二价HPV疫苗接种策略的卫生经济学评估：基于动态模型

Health economic evaluation of bivalent human papilloma virus vaccine in China：based on the dynamic model

目的 对接种二价HPV疫苗的预防效果及成本效益进行卫生经济学评价.方法 构建适用于我国的具有人口异质性的多健康状态的动态模型,模型包含疾病自然史模块和干预模块;假定疫苗保护力为100％,接种和醋酸染色检查/复方碘染色方法（VIA/VILI）筛查的覆盖率均为70％的前提下,针对接种二价HPV疫苗和VIA/VILI筛查制定19项干预方案,方案中设定常规接种为女性15岁时接种3剂次二价HPV疫苗.通过多健康状态的动态模型模拟19项干预方案的长期效果与成本,本研究从增量成本效益比（ICER,以152087元人民币为具有成本效益的阈值）和成本效益边界角度对方案进行分析,同时采用阈值分析法分析各方案中疫苗的最优价格,并以不干预为基准进行比较.结果 与不进行干预相比,常规接种二价HPV疫苗可使宫颈癌发病率降低69.5％,优于仅进行VIA/VILI筛查的5项方案（最低为9.0％,最高为69.2％,预防效果随筛查频率提高而显著提高）;常规接种并终生筛查1次使宫颈癌发病率降低72.0％,常规接种并3年筛查1次使发病率降低达89.4％.与不进行干预相比,常规接种并终生筛查2次的ICER为121292元人民币/年,具有成本效益.疫苗价格对方案的成本效益具有较大影响,当疫苗价格小于600元人民币,仅常规接种或常规接种后在16～39岁时补种的方案具有成本效益;当疫苗价格小于1200元人民币时,在16～29岁时补种并适时进行VIA/VILI筛查的方案具有成本效益.结论 对适龄人群接种二价HPV疫苗并进行VIA/VILI筛查能有效降低宫颈癌发病率,且具有成本效益的预防策略.

Objective This study aims to evaluate the prevention effect and cost-effectiveness of a prophylactic bivalent human papilloma virus （HPV） vaccine. Methods A multiple health status dynamic model was developed, including natural history of diseases and prevention strategies. We built 19 prevention strategies including visual inspection with acetic acid/lugol＆#39;s iodine （VIA/VILI） and/or 3 does prophylactic bivalent HPV vaccine administered to adolescent girls at the age of 15 years old every year under the assumption that vaccine coverage and screening coverage were 70%. The incremental cost-effectiveness ratio （ICER）, optimal price of 3 does vaccine and cost-effectiveness frontier of these strategies were analyzed compared with no-intervention. The ICER threshold is 152087 CNY. Results Compared with no-intervention, Routine vaccination reduced the incidence of cervical cancer by 69.5%, superior to 5 strategies including VIA/VILI screening only. The range of effect was between 9.0%and 69.2%, and the effect of strategy increased significantly with the increase of screening frequency. Combination vaccination with screening at ages of 35 reduced the incidence of cervical cancer by 72.0%, and the effect increased with the increase of screening frequency. Combination vaccination with screening every 3 years between （35-64） years old reduced the incidence by 89.4%. Compared with no-intervention, the ICER of combination vaccination with screening twice between 35 years and 64 years was 121292 CNY/life-year, which wascost-effective. The price of vaccine had a significant impact on the ICER of the strategy;when the vaccine price was less than 600 CNY, only routine vaccination or supplementary vaccination between 16-39 years old after routine vaccination was cost-effective; when the vaccine price was less than 1200 CNY, supplementary vaccination between 16-19 years old plus VIA/VILI was cost-effective. Conclusion Ther prevention strategy was cost-effective, which could effectively reduce the incidence of cervical cancer by implementation of HPV vaccination combined with VIA/VILI in suitable aging females.