Gender (in)equality in Human Papilloma Virus (HPV) vaccinations and treatment

The protective (herd) effect of the selective vaccination of pubertal girls against human papillomavirus (HPV) implies a high probability that one of the two partners involved in intercourse is immunised, hence preventing the other from this sexually transmitted infection. The dynamic transmission models used to inform immunisation policy should include consideration of sexual behaviours and population mixing in order to demonstrate an ecological validity, whereby the scenarios modelled remain faithful to the real-life social and cultural context. The primary aim of this review is to test the ecological validity of the universal HPV vaccination cost-effectiveness modelling available in the published literature. The research protocol related to this systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016034145). Our results are consistent with the outcomes of recently published reviews of HPV vaccination modelling approaches. The heterogeneity of outcomes observed in the reviewed studies results from the high degree of sensitivity to boundary conditions and the choice of inputs. In more general terms, sensitivity analyses showed that the vaccine price per vial is one of the factors most relevant to the determination of the incremental cost-effectiveness ratio, and hence of the cost-effectiveness of universal vaccination. All else equal, a vaccine price per vial of €28 would drive all the base-case incremental cost-effectiveness ratio (ICER) values reported by the studies included in the review below an acceptability threshold of $50,000 (in$2015 values). The main original contribution of our review is that all the included models might be affected by a different degree of ecological bias, which implies an inability to reflect the natural demographic and behavioural trends in their outcomes and, consequently, to accurately inform public healthcare policy. In particular, ecological bias have the effect to over-estimate the preference-based outcomes of selective immunisation. A relatively small (15 to 20%) over-estimation of quality-adjusted life years (QALYs) gained with selective immunisation programmes could induce a significant error in the estimate of cost-effectiveness of universal immunisation, by inflating its incremental cost effectiveness ratio (ICER) beyond the acceptability threshold

Risk of exposure to COVID-19 : visit duration data can inform our daily activities choices. An epidemiological investigation using community mobility data from the metropolitan area of Genoa, Italy

COVID-19 spreads mainly among people who are in close contact. Policymakers mostly resorted to normative measures to limit close contacts and impose social distancing. Our study aimed to estimate the risk of exposure to COVID-19 by location and activity in crowded metropolitan areas. The risk of exposure to COVID-19 was defined as the product of crowding (people within a six feet distance) and exposure duration (fraction of 15 min). Our epidemiological investigation used aggregated and anonymized mobility data from Google Maps to estimate the visit duration. We collected visit duration data for 561 premises in the metropolitan area of Genoa, Italy from October 2020 to January 2021. The sample was then clustered into 14 everyday activities, from grocery shopping to the post office. Crowding data by activity were obtained from pre-existing building norms and new government measures to contain the pandemic. The study found significant variance in the risk of exposure to COVID-19 among activities and, for the same activity, among locations. The empirical determination of the risk of exposure to COVID-19 can inform national and local public health policies to contain the pandemic’s diffusion. Its simple numerical form can help policymakers effectively communicate difficult decisions affecting our daily lives. Most importantly, risk data by location can help us rethink our daily routine and make informed, responsible choices when we decide to go out

Cost-effectiveness of direct acting oral anticoagulants in the prevention of thromboembolic complications : limits and concerns of economic evaluations

Economic evaluations have a widespread application in many areas of clinical research and play a key role in the clinical decision-making process. However, economic analyses have been sometimes used to produce new 'evidence' that is not adequately tested in the target population. This is the case of data arising from a systematic review of clinical trials evaluating the use of direct acting oral anticoagulants for the prevention of stroke in patients with atrial fibrillation. Taking into account this example, here we discuss the concerns raised by the improper interpretation of the results. Our conclusions are three-fold. Data from economic analyses should not be shifted to a clinical recommendation. Simulation models should not be used to generate new 'evidence' that is not supported by experimental data and is misleading. Clinical judgment is therefore pivotal to interpret results emerging from economic analyses

Whether and when to invest in transportation projects : combining scenarios and real options to manage the uncertainty of costs and benefits

Transportation infrastructure projects are a cornerstone of economic growth. However, the issue of whether new transportation infrastructure projects deliver the expected benefits has come under considerable scrutiny. The growing economic uncertainty and the tightening of budget constraints have made the design, evaluation, and selection of such high-cost projects particularly critical. There are disagreements as to how project decision-makers can evaluate the long-term costs and benefits of infrastructure projects. The objective of this article is to address such disagreements. We develop and apply an innovative methodological approach that combines real options with scenarios to help policymakers assess the costs and benefits of transportation projects. While these techniques have been widely adopted in corporations, there is little empirical evidence regarding their combined use by project decision-makers dealing with complex infrastructure projects. In this article, we fill this gap in the planning and project studies literature. We show that scenarios and real options can be very helpful in developing a more comprehensive understanding of long-term impacts of major infrastructure projects and thus in selecting the most relevant projects. Overall, our article assists the debate on the management of the uncertainty of long-term costs and benefits of infrastructure projects and helps cope with such uncertainty