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

  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。

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

  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.