Luttjeboer Jos, Simons Joost, Westra Tjalke, Wilschut Jan, Boersma Cornelis, Postma Maarten, van der Schans Jurjen
University Medical Center, Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
GSK, Wavre, Belgium.
Infect Dis Ther. 2023 Aug;12(8):2135-2145. doi: 10.1007/s40121-023-00851-9. Epub 2023 Aug 10.
Vaccination against human papillomavirus (HPV) is considered the most effective strategy to protect women from cervical cancer. Three HPV vaccines are currently licensed in Europe and, although they are generally supported by favorable health economic outcomes, current models fall short in predicting vaccination benefits. Here, we aim to re-evaluate the health benefits of HPV vaccination, using updated long-term effectiveness data and emphasizing quality of life losses related to pre-cancer disease and treatment.
We used a static Markov model that compared "only screening" (includes unvaccinated girls) and "vaccination" (assumes 100% vaccination coverage with the bivalent HPV vaccine). A lifetime cohort of 100,000 uninfected 12-year-old girls was included, in which the number of cases with cervical intraepithelial neoplasia grade 2 or higher/3 (CIN2+, CIN3), cervical cancer, and cervical cancer deaths per scenario were determined. Furthermore, the reduction in major excisional procedures, the preterm deliveries averted, and the related gain in quality-adjusted life years (QALYs) due to vaccination were estimated.
The bivalent vaccine showed larger reductions in CIN2+, CIN3, cervical cancer cases, cervical cancer deaths, and major excisional treatments, after including long-term efficacy and effectiveness data, compared to previous data. Moreover, we observed an increased amount of QALYs gained due to prevention of major excisional treatment and the negative side effects related to it.
Updated health economic models for HPV vaccination, using updated and long-term effectiveness data and including prevention of treatment-related side effects, demonstrate a substantial additional positive effect on vaccination outcomes. Indeed, extrapolation of the bivalent HPV vaccine's updated long-term effectiveness data against HPV-related cervical diseases shows that the positive effects of vaccination may be more substantial than previously estimated. There is a graphical abstract available for this article.
人乳头瘤病毒（HPV）疫苗接种被认为是保护女性免受宫颈癌侵害的最有效策略。目前欧洲已批准三种HPV疫苗，尽管它们总体上有良好的健康经济效益支持，但当前模型在预测疫苗接种益处方面存在不足。在此，我们旨在利用更新的长期有效性数据，并强调与癌前疾病及治疗相关的生活质量损失，重新评估HPV疫苗接种的健康益处。
我们使用了一个静态马尔可夫模型，比较“仅筛查”（包括未接种疫苗的女孩）和“接种疫苗”（假设二价HPV疫苗接种覆盖率为100%）。纳入了10万名未感染的12岁女孩的终生队列，确定每种情况下2级或更高/3级宫颈上皮内瘤变（CIN2+、CIN3）、宫颈癌及宫颈癌死亡病例数。此外，估计了接种疫苗导致的主要切除手术减少、避免的早产以及质量调整生命年（QALY）的相关增益。
与之前的数据相比，在纳入长期疗效和有效性数据后，二价疫苗在CIN2+、CIN3、宫颈癌病例、宫颈癌死亡及主要切除治疗方面的减少幅度更大。此外，我们观察到由于预防主要切除治疗及其相关负面副作用，获得的QALY数量有所增加。
使用更新的长期有效性数据并纳入预防治疗相关副作用的HPV疫苗接种更新健康经济模型，显示出对疫苗接种结果有显著的额外积极影响。事实上，二价HPV疫苗针对HPV相关宫颈疾病的更新长期有效性数据推断表明，疫苗接种的积极效果可能比之前估计的更为显著。本文有一个图形摘要。
