中国人乳头瘤病毒感染相关疾病经济负担：系统文献回顾和综合分析

贺妮楠; 邹卓如; 张云博; 何晓清; 熊苏嫱; 刘昌鑫; 包佳威; 夏茹意; 庄贵华

doi:10.16462/j.cnki.zhjbkz.2023.03.018

中国人乳头瘤病毒感染相关疾病经济负担：系统文献回顾和综合分析

doi: 10.16462/j.cnki.zhjbkz.2023.03.018

贺妮楠¹,
邹卓如^{1, 2},
张云博¹,
何晓清¹,
熊苏嫱¹,
刘昌鑫¹,
包佳威¹,
夏茹意^{1, 2},
庄贵华^{1, 2, ,}

1.
710061 西安，西安交通大学医学部公共卫生学院流行病与卫生统计学系
2.
710061 西安，陕西省疾病防控与健康促进研究重点实验室

贺妮楠和邹卓如为共同第一作者

基金项目:

西安预防医学会资助项目 2020-12-0001

详细信息

通讯作者:
庄贵华，E-mail: zhuanggh@mail.xjtu.edu.cn

中图分类号: R183.7
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出版历程
- 收稿日期: 2022-05-07
- 修回日期: 2022-09-25
- 网络出版日期: 2023-04-04
- 刊出日期: 2023-03-10

Economic burden of human papilloma virus related diseases in China: a systematic review and synthetic analysis

1.
Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
2.
Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an 710061, China

HE Ni-nan and ZOU Zhuo-ru contributed equally to this work

Funds:

Xi'an Preventive Medical Association 2020-12-0001

More Information

Corresponding author: ZHUANG Gui-hua, E-mail: zhuanggh@mail.xjtu.edu.cn

摘要

摘要: 目的整合中国内地人乳头瘤病毒(human papilloma virus, HPV)感染相关疾病的成本相关数据，估算中国内地HPV感染相关疾病的经济负担。方法以“成本/费用”分别联合HPV感染相关9种疾病即宫颈癌、阴道癌、外阴癌、肛门癌、阴茎癌、口咽部癌、宫颈上皮内瘤变(cervical intraepithelial neoplasia，CIN)、肛门生殖器疣(anogenital warts，AGW)和复发性呼吸道乳头状瘤(recurrent respiratory papillomatosis，RRP)的名称为关键词，检索PubMed、中国知网等7个数据库2001―2020年发表的针对中国内地患者的文献，摘取各类成本相关数据，并将成本数据按照相应的消费价格指数逐年调整至2020年，估算这9种疾病各自的例均直接医疗成本、直接非医疗成本和间接成本。收集这9种疾病各自的发病率、患病率和HPV归因分数数据，进一步估算2020年中国内地HPV感染相关疾病总经济负担。结果最终纳入文献247篇。6种恶性肿瘤的首年例均总成本为58 189~79 567元，随后年年例均总成本为13 025~27 965元。RRP的年例均总成本为41 329元。CIN和AGW的例均总成本为6 452~13 602元。2020年中国内地HPV感染相关疾病所致总经济负担为180.3亿元，其中宫颈癌为96.9亿元。直接医疗成本是经济负担的主要部分，占总成本的70%，其中宫颈癌的直接医疗成本为70.0亿元。结论 HPV感染相关疾病每年给中国内地造成的经济负担不容忽视，需扩大HPV疫苗接种以减少其经济损失。
- 人乳头瘤病毒 /
- 经济负担 /
- 综合分析
Abstract: Objective To integrate cost-related data of human papilloma virus (HPV) related diseases from Mainland China and estimate the economic burden. Methods We uesd "Cost/expense" combined with names of the nine major HPV-related diseases, i.e. cervical cancer, vaginal cancer, vulva cancer, anal cancer, penile cancer, oropharyngeal cancer, cervical intraepithelial neoplasia (CIN), anogenital warts (AGW), and recurrent respiratory papillomatosis (RRP), as keywords. Seven databases including PubMed and China National Knowledge Infrastructure were selected, for literature targeting patients in mainland China published between 2001-2020. Various cost-related data were extracted, and cost data were adjusted annually to 2020 according to appropriate consumer price indices. Data were used to estimate per-capita direct medical costs, direct non-medical costs, and indirect costs for each of the nine diseases. The incidence, prevalence, and HPV attribution fraction of each of the nine diseases were collected to further estimate the total economic burden of HPV-related diseases in Mainland China in 2020. Results A total of 247 articles were included. Annual per-capita total costs of each of the six cancers ranged from 58 189 to 79 567 yuan in the first year of the disease and from 13 025 to 27 965 yuan in each subsequent year. Annual per-capita total costs of RRP were 41 329 yuan. Per-capita total costs of CIN and AGW ranged between 6 452 and 13 602 yuan. The total economic burden due to HPV-related diseases in Mainland China in 2020 was about 18.03 billion yuan, with cervical cancer accounting for 9.69 billion yuan. Direct medical costs were a significant part of the economic burden, accounting for 70% of the total burden, with 7.0 billion yuan in direct medical costs due to cervical cancer. Conclusions The annual economic burden of HPV-related diseases in Mainland China cannot be ignored. Scaling up HPV vaccination is needed to reduce associated economic losses.
- Human papilloma virus /
- Economic burden /
- Synthetic analysis

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图 1 文献检索筛选流程图

Figure 1. Flow chart of the literature selection

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表 1 HPV感染相关6种恶性肿瘤首年和随后年年例均各类成本基准值(波动范围)(元)

