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首页> 外文期刊>Vaccine >The clinical benefit and cost-effectiveness of human papillomavirus vaccination for adult women in the Netherlands.
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The clinical benefit and cost-effectiveness of human papillomavirus vaccination for adult women in the Netherlands.

机译：在荷兰，成年女性进行人乳头瘤病毒疫苗接种的临床收益和成本效益。

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BACKGROUND: The use of human papillomavirus (HPV) vaccines has been universally approved for women from age 12 to 25 years, but those older than 16 years receive no reimbursement for the cost of the vaccine in the Netherlands. Reductions in the vaccine price as well as new insights in the efficacy of HPV vaccines offer renewed arguments to consider HPV vaccination in adult women. We calculated the clinical benefit and cost-effectiveness of vaccinating women aged 17-25 years in 2010. METHODS: The calculations were based on an individual-based simulation model for cervical carcinogenesis, with HPV infection risks obtained from a type-specific HPV transmission model. The indirect protective effect from vaccinating 12 to 16 year-old girls was adjusted for. Cervical screening in the model was incorporated according Dutch screening guidelines, i.e. 7 cytology-based rounds at 5-year intervals from the age of 30. As base-case, we assumed the vaccine to offer full protection against HPV16/18 only if no prior exposure to that type had occurred before vaccination. In sensitivity analyses, we considered partial cross-protection against types 31/33/45/58 and efficacy against all future infections, irrespective of previous or current infection status. RESULTS: In base-case analyses, vaccinating 17 year-olds reduced their lifetime risk of treatment for precancerous lesions from 7.77% to 3.48% and their lifetime cervical cancer risk from 0.52% to 0.24%. These risks were 6.12% and 0.45%, respectively, for a 25 year-old vaccinee. The incremental cost-effectiveness ratio (ICER) for vaccinating 17-25 year-olds was [Euro sign]22,526 per quality-adjusted life-year (QALY) at a vaccine price of [Euro sign]65 per dose, a 50% reduction of the 2010 pharmacy price in the Netherlands. If cross-protection against types 31/33/45/58 was included, the ICER decreased to [Euro sign]14,734 per QALY. Results were robust to efficacy assumptions with respect to previous or current infection status. CONCLUSION: The clinical benefit of HPV vaccination of women up to 25 years moderately depends on cross-protection to non-vaccine types. Refunding the cost of the vaccine to 17-25 year-old women in the Netherlands can be considered cost-effective at anticipated price reductions. Copyright Copyright 2011 Elsevier Ltd. All rights reserved.
机译：背景：人类乳头瘤病毒（HPV）疫苗已被普遍批准用于12至25岁的女性，但是16岁以上的女性在荷兰无法获得疫苗费用的补偿。疫苗价格的降低以及对HPV疫苗功效的新见解为考虑在成年女性中接种HPV疫苗提供了新的观点。我们计算了2010年年龄在17-25岁之间的女性疫苗接种的临床收益和成本效益。方法：计算是基于基于个体的宫颈癌发生模拟模型，其中HPV感染风险是通过特定类型的HPV传播模型获得的。调整了接种12到16岁女孩的间接保护作用。根据荷兰筛查指南，将模型进行宫颈筛查，即从30岁开始，每隔5年进行7次基于细胞学的检查。作为基础病例，我们假设只有在没有以前的情况下，疫苗才能提供针对HPV16 / 18的全面保护在接种疫苗之前曾发生过这种类型的接触。在敏感性分析中，我们考虑了针对31/33/45/58型的部分交叉保护以及针对所有未来感染的有效性，而与先前或当前的感染状态无关。结果：在基本病例分析中，为17岁的儿童接种疫苗可将他们一生中对癌前病变的治疗风险从7.77％降低到3.48％，并将一生子宫颈癌的风险从0.52％降低到0.24％。对于25岁的疫苗接种者，这些风险分别为6.12％和0.45％。疫苗价格为每剂[欧文] 65欧元时，为17-25岁的儿童接种疫苗的成本效益比（ICER）为[欧文] 22,526每质量调整生命年（QALY）。在荷兰的2010年药房价格中。如果包括针对31/33/45/58类型的交叉保护，则ICER降低至每QALY [欧元符号] 14,734。结果对于先前或当前感染状态的功效假设是可靠的。结论：HPV疫苗接种对25岁以下妇女的临床获益适度取决于对非疫苗类型的交叉保护。在荷兰，如果将疫苗费用退还给17-25岁的女性，可以认为可以降低价格，因此具有成本效益。版权版权所有2011 ElsevierLtd。保留所有权利。

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