中国12岁女性青少年接种不同人乳头瘤病毒疫苗策略的卫生经济学评价  

Health economics evaluation of vaccination strategies for different human papillomavirus vaccines for 12-year-old female adolescents in China

作　　者：李玖洪 刘晓雪 唐林 王富珍[1] 尹遵栋[1] Li Jiuhong;Liu Xiaoxue;Tang Lin;Wang Fuzhen;Yin Zundong(National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases/National Immunization Programme,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]传染病溯源预警与智能决策全国重点实验室,中国疾病预防控制中心免疫规划中心,北京102206

出　　处：《中华预防医学杂志》2025年第4期425-432,共8页Chinese Journal of Preventive Medicine

基　　金：中华预防医学会传染病防控领域中青年人才科研支撑项目(CPMA2024CRBFK);公共卫生人才培养支持项目。

摘　　要：目的分析12岁女性青少年接种2剂不同类型的人乳头瘤病毒(HPV)疫苗的成本效用。方法建立决策树-马尔科夫模型,以生殖器疣和宫颈癌为目标疾病,采用试点省份招采价格或自费接种疫苗价格的50%进行分析,模拟2023年12岁女性青少年队列,估算不接种、接种2剂二价(HPV-2)、2剂四价HPV(HPV-4)、2剂九价HPV(HPV-9)策略下效果、成本和质量调整生命年(QALY),比较不同策略之间避免的宫颈癌和生殖器疣病例数以及增量成本效用比(ICUR)。结果12岁女性青少年接种2剂HPV-2、HPV-4、HPV-9与不接种相比,HPV-2可以避免55.2%的宫颈癌发生,HPV-4和HPV-9分别可以避免77.11%、78.68%的生殖器疣和54.99%、73.46%的宫颈癌发生;策略HPV-2、HPV-4、HPV-9的ICUR分别为-28470.44元/QALY、29328.26元/QALY、48106.85元/QALY。单因素敏感性分析显示,影响较大的因素为贴现率、疫苗价格、低级别癌前病变直接医疗成本等因素。概率敏感性分析显示,与2023年全国人均国内生产总值比较,与不接种相比HPV-2、HPV-4、HPV-9具有成本效用的概率分别为99.51%、89.03%、67.81%;单剂HPV-4、HPV-9疫苗价格分别低于当前自费接种价格的26.12%、20.68%时,ICUR<0。结论在HPV-2采用试点省份招采价格,多价疫苗采用50%自费接种价格的情况下,12岁女性青少年接种HPV-2、HPV-4、HPV-9均具有成本效用,HPV-2是最具经济性的策略。ObjectiveTo analyze the cost-effectiveness of administering two doses of different types of human papillomavirus(HPV)vaccines to 12-year-old female adolescents.MethodsA decision tree Markov model with genital warts and cervical cancer as target diseases was established to analyze the effects,costs,and Quality Adjusted Life Years(QALY)of strategies such as no vaccination,two doses of bivalent HPV(HPV-2),two doses of quadrivalent HPV(HPV-4),and two doses of nine-valent HPV(HPV-9)in a 12-year-old female adolescent cohort in 2023 using 50%of the procurement price or self-funded vaccination price in pilot provinces.The number of avoided cases of cervical cancer and genital warts and the incremental cost-utility ratio(ICUR)were compared between different strategies.ResultsCompared with non-vaccination,female adolescents who received two doses of HPV-2,HPV-4 and HPV-9 were able to avoid 55.2%of cervical cancer cases with HPV-2,77.11%and 78.68%of genital warts with HPV-4,and 54.99%and 73.46%of cervical cancer with HPV-9,respectively.The ICUR of strategies HPV-2,HPV-4,and HPV-9 was-28470.44 yuan/QALY,29328.26 yuan/QALY and 48106.85 yuan/QALY,respectively.HPV-2 was the most economical strategy and could achieve net cost savings.Single-factor sensitivity analysis showed that the results were robust,and the most influential factors were discount rate,vaccine prices and direct medical costs for low-grade precancerous lesions.The probability sensitivity analysis showed that compared with the national gross domestic product(GDP)per capita in 2023,the probability of cost-utility of HPV-2,HPV-4 and HPV-9 compared with non-vaccination was 99.51%,89.03%and 67.81%,respectively.Only when the price of a single dose of HPV-4 and HPV-9 vaccines was lower than 26.12%and 20.68%of the current self-funded vaccination price,respectively,could there be a net cost saving.ConclusionIn the case where HPV-2 adopts the pilot province procurement price and the multivalent vaccine adopts a 50%self-funded vaccination price,the vaccination of 12-year-

关 键 词：人乳头瘤病毒 成本及成本分析 卫生经济学 马尔科夫模型 

分 类 号：R186[医药卫生—流行病学]