周大创 罗孟捷 唐文熙

中圖分类号 R956 文献标志码 A 文章编号 1001-0408（2021）13-1602-05

DOI 10.6039/j.issn.1001-0408.2021.13.11

摘 要 目的：评价我国12岁女性接种双价人乳头瘤病毒（HPV）疫苗的成本-效用，为卫生服务决策者提供经济学证据。方法：采用CERVIVAC模型对我国12岁女性进行长期模拟至全部人群均进入死亡状态（循环周期为1年），分别计算接种双价HPV疫苗的试验组人群与未接种该疫苗的对照组人群的成本与健康产出，结合意愿支付阈值[WTP，1倍2019年我国人均国内生产总值（GDP）]判断其经济性。结果：在模拟期限内，试验组相较于对照组的增量成本-效果比（ICER）为28 660.56元/质量调整生命年（QALY），小于WTP，具有药物经济学优势。单因素敏感性分析结果显示，对ICER影响较大的5个参数依次为贴现率、HPV-16/HPV-18所引起的宫颈癌占比、疫苗有效率、每年早期/原位癌直接经济负担和每年晚期/转移癌直接经济负担。概率敏感性分析结果显示，在以1倍2019年我国人均GDP作为WTP的情况下，试验组较对照组具有更大的可接受性（概率为74%）;当WTP高于25 876元/QALY时，试验组具有更大的成本-效用优势。结论：针对宫颈癌的预防，我国12岁女性接种双价HPV疫苗较不接种该疫苗更具有成本-效用优势。

关键词 宫颈癌;人乳头瘤病毒;双价疫苗;CERVIVAC模型;成本-效用分析

Cost-utility Analysis of 12-year-old Girls Vaccinated with Bivalent Human Papilloma Virus Vaccine in China

ZHOU Dachuang1，2，LUO Mengjie1，TANG Wenxi1（1. School of International Pharmaceutical Business，China Pharmaceutical University，Nanjing 211198，China; 2. Pharmacoeconomic Evaluation Research Center，China Pharmaceutical University，Nanjing 211198，China）

ABSTRACT   OBJECTIVE： To evaluate the cost-utility of bivalent human papilloma virus （HPV） vaccine for 12-year-old girls in China and provide economic evidence for health service decision makers. METHODS： The CERVIVAC model was used to simulate the population of 12-year-old girls in China for a long time until all the population entered a state of death （1 year as a cycle）. The cost and health output of the people in experimental group who received the bivalent HPV vaccine and the control group who did not receive the vaccine were calculated separately， and the economics was judged combined with willingness to pay threshold [WTP， 1 time of Chinas per capita gross domestic product （GDP） in 2019]. RESULTS： During the simulation period， the incremental cost-effectiveness ratio （ICER） of the experimental group compared with the control group was 28 660.56        yuan/QALY， which was less than WTP and had pharmacoeconomic advantages. The results of single-factor sensitivity analysis showed that the five parameters that had a greater impact on ICER were discount rate， the proportion of HPV-16/HPV-18-induced cervical cancer， vaccine effective rate， direct economic burden of early/in situ cancer each year and the direct economic burden of advanced/metastatic cancer each year. The results of probabilistic sensitivity analysis showed that the experimental group was more acceptable （74%） than the control group when using 1 time of Chinas per capita GDP in 2019 as WTP; the experimental group had a greater cost-utility advantage when WTP was higher than 25 876 yuan/QALY. CONCLUSIONS： For the prevention of cervical cancer， the bivalent HPV vaccine for 12-year-old girls in China has more cost-utility advantages than no vaccine intervention.

KEYWORDS   Cervical cancer; HPV; Bivalent vaccine; CERVIVAC model; Cost-utility analysis

宫颈癌是威胁全球女性生命健康的主要恶性肿瘤之一。据统计，2018年全球新发宫颈癌病例将近60万例、死亡病例超过30万例[1]。在我国，宫颈癌的发病率和病死率均居于妇科恶性肿瘤第2位;患者发病年龄趋于年轻化，而且大多数发病时已到中晚期，严重影响了其生命健康[2-3]。……