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'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 152 087 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 121 292 CNY/life-year, which was cost-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 1 200 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.
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152 087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121 292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1 200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。.
Keywords: Dynamic model; Economics, medical; Uterine cervical neoplasms; Vaccine.