论文标题
当最佳不是最好的:HPV流行模型的成本效益分析
When optimal is not the best: cost effectiveness analysis for HPV epidemic models
论文作者
论文摘要
本文旨在评估针对人乳头瘤病毒(HPV)的医疗干预措施的潜在成本效益。为此,我们考虑了HPV传播动力学的两性流行模型,其中包括筛查,青春期男孩和女孩的疫苗接种以及对性活跃成年人的疫苗接种。我们首先提出使用恒定控制参数的公共卫生政策,并开发成本效益分析(CEA),以确定哪种干预措施为投资的资金提供最佳有效性。其次,我们考虑时间依赖于时间的控制参数,并制定一个最佳控制问题,以获得干预措施的时间依赖性版本。与恒定控制参数一样,我们执行CEA来研究时间依赖性控制干预措施的成本效益。我们的发现表明,女性的疫苗接种,包括青春期女孩和成年女性,是最具成本效益的策略。我们还将常数与时间依赖性的医疗干预措施进行比较,这些干预措施在最小化最佳控制问题的客观功能的意义上是最佳的。结果表明,时间依赖性控制并不总是比恒定控制更具成本效益。
This paper aims to evaluate the potential cost-effectiveness of healthcare interventions against human papillomavirus (HPV). For this, we consider a two-sex epidemic model for the transmission dynamics of HPV which includes screening, vaccination of adolescent boys and girls, and vaccination of sexually active adults. We first propose public health policies using constant control parameters and develop a cost-effectiveness analysis (CEA) to identify which intervention delivers the best effectiveness for the money invested. Secondly, we consider time-dependent control parameters and formulate an optimal control problem to obtain time-dependent versions of the interventions. As in the case of constant control parameters, we perform a CEA to investigate the cost-effectiveness of the time-dependent control interventions. Our findings suggest that females' vaccination, including adolescent girls and adult women, is the most cost-effective strategy. We also compare constant against the time-dependent healthcare interventions which are optimal in the sense that they minimize the objective functional of the optimal control problem. The results indicate that time-dependent controls are not always more cost-effective than constant controls.