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Governance of preventive Health Intervention and On time Verification of its Efficiency: the GIOVE Study.

Mennini FS, Baio G, Montagano G, Cauzillo G, Locuratolo F, Becce G, Gitto L, Marcellusi A, Zweifel P, Capone A, Favato G - BMJ Open (2012)

Bottom Line: The alternatives compared were the screening programme alone and the quadrivalent immunisation with access to screening.A sensitivity analysis was carried out to assess the uncertainty associated with the main inputs of the model.When the price paid for the quadrivalent vaccine dropped to €85 per dose, the most efficient coverage rate (69.5%) shifted closer to the immunisation rate actually achieved during the 12-month observation period.

View Article: PubMed Central - PubMed

Affiliation: CEIS Sanità-Centre for Health Economics and Management (CHEM), Faculty of Economics, Tor Vergata University, Rome, Italy.

ABSTRACT

Objectives: The GIOVE Study was aimed to the achievement of allocative efficiency of the budget allocated to the prevention of human papillomavirus (HPV)-induced diseases. An ex-ante determination of the most efficient allocation of resources between screening and multicohort quadrivalent immunisation programmes was followed by the ex-post assessment of the allocative efficiency actually achieved after a 12-month period.

Design: A bound optimisation model was developed to determine the ex-ante allocative efficiency of resources. The alternatives compared were the screening programme alone and the quadrivalent immunisation with access to screening. A sensitivity analysis was carried out to assess the uncertainty associated with the main inputs of the model. Subsequently, a cohort of girls with a complete recorded vaccination history were enrolled in an observational retrospective study for 18 months to ensure full compliance with the recommended schedule of vaccination (0, 2, 6 months) within a 12-month time horizon.

Setting: Basilicata region, in the south of Italy.

Participants: 12 848 girls aged 12, 15, 18 or 25 years.

Intervention: Immunisation with quadrivalent anti-HPV vaccine.

Outcome measures: The vaccination coverage rate was considered to be the indicator of the best achievable benefit, given the budgetary constraints.

Results: Assuming a vaccine price of €100 per dose, a vaccination coverage rate of 59.6% was required for the most effective allocation of resources. The optimal rate of coverage was initially in favour of the multicohort strategy of vaccination against HPV (72.8%±2%). When the price paid for the quadrivalent vaccine dropped to €85 per dose, the most efficient coverage rate (69.5%) shifted closer to the immunisation rate actually achieved during the 12-month observation period.

Conclusions: The bound optimisation model demonstrated to be a useful approach to the ex-ante allocation and the ex-post assessment of the resources allocated to the implementation of a multicohort quadrivalent anti-HPV vaccination programme.

No MeSH data available.


Related in: MedlinePlus

Relationship between coverage rate and number of cohorts vaccinated.21 Figure illustrates the expected long-term effect of the vaccination, correlated to the number of cohorts targeted. The combined reduction of all events, such as abnormal Pap smears, colposcopies, Atypical Squamous Cells of Undetermined Significance, Low-grade Squamous Intraepithelial Lesion, High-grade Squamous Intraepithelial Lesions, cervical cancer and genital warts, showed a significant difference between the second and the third cohort. The vaccination of three to four cohorts was likely to enhance the percentage of events avoided, shortening the time required to reach the optimal cost/effective outcome.
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fig3: Relationship between coverage rate and number of cohorts vaccinated.21 Figure illustrates the expected long-term effect of the vaccination, correlated to the number of cohorts targeted. The combined reduction of all events, such as abnormal Pap smears, colposcopies, Atypical Squamous Cells of Undetermined Significance, Low-grade Squamous Intraepithelial Lesion, High-grade Squamous Intraepithelial Lesions, cervical cancer and genital warts, showed a significant difference between the second and the third cohort. The vaccination of three to four cohorts was likely to enhance the percentage of events avoided, shortening the time required to reach the optimal cost/effective outcome.

Mentions: Our findings for the 12-month period of our study demonstrate that the Basilicata region was able to leverage the reduction in the price of the vaccine from €100 to €85 per phial to achieve an higher than planned coverage rate (73% vs 60%), progressively reducing the inefficiency of the actual resource allocation to the quadrivalent multicohort vaccination from 21% in the period July 2007 to August 2008 to an almost negligible 5% after September 2008, when the price reduction came into effect. In the context of the Italian national programme of vaccination, the Basilicata region is in full compliance with the guidelines established by the Italian State-Regions Conference, which in turn were determined in accordance with both the Ministry of Health and the National Institute of Health. Moreover, the implementation of a multicohort strategy of vaccination in the region should provide clinical and economic benefits 5–8 years earlier than would be expected with a single-cohort strategy. Figure 3 provides an explanation of the benefits associated with the multicohort programme. Our findings are consistent with those of a modelling study published in 2008,18 which demonstrated that the greater flexibility in the rate of coverage that results from vaccinating between three and four cohorts rather than one (in the range 63.0%–72.0% for a four-cohort strategy compared with a range of 78.0%–83.5% for a two-cohort strategy) enables a higher efficiency of vaccination to be maintained.21


Governance of preventive Health Intervention and On time Verification of its Efficiency: the GIOVE Study.