Table 1. Per-capita base-case values (ranges) of various costs for six HPV related cancers in the first year of the disease and in each of the subsequent years (yuan)

疾病名称	总成本	直接医疗成本	直接非医疗成本	间接成本
宫颈癌
首年	58 189 (19 542~121 514)	41 976 (13 194~86 881)	4 184 (1 408~7 845)	12 029 (4 940~26 788)
随后年	13 025 (5 897~24 670)	9 432 (3 972~17 875)	845 (408~1 438)	2 748 (1 516~5 357)
阴道癌
首年	66 836 (24 570~119 861)	43 690 (14 741~82 146)	4 184 (1 408~7 845)	18 962 (8 421~29 869)
随后年	14 771 (7 355~24 367)	9 778 (4 421~17 007)	845 (408~1 438)	4 148 (2 526~5 922)
外阴癌
首年	66 836 (24 570~119 861)	43 690 (14 741~82 146)	4 184 (1 408~7 845)	18 962 (8 421~29 869)
随后年	14 771 (7 355~24 367)	9 778 (4 421~17 007)	845 (408~1 438)	4 148 (2 526~5 922)
肛门癌
首年	73 498 (26 098~135 003)	53 619 (19 223~98 320)	4 184 (1 408~7 845)	15 695 (5 467~28 838)
随后年	27 965 (13 887~46 252)	20 448 (10 149~33 799)	1 529 (746~2 589)	5 988 (2 992~9 865)
阴茎癌
首年	62 670 (22 889~113 168)	51 311 (18 963~92 214)	4 184 (1 408~7 845)	7 174 (2 518~13 108)
随后年	14 659 (7 090~24 238)	12 047 (5 810~19 972)	845 (408~1 438)	1 768 (872~2 827)
口咽部癌
首年	79 567 (24 533~205 822)	63 445 (18 777~170 013)	4 184 (1 408~7 845)	11 938 (4 348~27 963)
随后年	17 768 (7 722~40 707)	14 118 (5 855~33 601)	865 (422~1 464)	2 785 (1 444~5 642)

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表 2 CIN和AGW例均各类成本基准值(波动范围)(元)

Table 2. Per-capita base-case values (ranges) of various costs for CIN and AGW (yuan)

疾病名称	总成本	直接医疗成本	直接非医疗成本	间接成本
CIN Ⅱ	6 452 (3 373~9 062)	3 203 (2 504~3 902)	1 153 (478~1 361)	2 095 (391~3 800)
CIN Ⅲ	13 602 (5 065~20 674)	6 500 (3 911~7 897)	1 288 (634~1 669)	5 814 (520~11 109)
AGW	11 819 (3 527~22 870)	8 909 (2 101~17 955)	19 (9~31)	2 891 (1 417~4 884)

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表 3 2020年中国内地HPV感染造成的相关疾病发病、患病人数及各类经济负担基准值(波动范围)

Table 3. Base-case values (ranges) of the numbers of incidence and prevalence cases and the economic burden of HPV related diseases in mainland China in 2020

疾病名称	发病人数 (n)	患病人数 (n)	总成本 (万元)	直接医疗成本 (万元)	直接非医疗成本 (万元)	间接成本 (万元)
宫颈癌	118 340	333 931	969 411 (358 394~1 969 873)	700 088 (241 778~1 413 509)	67 730 (25 468~123 850)	201 593 (91 148~432 513)
阴道癌	1 307 (1 139~1 441)	7 378 (6 432~81 345)	17 703 (6 692~211 976)	11 647 (4 019~147 726)	1 060 (377~12 623)	4 996 (2 296~51 626)
外阴癌	968 (355~1 743)	8 498 (3 116~15 296)	17 592 (2 903~539 166)	11 592 (1 744~37 367)	1 041 (163~3 317)	4 959 (996~13 233)
肛门癌	4 264 (4 119~4 410)	13 364 (12 908~13 819)	56 788 (22 955~103 056)	41 471 (16 838~75 160)	3 175 (1 236~5 896)	12 142 (4 881~21 999)
阴茎癌	2 781 (2 562~2 999)	12 118 (11 168~13 069)	31 116 (11 966~58 347)	25 518 (9 858~47 767)	1 952 (712~3 801)	3 646 (1 396~6 778)
口咽部癌	2 736 (2 022~3 212)	22 103 (16 337~25 948)	56 180 (16 015~158 662)	44 701 (12 179~131 003)	2 820 (889~5 850)	8 660 (2 947~21 810)
CIN Ⅱ ^a	119 912		77 361 (40 441~108 668)	38 407 (30 021~46 792)	13 828 (5 728~16 314)	25 127 (4 692~45562)
CIN Ⅲ ^a	92 240		125 468 (46 716~190 701)	59 960 (36 071~72 843)	11 878 (5 852~15 392)	53 629 (4 794~102 465)
AGW	347 510		410 717 (122 579~794 754)	309 613 (73 006~623 950)	646 (317~1 092)	100 457 (49 256~169 712)
RRP ^b	2 382	9 882	40 841 (24 219~61 208)	24 991 (15 900~35 448)	7 952 (3 896~13 438)	7 899 (4 423~12 322)
合计	692 440 (690 581~694 189)	407 274 (393 774~493 290)	1 803 177 (652 879~3 711 160)	1 267 987 (441 413~2 631 566)	112 083 (44 637~201 573)	423 107 (166 829~878 021)
注：^a仅考虑35~64岁女性的经济负担；^b仅考虑幼儿型RRP患者(≤14岁)的经济负担。

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