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<< 学会誌へ戻る With the approval of the prophylactic cervical cancer vaccines against human papillomavirus（HPV）in many countries, some have started to introduce it into their national immunisation program. Most countries have chosen to routinely vaccinate schoolgirls aged 12 or13 years old, with catch up program for women up to 26 years old. When integrated with any existing screening programs for early detection of cervical cancer, HPV vaccination alongside screening will reduce the risk of cervical cancer further than screening alone, and will also significantly reduce the number of abnormal screening results requiring follow-up. It is important to have a good participation rate for the success of the program. In Australia, approximately 2.2 million girls and women aged 12-26 will be eligible for the free vaccine under the National Immunisation Program and the Government will spend $536 million on the vaccination program over the next four years. With estimated coverage of 86％, the public program is predicted to result in a reduction in the age-standardized incidence of HPV16 infections of 56％ by 2010 and 92％ by 2050.1） Elective vaccination of older women and vaccination of males may provide some incremental gains, but the benefits to women of vaccinating males will be less if coverage of females remains high. In United Kingdom, it is predicted that 100％ vaccination coverage of a 12-year-old cohort of girls would lead to a reduction of 66％ in the prevalence of high-grade cervical lesions and a 76％ reduction in cervical cancer deaths.2） Models working on the economic impact of cervical cancer vaccination need to take into account the cost for each country of their screening program if any, and treatments of various conditions including cancer due to the HPV infections. It is also important to take into account the expected epidemiological changes as a result of changes to screening practices. Adding an HPV vaccine to Australia's current screening regimen is a potentially cost-effective way to reduce cervical cancer and the clinical interventions that are currently associated with its prevention via screening alone.3） In Taiwan, vaccination is also predicted to result in substantial cost-offsets in screening outcomes and treatment costs.4） Economic evaluation in United Kingdom indicates that routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective. Vaccination has the greatest impact（and therefore is most likely to be cost effective）if the duration of protection is long and the duration of natural immunity is short, making this a key influential variable.5） References： 1）Megan A. Smith et al The predicted impact of vaccination on human papillomavirus infections in Australia. Int J Cancer. 2008 Oct 15；123（8）：1854-63. 2）M Kohli et al Estimating the long-term impact of a prophylactic human papillomavirus 16/18 vaccine on the burden of cervical cancer in the UK. British Journal of Cancer（2007）96, 143-150. 3）Kulasingam S et al. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007 Sep；4（3）：165-75. 4）Shan-Lin You et al. The Long-Term Economic Impact of Cervical Cancer Vaccination in Taiwan. Presentation at ISPOR 3rd Asia-Pacific Conference 9-2008. 5）Mark Jit et al. Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ 2008；337：a769. 日本産科婦人科学会関東連合地方部会会誌, 45(3) 225-226, 2008 |
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