RESUMO
This paper analyses the tensions between scientific literature and systematic reviews in the production of evidence in healthcare. Systematic reviews are devices developed - within evidence-based medicine - to navigate the complexities of scientific literature promising a clear and simple account of the knowledge on a particular issue. However, in practice, systematic reviews have a more complex relation with literature. Systematic reviews are shaped according to the interest of the local groups that produce them. In this paper, I explore the formatting, making and managing of systematic reviews of evidence relating to HPV vaccines in Colombia. This case shows the ways in which systematic reviews mediate between the requirement of presenting the evidence that emerges from the international literature and the necessity of having data locally relevant.
Assuntos
Tomada de Decisões Gerenciais , Medicina Baseada em Evidências/organização & administração , Vacinas contra Papillomavirus/administração & dosagem , Publicações Periódicas como Assunto , Revisões Sistemáticas como Assunto , Colômbia , Atenção à Saúde/organização & administração , Medicina Baseada em Evidências/economia , Feminino , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/administração & dosagem , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/economia , Humanos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/economia , Política , Neoplasias do Colo do Útero/prevenção & controleRESUMO
OBJECTIVE: To assess the cost-effectiveness of the quadrivalent vaccine against human papillomavirus (HPV) in Argentina from the health system perspective. MATERIALS AND METHODS: A dynamic transmission model was used to estimate the impact of the vaccine on the incidence of cervical cancer, warts, and other HPV related diseases; in quality adjusted life years (QALYs); and in healthcare costs. RESULTS: Vaccination could reduce the risk of cervical cancer by 60% and by 67% the risk of genital warts. Compared to a non-vaccine scenario, the immunization strategy showed an incremental benefit of 0.00234 QALY per person at an incremental cost of US$2.36, resulting in an incremental cost-effectiveness ratio of US$1007.55 per QALY gained. Sensitivity analysis proved the robustness of these results. CONCLUSIONS: Immunization with the quadrivalent vaccine was a cost-effective intervention in Argentina, and it was far below the threshold of one gross domestic product per capita (US$15 009) per QALY gained.
Assuntos
Condiloma Acuminado/prevenção & controle , Neoplasias dos Genitais Femininos/prevenção & controle , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/economia , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/economia , Argentina , Criança , Condiloma Acuminado/virologia , Análise Custo-Benefício , Feminino , Neoplasias dos Genitais Femininos/virologia , Produto Interno Bruto , Humanos , Modelos Teóricos , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/transmissão , Anos de Vida Ajustados por Qualidade de Vida , Neoplasias do Colo do Útero/virologiaRESUMO
Objetivo. Evaluar la costo-efectividad (CE) de la vacuna tetravalente contra el virus de papiloma humano (VPH) en Argentina, desde la perspectiva del sistema de salud. Material y métodos. Se utilizó un modelo dinámico de transmisión para estimar el impacto en la incidencia de cáncer de cuello uterino (Cacu), verrugas y otras lesiones, en los años de vida ajustados por calidad (AVAC) y en costos sanitarios. Resultados. La vacuna podría reducir en 60% el riesgo de muerte por Cacu y en 67% el de padecer verrugas genitales. Comparada con no vacunar, la estrategia de vacunación mostró un beneficio incremental promedio de 0.00234 AVAC por persona a un costo incremental de 2.36 dólares, con una CE de 1007.55 dólares por AVAC ganado. Los resultados demostraron ser robustos en el análisis de sensibilidad. Conclusiones. La inmunización resultaría costo-efectiva, con una CE inferior a un producto interno bruto per cápita (15 009 dólares) por AVAC ganado.
Objective. To assess the cost-effectiveness of the quadrivalent vaccine against human papillomavirus (HPV) in Argentina from the health system perspective. Materials and methods. A dynamic transmission model was used to estimate the impact of the vaccine on the incidence of cervical cancer, warts, and other HPV related diseases; in quality adjusted life years (QALYs); and in healthcare costs. Results. Vaccination could reduce the risk of cervical cancer by 60% and by 67% the risk of genital warts. Compared to a non-vaccine scenario, the immunization strategy showed an incremental benefit of 0.00234 QALY per person at an incremental cost of US$2.36, resulting in an incremental cost-effectiveness ratio of US$1007.55 per QALY gained. Sensitivity analysis proved the robustness of these results. Conclusions. Immunization with the quadrivalent vaccine was a cost-effective intervention in Argentina, and it was far below the threshold of one gross domestic product per capita (US$15 009) per QALY gained.
Assuntos
Humanos , Feminino , Criança , Condiloma Acuminado/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/economia , Infecções por Papillomavirus/prevenção & controle , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/economia , Neoplasias dos Genitais Femininos/prevenção & controle , Argentina , Condiloma Acuminado/virologia , Neoplasias do Colo do Útero/virologia , Análise Custo-Benefício , Anos de Vida Ajustados por Qualidade de Vida , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/transmissão , Produto Interno Bruto , Neoplasias dos Genitais Femininos/virologia , Modelos TeóricosRESUMO
OBJECTIVE: Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. METHODOLOGY: The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. RESULTS: In a cohort of â¼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. CONCLUSION: Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program.