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Costo-efectividad de la vacunación universal antineumocócica en Uruguay

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Date
2010
Author
Giachetto Larraz, Gustavo
Telechea Ortiz, Héctor
Speranza Mourine, Noelia
Giglio, Norberto
Cané, Alejandro
Pírez García, María C
Lucas Paiva, Liriana
Pallares Barrios, Carla
Gesuele Ruggiero, Juan
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Abstract
OBJETIVO: Evaluar la relación costo-efectividad del programa de vacunación universal con la vacuna antineumocócica conjugada heptavalente (VCN7) en niños menores de 5 años en Uruguay. MÉTODOS: Se desarrolló un modelo Markov simulando una cohorte de 48 000 niños nacidos en 2007 y su evolución hasta los 76 años de edad. El caso base usó un esquema de tres dosis con una duración estimada de protección de cinco años. La presunción de eficacia y efectividad de la vacuna se realizó acorde con estudios realizados en Estados Unidos con ajuste a la prevalencia-incidencia de serotipos en Uruguay. Los resultados se expresaron como costo incremental por año de vida ganado (AVG) y por año de vida [ganado] ajustado por calidad (AVAC). RESULTADOS: Para el caso base, el costo incremental fue de US$ 7 334,6 por AVG y US$ 4 655,8 por AVAC, previniéndose 8 muertes y 4 882 casos de otitis, 56 bacteriemias-sepsis, 429 neumonías y 7 meningitis. El modelo muestra sensibilidad a variaciones en eficacia, costo de la vacuna y tasa de mortalidad por neumonía. CONCLUSIONES: El programa de vacunación universal con VCN7 en Uruguay es altamente costo-efectivo y, en consecuencia, recomendable para otros países con carga de enfermedad neumocócica y cobertura de serotipos similares a Uruguay.(AU)
 
OBJECTIVE: Evaluate the cost-effectiveness ratio of the program for universal vaccination with heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Uruguay. METHODS: A Markov model was developed that simulated a cohort of 48 000 children born in 2007 and their progress to age 76. The baseline case used a regimen of three doses with estimated protection for five years. The presumption of vaccine efficacy and effectiveness was based on studies conducted in the United States with adjustment for serotype prevalence-incidence in Uruguay. The results were expressed as the incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) [gained]. RESULTS: For the baseline case, the incremental cost was US $7334.60 for each LYG and US $4655.80 for each QALY. Eight deaths and 4 882 cases of otitis, 56 cases of bacteremia-sepsis, 429 cases of pneumonia, and 7 cases of meningitis were prevented. The model shows sensitivity to variations in vaccine cost, efficacy, and pneumonia-related mortality. CONCLUSIONS: The universal vaccination program with PCV7 in Uruguay is highly cost-effective. Therefore, it is recommended for other countries with burden of pneumococcal disease and serotype coverage similar to those of Uruguay.(AU)
 
Series
Rev Panam Salud Publica;28(2),ago. 2010
Subject
Streptococcus pneumoniae; Bacteriemia; Economía de la Salud; Empiema; Economía Farmacéutica; Otitis; Salud del niño; Vacunación Masiva; Vacunas Pneumocócicas; Uruguay; Streptococcus pneumoniae; Bacteremia; Health Economics; Empyema; Economics, Pharmaceutical; Otitis; Child Health; Mass Vaccination; Pneumococcal Vaccines; Uruguay; Vacinas Pneumocócicas; Vacinação; Bacteriemia; Bacteriemia; Simulação por Computador; Análise Custo-Benefício; Empiema; Empiema; Gastos em Saúde; Incidência; Cadeias de Markov; Modelos Teóricos; Otite Média; Otite Média; Infecções Pneumocócicas; Infecções Pneumocócicas; Infecções Pneumocócicas; Anos de Vida Ajustados por Qualidade de Vida; Sepse; Sepse; Uruguai; Vacinas Conjugadas
URI
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000800004
https://iris.paho.org/handle/10665.2/9653
Citation
Giachetto Larraz, Gustavo,Telechea Ortiz, Héctor,Speranza Mourine, Noelia,Giglio, Norberto,Cané, Alejandro,Pírez García, María C,Lucas Paiva, Liriana,Pallares Barrios, Carla,Gesuele Ruggiero, Juan (2010) Costo-efectividad de la vacunación universal antineumocócica en Uruguay. Rev Panam Salud Publica;28(2) 92-99,agosto 2010. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000800004
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