Mennini FS, Baio G, Montagano G, Cauzillo G, Locuratolo F, Becce G, Gitto L, Marcellusi A, Zweifel P, Capone A, Favato G - BMJ Open (2012)

Relationship between coverage rate and number of cohorts vaccinated.21 Figure illustrates the expected long-term effect of the vaccination, correlated to the number of cohorts targeted. The combined reduction of all events, such as abnormal Pap smears, colposcopies, Atypical Squamous Cells of Undetermined Significance, Low-grade Squamous Intraepithelial Lesion, High-grade Squamous Intraepithelial Lesions, cervical cancer and genital warts, showed a significant difference between the second and the third cohort. The vaccination of three to four cohorts was likely to enhance the percentage of events avoided, shortening the time required to reach the optimal cost/effective outcome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3307037&req=5

fig3: Relationship between coverage rate and number of cohorts vaccinated.21 Figure illustrates the expected long-term effect of the vaccination, correlated to the number of cohorts targeted. The combined reduction of all events, such as abnormal Pap smears, colposcopies, Atypical Squamous Cells of Undetermined Significance, Low-grade Squamous Intraepithelial Lesion, High-grade Squamous Intraepithelial Lesions, cervical cancer and genital warts, showed a significant difference between the second and the third cohort. The vaccination of three to four cohorts was likely to enhance the percentage of events avoided, shortening the time required to reach the optimal cost/effective outcome.
Mentions: Our findings for the 12-month period of our study demonstrate that the Basilicata region was able to leverage the reduction in the price of the vaccine from €100 to €85 per phial to achieve an higher than planned coverage rate (73% vs 60%), progressively reducing the inefficiency of the actual resource allocation to the quadrivalent multicohort vaccination from 21% in the period July 2007 to August 2008 to an almost negligible 5% after September 2008, when the price reduction came into effect. In the context of the Italian national programme of vaccination, the Basilicata region is in full compliance with the guidelines established by the Italian State-Regions Conference, which in turn were determined in accordance with both the Ministry of Health and the National Institute of Health. Moreover, the implementation of a multicohort strategy of vaccination in the region should provide clinical and economic benefits 5–8 years earlier than would be expected with a single-cohort strategy. Figure 3 provides an explanation of the benefits associated with the multicohort programme. Our findings are consistent with those of a modelling study published in 2008,18 which demonstrated that the greater flexibility in the rate of coverage that results from vaccinating between three and four cohorts rather than one (in the range 63.0%–72.0% for a four-cohort strategy compared with a range of 78.0%–83.5% for a two-cohort strategy) enables a higher efficiency of vaccination to be maintained.21

Bottom Line: The alternatives compared were the screening programme alone and the quadrivalent immunisation with access to screening.A sensitivity analysis was carried out to assess the uncertainty associated with the main inputs of the model.When the price paid for the quadrivalent vaccine dropped to €85 per dose, the most efficient coverage rate (69.5%) shifted closer to the immunisation rate actually achieved during the 12-month observation period.

View Article: PubMed Central - PubMed

Affiliation: CEIS Sanità-Centre for Health Economics and Management (CHEM), Faculty of Economics, Tor Vergata University, Rome, Italy.

ABSTRACT

Objectives: The GIOVE Study was aimed to the achievement of allocative efficiency of the budget allocated to the prevention of human papillomavirus (HPV)-induced diseases. An ex-ante determination of the most efficient allocation of resources between screening and multicohort quadrivalent immunisation programmes was followed by the ex-post assessment of the allocative efficiency actually achieved after a 12-month period.

Design: A bound optimisation model was developed to determine the ex-ante allocative efficiency of resources. The alternatives compared were the screening programme alone and the quadrivalent immunisation with access to screening. A sensitivity analysis was carried out to assess the uncertainty associated with the main inputs of the model. Subsequently, a cohort of girls with a complete recorded vaccination history were enrolled in an observational retrospective study for 18 months to ensure full compliance with the recommended schedule of vaccination (0, 2, 6 months) within a 12-month time horizon.

Setting: Basilicata region, in the south of Italy.

Participants: 12 848 girls aged 12, 15, 18 or 25 years.

Intervention: Immunisation with quadrivalent anti-HPV vaccine.

Outcome measures: The vaccination coverage rate was considered to be the indicator of the best achievable benefit, given the budgetary constraints.

Results: Assuming a vaccine price of €100 per dose, a vaccination coverage rate of 59.6% was required for the most effective allocation of resources. The optimal rate of coverage was initially in favour of the multicohort strategy of vaccination against HPV (72.8%±2%). When the price paid for the quadrivalent vaccine dropped to €85 per dose, the most efficient coverage rate (69.5%) shifted closer to the immunisation rate actually achieved during the 12-month observation period.

Conclusions: The bound optimisation model demonstrated to be a useful approach to the ex-ante allocation and the ex-post assessment of the resources allocated to the implementation of a multicohort quadrivalent anti-HPV vaccination programme.

No MeSH data available.


Related in: MedlinePlus