The Value of Preventing Cryptosporidium Contamination

The authors evaluate the need for preventing illnesses and fatalities caused by Cryptospiridium contamination of water supplies based on the impacts of recent and likely future outbreaks

Cost-effectiveness analysis of human papillomavirus vaccination in South Africa accounting for human immunodeficiency virus prevalence

Input ranges for one way sensitivity analyses. (PDF 156 kb

A generally applicable cost-effectiveness model for the evaluation of vaccines against cervical cancer

OBJECTIVE: This study aimed at evaluating the cost-effectiveness of human papillomavirus virus (HPV) vaccination in France, using a generally applicable succinct cohort model. METHODS: A lifetime Markov cohort model, adapted to the French setting, simulate the natural history of oncogenic HPV infection towards cervical cancer (CC). Additional modules account for the effects of screening and vaccination. The girls’ cohort is vaccinated at age 12 and follows current screening. Costs and outcomes (discounted at 3 and 1.5%, respectively) were compared with a cohort receiving screening alone. RESULTS: The model results agreed well with real-life data. Vaccination in addition to screening would substantially reduce the incidence of and mortality from CC, compared with screening alone, at an estimated cost-effectiveness of €9,706 per quality-adjusted-life-year. Sensitivity analysis showed that the discount rate and the parameters related to the disease history have the largest impact on the results. CONCLUSION: This succinct cohort model indicated that HPV vaccination would be a cost-effective policy option in France. It uses readily available data and should be generally applicable to the evaluation of HPV vaccination in a variety of countries and settings

Abruzzo

In Abruzzo region 55,4% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 29 cases of cervicocarcinoma and 12 related deaths and thus results to be cost-effective (20.836 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 28 cancer cases and 12 deaths could be prevented, with a very similar cost-effectiveness ratio. In Abruzzo region, the net cost for woman vaccinated is 199 € for the single cohort and 202 € for the multiple cohort

L'introduzione del vaccino anti-HPV bivalente adiuvato con AS04 nelle regioni italiane: impatto economico ed effetti sulla salute delle donne

Introduction: the impact of cervical cancer prevention, in particular through HPV female vaccination, has been published for many countries at the national level. However, to our knowledge no attempt has been made to address the impact at a regional level. Since the Italian health reforms of the early 1990s, introducing "managerialism", decentralization and quasi-market mechanisms, regional authorities have consequently been experimenting with different organizational and funding models to achieve an acceptable combination of equity, efficiency, freedom of choice and cost-containment. Methods: a Markov model, previously described and successfully adapted to the national scenario [La Torre, 2007], has been used to explore the impact of preventive cervical cancer vaccination with Cervarix™ at a regional level in Italy. Resource use was based on a standard therapeutic path applied to all regions. However we quantified the impact of the so-called "decentralization progress" by collecting regional data on: pap-test coverage, tariffs for treatments and cost of the vaccination course. We performed for each Italian region a cost-effectiveness analysis combined with a regional budget impact analysis. The regional analyses compared HPV vaccination, both of a single female cohort (12 years old) and a multiple female cohort (12+16 years old), plus screening to screening only. Results: 21 regional reports were produced presenting regional results on screening coverage, treatments costs, ICER and ICUR, net cost per subject vaccinated etc. Conclusions: national and regional analyses have two different aims: the former wants to address national regulatory agencies and needs to be representative of the national population whereas the latter deals with the real budget-holders, accountable in the eyes of patients. Furthermore in the Italian scenario, characterized by decentralization and local autonomy, a further level of detail is essential in order to describe the specific local settings and implications of a new health intervention

Puglia

In Apulia region 43,9% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 127 cases of cervicocarcinoma and 52 related deaths and thus results to be cost-effective (13.471€/QALY). When the vaccination programme is extended to 16-year-old girls a further 133 cancer cases and 54 deaths could be prevented, with a very similar cost-effectiveness ratio. In Apulia region, the net cost for woman vaccinated is 137€ for the single cohort and 141€ for the multiple cohort

Friuli Venezia Giulia

In Friuli Venezia Giulia region 75,1% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 15 cases of cervicocarcinoma and 6 related deaths and thus results to be cost-effective (27.766 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 14 cancer cases and 6 deaths could be prevented, with a very similar cost-effectiveness ratio. In Friuli Venezia Giulia region, the net cost for woman vaccinated is 167 € for the single cohort and 169 € for the multiple cohort

Bolzano

In Bolzano province 84,8% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering local tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 7 cases of cervicocarcinoma and 3 related deaths and thus results to be cost-effective (40.541 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 6 cancer cases and 3 deaths could be prevented, with a very similar cost-effectiveness ratio. In Bolzano province, the net cost for woman vaccinated is 216 € for the single cohort and 218 € for the multiple cohort

Trento

In Trento province 72,4% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering local tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 8 cases of cervicocarcinoma and 4 related deaths and thus results to be cost-effective (30.267 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 8 cancer cases and 3 deaths could be prevented, with a very similar cost-effectiveness ratio. In Trento province, the net cost for woman vaccinated is 197 € for the single cohort and 199 € for the multiple cohort

Valle d’Aosta

In Aosta Valley region 77,9% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 2 cases of cervicocarcinoma and 1 related death and thus results to be cost-effective (33.211 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 1 cancer case could be prevented, with a very similar cost-effectiveness ratio. In Aosta Valley region, the net cost for woman vaccinated is 209 € for the single cohort and 211 € for the multiple cohort