期刊
BRITISH JOURNAL OF CANCER
卷 97, 期 9, 页码 1322-1328出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.bjc.6604023
关键词
cost-effectiveness analysis; HPV vaccination; cervical cancer; mathematical models; dynamic models; computer simulation
类别
资金
- NCI NIH HHS [R01 CA93435, R01 CA093435] Funding Source: Medline
We assessed the cost-effectiveness of including boys vs girls alone in a pre-adolescent vaccination programme against human papillomavirus (HPV) types 16 and 18 in Brazil. Using demographic, epidemiological, and cancer data from Brazil, we developed a dynamic transmission model of HPV infection between males and females. Model-projected reductions in HPV incidence under different vaccination scenarios were applied to a stochastic model of cervical carcinogenesis to project lifetime costs and benefits. We assumed vaccination prevented HPV-16 and -18 infections in individuals not previously infected, and protection was lifelong. Coverage was varied from 0-90% in both genders, and cost per-vaccinated individual was varied from 1$25 to 400. At 90% coverage, vaccinating girls alone reduced cancer risk by 63%; including boys at this coverage level provided only 4% further cancer reduction. At a cost per-vaccinated individual of $50, vaccinating girls alone was <$200 per year of life saved (YLS), while including boys ranged from $810-18 650 per YLS depending on coverage. For all coverage levels, increasing coverage in girls was more effective and less costly than including boys in the vaccination programme. In a resource-constrained setting such as Brazil, our results support that the first priority in reducing cervical cancer mortality should be to vaccinate pre-adolescent girls.
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