (Gardasil 9®) in 2021. To estimate and compare the health and economic outcomes of 2 HPV vaccination programs in the UK targeting girls and boys aged 12-13 years from the perspective of the UK National Health Service. The 2 vaccination strategies were (1) universal vaccination 4-valent (UV4V), using the 4-valent HPV vaccine (4vHPV), and (2) universal vaccination 9-valent (UV9V), using the 9-valent HPV vaccine (9vHPV). A deterministic heterosexual compartmental disease transmission model was used to track health and economic outcomes over a 100-year time horizon. Outcomes were discounted at an annual rate of 3.5% and 1.5%. All costs were adjusted to 2020 British pounds (£). Health outcomes were measured in quality-adjusted life-years (QALYs), and the summary results were presented as incremental cost-effectiveness ratios (£/QALY gained) when comparing UV4V with UV9V. Using the same vaccine coverage for both programs, the total cumulative cases of HPV-related health outcomes tracked over the 100-year horizon indicated that the relative number of cases averted (UV9V vs UV4V) ranged from 4% (anal male cancers and deaths) to 56% (cervical intraepithelial neoplasia [CIN1]). Assuming that 9vHPV cost £15.18 more than 4vHPV (a cost differential based on discounted list prices), the estimated incremental cost-effectiveness ratio was £8600/QALY gained when discounted at 3.5%, and £3300/QALY gained when discounted at 1.5%. The estimated incremental cost-effectiveness ratios from the sensitivity analyses remained <£28000/QALY over a wide range of parameter inputs and demonstrated that disease utilities, discount rate, and vaccine efficacy were the 3 most influential parameters. Consistent with other published studies, the results from this study found that the 9vHPV vaccine prevented a substantial number of cases when compared with the 4vHPV vaccine and was highly cost-effective. These results demonstrate that replacing universal 4vHPV with 9vHPV can prevent a substantial additional number of HPV-related cases/deaths (in both women and men) and remain cost-effective over a range of 9vHPV price premiums.
英国于2021年从使用四价人乳头瘤病毒（HPV）疫苗（佳达修®）转为使用九价疫苗（佳达修9®）。从英国国家医疗服务体系的角度，估计并比较英国针对12至13岁女孩和男孩的两种HPV疫苗接种计划的健康和经济结果。两种疫苗接种策略分别为：（1）四价通用接种（UV4V），使用四价HPV疫苗（4vHPV）；（2）九价通用接种（UV9V），使用九价HPV疫苗（9vHPV）。采用确定性异性传播疾病分区模型，在100年的时间范围内跟踪健康和经济结果。结果按3.5%和1.5%的年利率进行贴现。所有成本均调整为2020年英镑（£）。健康结果以质量调整生命年（QALY）衡量，比较UV4V和UV9V时，汇总结果以增量成本效益比（£/获得的QALY）呈现。两种接种计划采用相同的疫苗覆盖率，在100年时间范围内跟踪的HPV相关健康结果的累计病例总数表明，避免的病例相对数量（UV9V与UV4V相比）从4%（男性肛管癌和死亡）到56%（宫颈上皮内瘤变[CIN1]）不等。假设9vHPV比4vHPV贵15.18英镑（基于贴现标价的成本差异），贴现率为3.5%时，估计的增量成本效益比为£8600/获得的QALY，贴现率为1.5%时为£3300/获得的QALY。敏感性分析得出的估计增量成本效益比在广泛的参数输入范围内仍<£28000/QALY，表明疾病效用、贴现率和疫苗效力是三个最具影响力的参数。与其他已发表的研究一致，本研究结果发现，与4vHPV疫苗相比，9vHPV疫苗可预防大量病例，且具有很高的成本效益。这些结果表明，用9vHPV取代通用的4vHPV可预防大量额外的HPV相关病例/死亡（包括女性和男性），并且在9vHPV价格溢价范围内仍具有成本效益。
