基于Markov模型不同人乳头瘤病毒疫苗免疫策略下北京市宫颈癌发病的远期预测

Long-term prediction of cervical cancer incidence in Beijing under different human papillomavirus immunization strategies by Markov models

目的构建北京市人乳头瘤病毒(HPV)疫苗不同免疫策略的Markov模型,进行北京市女性宫颈癌发病的远期预测。方法收集模型参数,构建Markov模型;在构建和验证宫颈癌自然史模型和筛查模型的基础上构建HPV疫苗接种模型,预测实施三种HPV疫苗(2价、4价和9价疫苗)接种和9价HPV疫苗四种免疫策略(接种年龄和接种率:10-15岁80%、16-44岁10%;10-19岁80%、20-44岁10%;10-15岁90%、16-44岁30%;10-19岁90%、20-44岁30%)后2017-2100年宫颈癌发病。结果本研究成功构建北京市HPV疫苗接种的Markov模型。模型预测结果显示,2017-2100年实施3种HPV疫苗免疫策略后北京市女性宫颈癌的预测发病数均逐年下降。在9价疫苗免疫策略中,策略1与策略2、策略3与策略4的宫颈癌预测发病曲线几乎相同;将策略1改为策略3或将策略2改为策略4,宫颈癌发病明显下降。与筛查模型的同年预测发病率相比,实施四种9价疫苗免疫策略后2030年宫颈癌发病率分别下降34%、36%、48%、48%,2060年分别下降84%、85%、90%、90%。结论HPV疫苗不同免疫策略均可降低女性宫颈癌发病;青少年女性高水平接种率与成年女性低水平接种率相结合策略可达到较好的宫颈癌防控效果。

Objective To predict long-term incidence of cervical cancer among women in Beijing by constructing Markov models of diff erent immunization strategies with human papillomavirus(HPV)vaccine.Methods We determined model parameters f or Markov models.Based on a natural history model and a screening model f or cervical cancer,we constructed an HPV vaccination model to predict cervical cancer incidence in 2017-2100 af ter immunization with three different HPV vaccines(2-valent,4-valent,and 9-valent),and after implementation of four immunization strategies with 9-valent HPV vaccine(vaccination age and coverage:80%in 10-15-year-olds and 10%in 16-44-year-olds;80%in 10-19-year-olds and 10%in 20-44-year-olds;90%in 10-15-year-olds and 30%in 16-44-yearolds;90%in 10-19-year-olds and 30%in 20-44-year-olds).Results Markov models of HPV vaccination in Beijing were successf ully constructed.The models predicted that the incidence of cervical cancer among women in Beijing would decrease gradually f rom 2017 to 2100 after immunization with any of three HPV vaccines.In the four immunization strategies with 9-valent vaccine,the predicted cervical cancer incidence curves were similar for strategies 1 and 2,or for strategies 3 and 4.The incidence of cervical cancer would decreased significantly if changing f rom strategy 1 to strategy 3,or changing f rom strategy 2 to strategy 4.Af ter implementation of four immunization strategies with 9-valent vaccine,the incidence of cervical cancer was predicted to decrease by 34%,36%,48%,and 48%by 2030,or by 84%,85%,90%,and 90%by 2060,respectively,compared with a screening-only model.Conclusions Each HPV vaccine immunization strategy could reduce the incidence of cervical cancer.A combined strategy of high vaccination coverage for adolescent girls and low vaccination coverage for adult women could achieve effective cervical cancer prevention and control.