Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model

Autor: Bardach, Ariel Esteban, Garay, Osvaldo Ulises, Calderón, María, Pichón-Riviére, Andrés, Augustovski, Federico, Martí, Sebastián García, Cortiñas, Paula, Gonzalez, Marino, Naranjo, Laura T., Gomez, Jorge Alberto, Caporale, Joaquín Enzo, 0000-0003-4437-0073
Rok vydání: 2017
Předmět:
Adult
Pathology
medicine.medical_specialty
Health economic evaluation
Cost effectiveness
Cost-Benefit Analysis
Population
Uterine Cervical Neoplasms
HPV vaccines
Genital warts
Cohort Studies
03 medical and health sciences
Papillomavirus Vaccines
0302 clinical medicine
Humans
Medicine
030212 general & internal medicine
Child
education
health care economics and organizations
education.field_of_study
business.industry
lcsh:Public aspects of medicine
Papillomavirus Infections
Markov cohort model
Public Health
Environmental and Occupational Health
lcsh:RA1-1270
Health Care Costs
Venezuela
medicine.disease
Markov Chains
Quality-adjusted life year
Vaccination
Condylomata Acuminata
030220 oncology & carcinogenesis
Economic evaluation
Cervical cancer
Female
Quality-Adjusted Life Years
business
Research Article
Demography
Zdroj: RIUR. Repositorio Institucional de la Universidad de La Rioja
instname
BMC Public Health, Vol 17, Iss 1, Pp 1-15 (2017)
BMC Public Health
ISSN: 1471-2458
DOI: 10.1186/s12889-017-4064-7
Popis: Background Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. Methods A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. Results Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. Conclusions Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4064-7) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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