ABSTRACT
Health technology assessment (HTA) provides evidence-based information on healthcare technology to support decision making in many countries. Environmental impact is a relevant dimension of a health technology's value, but it has been poorly addressed in HTA processes in spite of the commitment that the health sector must have to contribute to mitigating the effects of climate change. This study aims to identify the state of the art and challenges for quantifying environmental impacts that could be incorporated into the economic evaluation (EE) of HTA. We performed a scoping review that included 22 articles grouped into four types of contribution: (1) concepts to draw up a theoretical framework, (2) HTA reports, (3) parameter designs or suitable indicators, and (4) economic or budgetary impact assessments. This review shows that evaluation of the environmental impact of HTAs is still very incipient. Small steps are being taken in EE, such as carbon footprint estimations from a life-cycle approach of technologies and the entire care pathway.
Subject(s)
Biomedical Technology , Technology Assessment, Biomedical , Cost-Benefit Analysis , Technology Assessment, Biomedical/methods , Carbon Footprint , Climate ChangeABSTRACT
All EU countries have introduced Human papilloma virus (HPV) vaccination for adolescent girls and many countries are expanding the strategy to include adolescent boys. There is uncertainty about the cost-effectiveness and epidemiological impact of a gender-neutral HPV vaccination strategy. Here we present the results of an economic model adapted for Spain. Five vaccination strategies were compared from the Spanish healthcare system perspective, combining two vaccines (4-valent and 9-valent) in a gender-neutral or girls-only programme in a dynamic population-based model with a discrete-time Markov approach. Costs and benefits were discounted at 3%. The benefits of immunization were measured with quality-adjusted life years (QALYs), which are achieved by reducing the incidence of diseases attributable to HPV. Incremental cost-effectiveness ratio (ICER) was compared with the willingness-to-pay threshold in Spain. The two most effective strategies were compared: gender-neutral 9-valent vaccination vs. girls-only 9-valent vaccination, resulting in an ICER of 34,040/QALY, and an important number of prevented cases of invasive cancers and anogenital warts. The sensitivity analysis revealed that gender-neutral 9-valent vaccination would become cost-effective if protection against oropharyngeal and penile cancers was included or if the price per dose decreased from 45 to 28. The gender-neutral 9-valent HPV vaccination in Spain offers more benefits than any other modeled strategy, although in the conservative base case it is not cost-effective. However, certain plausible assumptions would turn it into an efficient strategy, which should be borne in mind by the decision makers together with equity and justice arguments.
What is the context? Human papillomavirus (HPV) is a group of viruses that causes sexually transmitted diseases, including certain cancers. European countries offer HPV vaccination to adolescent girls.Many countries have also introduced the vaccination in adolescent boys.There are doubts about whether it is worth vaccinating adolescents of both genders.What this study adds? We estimated costs and benefits of the vaccination in Spain, comparing two types of vaccine, only in girls and in both genders. This analysis considered indirect protection of vaccinated people to unvaccinated ones.It seems that the benefits of HPV vaccination in all adolescents do not compensate the costs.However, when we included likely protection against additional cancers or we reduced the price per vaccine dose, it would be worth vaccinating all adolescents in Spain.We also stated ethical arguments in favor of HPV vaccination for both genders.What is the impact? HPV vaccination in adolescent boys and girls in Spain will prevent more HPV-related diseases.For certain scenarios, HPV vaccination in both genders would be worth in Spain.Ethically, vaccinating also boys would be fair, equitable and would not discriminate a part of the population.
Subject(s)
Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , Adolescent , Male , Female , Humans , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Cost-Benefit Analysis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Vaccination , Quality-Adjusted Life YearsABSTRACT
BACKGROUND: Human papillomavirus (HPV) infection can have severe consequences both in women and men. Preadolescent girls are vaccinated against HPV worldwide but a gender-neutral vaccination is being adopted only little by little. This systematic review offers an overview of cost-effectiveness of the gender-neutral HPV vaccination. METHODS: Economic evaluations of gender-neutral HPV vaccination with a two-dose schedule compared with girls-only strategy were systematically searched in Medline, Embase and WOS up to June 2020. Incremental cost-effectiveness ratios and key parameters were analysed. RESULTS: Nine studies met the inclusion criteria. Four studies concluded in favour of the gender-neutral programme, another four found it cost-effective only in alternative scenarios. The most influential parameters are the discount rate of benefits (same as for costs vs reduced), vaccine price (listed vs publicly negotiated) and included health problems (inclusion of oropharyngeal and penile cancers). Sponsorship was not decisive for the final result, but there were differences between industry-funded and independent studies in some cost categories. CONCLUSIONS: The evidence of the cost-effectiveness of extending HPV vaccination to boys is scarce and ambiguous. Before the adoption of such a strategy, countries should carry out context-specific cost-effectiveness analyses, but the decision should also take into account other criteria, such as gender-related equality.
