PDF(Pubmed)
Abstract：
Background: The United Kingdom (UK) switched from using the 4-valent human papillomavirus (HPV) vaccine (Gardasil®) to the 9-valent vaccine (Gardasil 9®) in 2021. Objective: To estimate and compare the health and economic outcomes of 2 HPV vaccination programs in the UK targeting girls and boys aged 12-13 years from the perspective of the UK National Health Service. The 2 vaccination strategies were (1) universal vaccination 4-valent (UV4V), using the 4-valent HPV vaccine (4vHPV), and (2) universal vaccination 9-valent (UV9V), using the 9-valent HPV vaccine (9vHPV). Methods: A deterministic heterosexual compartmental disease transmission model was used to track health and economic outcomes over a 100-year time horizon. Outcomes were discounted at an annual rate of 3.5% and 1.5%. All costs were adjusted to 2020 British pounds (£). Health outcomes were measured in quality-adjusted life-years (QALYs), and the summary results were presented as incremental cost-effectiveness ratios (£/QALY gained) when comparing UV4V with UV9V. Results: Using the same vaccine coverage for both programs, the total cumulative cases of HPV-related health outcomes tracked over the 100-year horizon indicated that the relative number of cases averted (UV9V vs UV4V) ranged from 4% (anal male cancers and deaths) to 56% (cervical intraepithelial neoplasia [CIN1]). Assuming that 9vHPV cost £15.18 more than 4vHPV (a cost differential based on discounted list prices), the estimated incremental cost-effectiveness ratio was £8600/QALY gained when discounted at 3.5%, and £3300/QALY gained when discounted at 1.5%. The estimated incremental cost-effectiveness ratios from the sensitivity analyses remained <£28000/QALY over a wide range of parameter inputs and demonstrated that disease utilities, discount rate, and vaccine efficacy were the 3 most influential parameters. Discussion: Consistent with other published studies, the results from this study found that the 9vHPV vaccine prevented a substantial number of cases when compared with the 4vHPV vaccine and was highly cost-effective. Conclusions: These results demonstrate that replacing universal 4vHPV with 9vHPV can prevent a substantial additional number of HPV-related cases/deaths (in both women and men) and remain cost-effective over a range of 9vHPV price premiums.
摘要：
背景：英国（UK）在2021年从使用4价人乳头瘤病毒（HPV）疫苗（Gardasil®）转变为9价疫苗（Gardasil9®）。目的：从英国国家卫生服务的角度，评估和比较英国针对12-13岁女孩和男孩的2种HPV疫苗接种计划的健康和经济结果。2种疫苗接种策略是(1)通用疫苗接种4价(UV4V)，使用4价HPV疫苗（4vHPV），和（2）通用疫苗9价（UV9V），使用9价HPV疫苗（9vHPV）。方法：使用确定性异性恋房室疾病传播模型来跟踪100年时间范围内的健康和经济结果。结果以3.5%和1.5%的年率进行了折价。所有费用均调整为2020英镑（£）。健康结果以质量调整寿命年(QALYs)衡量，当比较UV4V和UV9V时，总结结果以增量成本效益比(£/QALY增益)表示。结果：两个项目使用相同的疫苗覆盖率，在100年范围内追踪的HPV相关健康结局的累积病例总数表明,避免的相对病例数(UV9VvsUV4V)在4%(肛门男性癌症和死亡)至56%(宫颈上皮内瘤变[CIN1])之间.假设9vHPV的成本比4vHPV高15.18英镑（基于折扣标价的成本差异），估计的增量成本效益比为8600GB/QALY，当贴现为3.5%时，当折价1.5%时，收益为3300GB/QALY。在广泛的参数输入范围内，敏感性分析估计的增量成本效益比保持<28000英镑/QALY，并证明了疾病效用，贴现率，和疫苗效力是最有影响的3个参数。讨论：与其他已发表的研究一致，这项研究的结果发现,与4vHPV疫苗相比,9vHPV疫苗可以预防大量病例,并且具有很高的成本效益.结论：这些结果表明，用9vHPV代替通用4vHPV可以预防大量与HPV相关的病例/死亡（女性和男性），并在9vHPV价格溢价范围内保持成本效益。
