ABSTRACT
Background: Hepatitis A vaccination is justified in areas with an intermediate endemicity of the infection. Aim: To estimate the epidemiological impact of hepatitis A infection in Colombia. Material and Methods: Epidemiological indicators of hepatitis A infection prevalence by age, morbidity by age, and lethality by age were estimated from a literature search. These measures were projected on a hypothetical cohort of children followed from birth until 15 years of age. The number of cases of infection, jaundice, hepatic failure, hospitalizations and deaths were estimated. Results: From birth to adolescence, a cohort of 872 923 urban children in Colombia would generate between 312,331 and 598,591 infections, between 13,586 and 25,960 hospitalizations, between 213 and 407 hepatic failures and between 107 and 204 deaths. Conclusions: The impact of hepatitis A infection in Colombia, is important. Introducing hepatitis A vaccination would reduce a substantial number of severe hepatitis A cases.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Hepatitis A/epidemiology , Models, Theoretical , Age Distribution , Colombia/epidemiology , Hepatitis A/mortality , Hospitalization/statistics & numerical data , Logistic Models , Prevalence , Urban Population/statistics & numerical dataABSTRACT
OBJETIVOS: Evaluar la relación costo-efectividad de la introducción de la vacuna inyectable contra la poliomielitis (VIP) en Colombia con respecto al sistema actual basado en el empleo de la vacuna oral (VOP). MÉTODOS: Se diseñó un modelo de Markov basado en una cohorte hipotética de recién nacidos que recibiría la VIP o la VOP con un seguimiento de dos años y estimaciones mensuales del número de casos de poliomielitis paralítica asociada con la vacuna (PPAV). El análisis del costo se realizó desde la perspectiva del asegurador (costos a lo largo de la vida) y la sociedad (casos de PPAV evitados y años de vida ajustados por discapacidad [AVAD] evitados). RESULTADOS: Entre 1988 y 1998 se aplicaron en Colombia 22,5 millones de dosis de la VOP y se detectaron nueve casos de PPAV, para una tasa de 4,0 ¥ 10-7 por dosis. Según el modelo, se podrían esperar entre 2 y 4 casos de PPAV en los dos años de seguimiento. El costo de tratar los casos de PPAV sería de US$ 302 008, con costos de vacunación con la VOP de US$ 737 037 y de US$ 5 527 777 con la VIP. La vacunación con la VIP permitiría evitar 64 AVAD con un costo de US$ 71 062 por AVAD evitado; evitar un caso de PPAV mediante la sustitución de la VOP por la VIP costaría entre US$ 1,8 millones y US$ 2,2 millones. CONCLUSIONES: La sustitución de la VOP por la VIP no es una medida efectiva en función del costo en Colombia, incluso si se sustituyera la vacuna celular contra la tos ferina, actualmente en uso, por una vacuna acelular combinada con una VIP.
OBJECTIVE: Evaluate the cost-effectiveness of introducing the injectable inactivated polio vaccine (IPV) in Colombia versus the current system based on the use of the oral vaccine (OPV). METHODS: A Markov model was designed, based on a hypothetical cohort of newborns that would receive the IPV or the OPV vaccine, with a two-year follow-up and monthly estimates of the number of cases of vaccine-associated paralytic poliomyelitis (VAPP) that would emerge. The cost was analyzed from the perspective of the insurer (costs throughout life) and society (cases of VAPP and disability-adjusted life years [DALYs] prevented). RESULTS: From 1988 to 1998, some 22.5 million doses of OVP were administered in Colombia and nine cases of VAPP were detected, for a rate of 4.0 ¥ 10-7 dose. According to the model, 2 to 4 cases of VAPP could be anticipated in the following two years. The cost of treating the VAPP cases would total US$302 008, with the cost of vaccination with OPV coming to US$737 037 and with IPV, US$5 527 777. Vaccination with IPV would prevent 64 DALYs, at a cost of US$71 062 per DALY prevented; preventing one case of VAPP by substituting OPV with IPV would cost between US$1.8 and US$2.2 million. CONCLUSIONS: Substituting OPV with IPV is not a cost-effective measure in Colombia, even if the cellular vaccine against whooping cough currently in use were replaced with an acellular vaccine combined with an IPV.
Subject(s)
Humans , Infant, Newborn , Immunization Programs/economics , Poliomyelitis/prevention & control , Poliovirus Vaccine, Inactivated/economics , Poliovirus Vaccine, Oral/economics , Colombia/epidemiology , Cost-Benefit Analysis , Markov Chains , Poliomyelitis/economics , Poliomyelitis/epidemiology , Poliomyelitis/etiology , Poliovirus Vaccine, Inactivated/administration & dosage , Poliovirus Vaccine, Inactivated/adverse effects , Poliovirus Vaccine, Oral/administration & dosage , Poliovirus Vaccine, Oral/adverse effects , Program Evaluation/economics , Quality-Adjusted Life Years , Sensitivity and SpecificityABSTRACT
Objetivo Se realizó un estudio en Bogotá para estimar la magnitud de la carga de enfermedad asociada a la infección por el virus del papiloma humano (VPH) y la proporción potencialmente evitable con el uso de vacunas. Materiales y métodos Se combinaron una revisión sistemática de la literatura colombiana sobre infección por VPH, el análisis de datos rutinarios de vigilancia de Bogotá y un análisis de costos de la enfermedad. Resultados Después de corregir por subregistro y mala clasificación en Bogotá se registrarían 322 muertes y 676 casos asociados a cáncer de cuello uterino anualmente. Esto ocasiona la pérdida de 1,5 años de vida por cada 1 000 mujeres al año, la mayoría en mujeres entre los 40 y 69 años. Adicionalmente, se diagnosticarían 6 084 lesiones de cuello uterino de alto grado y 22 984 de bajo grado. El costo de la enfermedad ascendería a 7 millones de dólares anuales aproximadamente. Se encontraron debilidades en el manejo de los casos con displasias o neoplasias cervicales. Conclusión El fortalecimiento de los programas de prevención de cáncer de cuello uterino en Bogotá permitiría disminuir de manera importante el impacto epidemiológico y económico de la infección por VPH en Bogotá. Se podría considerar, adicionalmente, la inclusión de una vacuna contra VPH pero solo incluida dentro de una estrategia integral de control y a un precio que pueda ser sostenible.
Objective A study was carried out in Bogota aimed at estimating the burden of disease associated with human papillomavirus infection (HPV) and the potentially avoidable percentage due to using new vaccines. Methods A literature review was combined with analysing surveillance system data and disease cost evaluation. Results After adjusting for underreporting and misclassification, it was estimated that 322 deaths from cervical cancer occur annually in Bogota (corresponding to 676 new cases). This would cause the loss of 15 years of life for each 1,000 women per year (most occurring amongst women aged 40 to 69). In addition to cervical cancer, there would be around 6,084 cases of high-grade and 22,984 low-grade cervical lesions yearly. The disease's yearly cost would amount to around 7 million dollars. Important weaknesses were found in the clinical management of women suffering from cervical lesions. Conclusion Strengthening cervical cancer prevention programmes in Bogota would lead to saving a significant number of deaths, cases of cancer and the costs associated with HPV infection. Introducing an anti-HPV vaccine may be considered, but only as part of a more widespread preventative strategy and provided that more affordable prices have been found.