男男性行为者自费接种HPV疫苗的成本效果分析

Cost-effectiveness analysis of self-funded HPV vaccination for men who have sex with men

目的评估MSM自费接种四价和九价HPV疫苗的成本效果。方法招募MSM通过问卷调查自费接种HPV疫苗意愿,采集肛门脱落细胞检测HPV感染状况,构建静态马尔可夫模型模拟MSM生殖器疣和肛门癌未来40年发展的自然状态与治疗费用,计算自费接种四价疫苗和九价疫苗总成本,比较愿意自费接种疫苗相对不接种疫苗的增量成本效果比(ICER)。结果共有1283名MSM参与调查,自费HPV疫苗的可接受率为61.8%。任一型、低危型、高危型肛门HPV感染率分别48.7%、12.6%、36.2%。相对于不接种疫苗,MSM接种四价疫苗预防生殖器疣和肛门癌的ICER值分别为39324.10元/QALY和33379.88元/QALY,而接种九价疫苗预防生殖器疣和肛门癌的ICER值分别为62240.56元/QALY和53096.97元/QALY,以2022年中国1倍人均国内生产总值(GDP)为判定阈值,接种四价和九价HPV疫苗均符合成本效果。结论MSM对自费接种HPV疫苗具有较高的接受意愿。从卫生体系角度看,扩大至MSM接种四价和九价疫苗均具有成本效益,MSM接种四价疫苗更具经济性。

Objective This study aimed to assess the cost-effectiveness of self-funded 4-valent and 9-valent human papillomavirus(HPV)vaccines in men who have sex with men(MSM).Methods MSM were recruited to investigate their willingness to receive self-funded HPV vaccination and tested anal exfoliated cells for HPV infection.A static Markov model was constructed to simulate the natural history and treatment costs of MSM genital warts and anal cancer over 40 years.The total cost of self-funded 4-valent and 9-valent HPV vaccines were calculated,and the incremental costeffectiveness ratio(ICER)of vaccination versus no vaccination was compared.Results A total of 1283 MSM participated;61.8% were willing to receive the self-funded HPV vaccination.Any-type HPV,low-risk HPV,and high-risk HPV infection rates were 48.7%,12.6%,and 36.2%,respectively.Compared to no vaccination,the ICERs for the 4-valent vaccine were RMB 39324.10/QALY and RMB 33379.88/QALY for preventing genital ward and anal cancer,respectively.The corresponding ICERs for the 9-valent HPV vaccine were RMB 62240.56/QALY and RMB 53096.97/QALY,respectively.Based on China's 2022 gross domestic product(GDP)per capita as the threshold,both of 4-valent and 9-valent vaccines were considered cost-effective.Conclusions MSM are highly willing to receive self-funded HPV vaccination.Expanding access to both 4-valent and 9-valent HPV vaccination for MSM is cost-effective from a healthcare system perspective,with the 4-valent vaccine being slightly more economical.