| 许晓君,唐 娴,李小毛.广东省适龄人群HPV疫苗不同免疫策略的卫生经济学评价[J].中国肿瘤,2022,31(2):139-145. |
| 广东省适龄人群HPV疫苗不同免疫策略的卫生经济学评价 |
| Health Economics Evaluation of Different HPV Vaccination Strategies in Guangdong Province |
| 投稿时间：2021-08-24 |
| DOI：10.11735/j.issn.1004-0242.2022.02.A009 |
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| 中文关键词: 宫颈癌 HPV疫苗 卫生经济学 PRIME模型 |
| 英文关键词:cervical cancer HPV vaccine health economic evaluation PRIME model |
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| 中文摘要: |
| 摘 要：［目的］ 评估广东省适龄人群人乳头瘤病毒（HPV）疫苗不同免疫策略在卫生经济学方面的优劣，并提出最优经济学表现方案。［方法］ 应用PRIME工具，使用广东本地数据进行自定义参数修改，分别评估全省适龄人群不同HPV疫苗免疫方案的卫生经济学优劣，并结合敏感性分析结果得出最佳方案的卫生经济学方案。［结果］ 假定从2021年起在广东省所有适龄女生（13岁）中开展HPV疫苗免费接种项目，在目标接种人群全程接种覆盖率达80%、贴现率3%情况下，使用国产二价及进口二价、进口四价和九价HPV疫苗开展全省免疫接种的方案，每年须投入的净成本分别为2.84亿、8.22亿、11.43亿、18.55亿元，接种任一种HPV疫苗均可使目标人群在未来一生中患宫颈癌概率明显降低，使用二价/四价HPV疫苗可减少4 295例宫颈癌发生，可避免1 373例宫颈癌死亡，使用九价HPV疫苗可减少5 522例宫颈癌发生，可避免1 766例宫颈癌死亡；与未实施干预计划比较，对于每挽救1个因宫颈癌导致的伤残调整寿命年（DALY）所需增量成本（CER），国产二价及进口二价、四价和九价HPV疫苗分别是3.3万、9.7万、13.4万、17.0万元；国产二价及进口二价、四价和九价疫苗的增量成本效果比（ICER）/年人均GDP比值分别为0.35、1.03、1.43和1.80。单因素敏感性分析显示，当贴现率、疫苗成本、治疗费用、目标人群接种年龄变化时，ICER/年人均GDP比值均小于1，其中贴现率的变化对经济学评价结果影响最大。推荐方案为应用国产二价疫苗、疫苗采购成本折价80%、全程接种覆盖率达90%，此方案ICER/年人均GDP比值为0.27，具有最优经济学表现，全省预计能在2071年将宫颈癌发病率降到4/10万以下。［结论］ 应用国产二价HPV疫苗的适龄人群免疫策略在成本效益、成本效果和效用三方面均具有高度良好的卫生经济学表现，较高接种覆盖率可使目标人群未来一生宫颈癌发病率下降幅度增大，实现对宫颈癌的综合防控。 |
| 英文摘要: |
| Abstract：［Purpose］ To evaluate the cost-effectiveness of different immunization strategies of HPV vaccination in the target-age population of Guangdong Province. ［Methods］ The health impact and cost-effectiveness of the four different HPV vaccination strategies were evaluated by Papilloma Virus Rapid Interface for Modelling and Economics(PRIME) model with customized parameters using the local data from Guangdong Province. The one with best health economics solutions was opted for sensitivity analysis. ［Results］ It was assumed that the HPV vaccination program for target-age girls (13 years old) would be implemented in Guangdong from 2021， with the full coverage rate of 80% and 3% of discount rate， the annual net cost of using domestic bivalent， imported bivalent， 4-valent and 9-valent vaccines was 284 million， 822 million， 1.143 billion and 1.855 billion Yuan， respectively. The lifetime risk of cervical cancer in the target age birth cohort was significantly reduced by any HPV vaccination. A total of 4 295 cervical cancer cases and 1 373 cervical cancer deaths would be averted with the use of the bivalent/4-valent vaccines， and 5 522 cervical cancer cases and 1 766 cervical cancer deaths would be averted with the use of 9-valent HPV vaccine. Compared with no HPV immunization， the incremental costs per disability-adjusted life year(CER) were 33 thousand， 97 thousand， 134 thousand and 170 thousand Yuan for domestic bivalent， imported bivalent， 4-valent and 9-valent vaccines， respectively. And the incremental cost effectiveness ratio(ICER)/GDP per capita were 0.35， 1.03， 1.43 and 1.80， accordingly. The results were robust in one-way sensitivity analysis with changing discount rate， vaccine cost， treatment cost and vaccination coverage， and the discount rate had the greatest impact on the ICER. The recommended strategy was to apply domestic bivalent with the 20% off of the vaccination price and the full coverage rate of 90%. Under this plan， the ICER/GDP per capital was 0.27 with the best economic performance and the goal of reducing the incidence of cervical cancer to less than 4/105 in Guangdong in 2071. ［Conclusion］ The immunization strategy of introducing the domestic bivalent HPV vaccine in 13 year-old girls has a highly good performance of health economics in cost-benefit， cost-effectiveness and cost-utility. By expanding the vaccination coverage， the incidence rate would decrease more significantly and realize the comprehensive prevention and control of cervical cancer. |
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