Diakite Ibrahim, Nguyen Sylvi, Sabale Ugne, Pavelyev Andrew, Saxena Kunal, Tajik Athar Ali, Wang Wei, Palmer Cody
Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA.
MSD, Oslo, Norway.
J Med Econ. 2023 Jan-Dec;26(1):1085-1098. doi: 10.1080/13696998.2023.2250194.
The objective of this study was to estimate and compare the cost-effectiveness of switching from a bivalent to a nonavalent human papillomavirus (HPV) vaccination program in Norway, incorporating all nonavalent vaccine-preventable HPV-related diseases and in the context of the latest cervical cancer screening program.
A well-established dynamic transmission model of the natural history of HPV infection and disease was adapted to the Norwegian population. We determined the number of cases of HPV-related diseases and subsequent number of deaths, and the economic burden of HPV-related disease under the current standard of care conditions of bivalent and nonavalent vaccinations of girls and boys aged 12 years.
Compared to bivalent vaccination, nonavalent vaccination averted an additional 4,357 cases of HPV-related cancers, 421,925 cases of genital warts, and 543 cases of recurrent respiratory papillomatosis (RRP) over a 100-year time horizon. Nonavalent vaccination also averted an additional 1,044 deaths over the 100-year time horizon when compared with bivalent vaccination. Total costs were higher for the nonavalent strategy (10.5 billion NOK [€1.03 billion] vs. 9.3-9.4 billion NOK [€915-925 million] for bivalent vaccination). A switch to nonavalent vaccination had a higher vaccination cost (4.4 billion NOK [€433 million] vs. 2.7 billion NOK [€266 million] for bivalent vaccination) but resulted in a savings of 627-694 million NOK [€62-68 million] in treatment costs. A switch to nonavalent vaccination demonstrated an incremental cost-effectiveness ratio of 102,500 NOK (€10,086) per QALY versus bivalent vaccination.
Using a model that incorporated the full range of HPV-related diseases, and the latest cervical cancer screening practices, we found that switching from bivalent to nonavalent vaccination would be considered cost-effective in Norway.
本研究的目的是在挪威评估并比较从二价人乳头瘤病毒（HPV）疫苗接种计划转换为九价HPV疫苗接种计划的成本效益，纳入所有九价疫苗可预防的HPV相关疾病，并结合最新的宫颈癌筛查计划。
将一个成熟的HPV感染和疾病自然史动态传播模型应用于挪威人群。我们确定了HPV相关疾病的病例数和随后的死亡人数，以及在当前12岁女孩和男孩二价和九价疫苗接种护理标准条件下HPV相关疾病的经济负担。
与二价疫苗接种相比，在100年的时间范围内，九价疫苗接种避免了额外4357例HPV相关癌症、421925例尖锐湿疣和543例复发性呼吸道乳头状瘤病（RRP）。与二价疫苗接种相比，九价疫苗接种在100年的时间范围内还避免了额外1044例死亡。九价策略的总成本更高（105亿挪威克朗[10.3亿欧元]，而二价疫苗接种为93 - 94亿挪威克朗[9.15 - 9.25亿欧元]）。转换为九价疫苗接种的疫苗接种成本更高（44亿挪威克朗[4.33亿欧元]，而二价疫苗接种为27亿挪威克朗[2.66亿欧元]），但治疗成本节省了6.27 - 6.94亿挪威克朗[6200 - 6800万欧元]。与二价疫苗接种相比，转换为九价疫苗接种的增量成本效益比为每获得一个质量调整生命年（QALY）102500挪威克朗（10086欧元）。
使用一个纳入了所有HPV相关疾病范围和最新宫颈癌筛查实践的模型，我们发现从二价疫苗接种转换为九价疫苗接种在挪威将被认为具有成本效益。
