Otimização do emprego de recursos econômicos para vacinação contra hepatite B em profissionais da área de saúde

Abstract

In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers, two different aspects were studied: the need of a pre-vaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost-minimization study) showed that when the prevalence of immune individuals is higher than 11% it is more cost-effective to perform pre-vaccination screening. This situation was observed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92% and 93%, respectively) and geometric mean titers of antiHBs (1278 UI/L and 789.6 UI/L) were similar, and both were different from group A (p < 0.05), showing that alternative vaccination schedules may be cost-effective.

A systematic review of health economic evaluations of vaccines in Brazil

“…1), 20 were full HEEs that dealt with vaccines, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] all them published between 1995 and 2013. Figure 2 shows the growth in the number of HEEs on vaccines published in the period.…”

“…Only 3 studies reported using local data. 13,14,30 Indirect effects of the vaccination program (herd protection) was considered in 40% (8/ 20) of the reviewed studies: in 5 studies, which assessed HPV (2 studies), varicella, hepatitis A and dengue vaccination programs, 19,[26][27][28]32 the indirect effects were captured in the base case analysis by a dynamic model; and in 3 studies that assessed childhood pneumococcal conjugate vaccination using statistic decision tree model, the indirect protection was evaluated in a secondary or sensitivity analysis. [21][22][23] Six studies did not take indirect protection into account 14,17,18,24,25,29 and 6 did not inform.…”

“…[21][22][23] Six studies did not take indirect protection into account 14,17,18,24,25,29 and 6 did not inform. 13,15,16,20,30,31 Table 2 and Table 3 present the main methodological characteristics of the selected articles.…”

“…[17][18][19][21][22][23][24][25][26][27][28][29]31 One study presented the net benefit, 14 and another presented cost difference. 13 Based on WHO proposed criteria for cost-effectiveness to interpret the studies' results, 11 considering the 13 studies that reported ICERs, the vaccination strategy was cost-saving in 3 studies; the ICER was <1 per capita gross domestic product (GDP) per DALY, considered as very cost-effective, in 7 studies; and the ICER was between 1 and 3 GDP/DALY, considered cost-effective, in 3 studies. The conclusions of all these 13 studies were favorable to the vaccines evaluated.…”

“…15,27,32 Regarding the decision models developed in the studies, 40% used decision tree, 15 25 One study did not report the type of sensitivity analysis conducted. 13 …”