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 SM ISO690:2012JARYNOWSKI, Andrzej. Cost-effectiveness analysis for HPV mitigation strategies in the Republic of Moldova based on infectious disease modelling. In: Economie şi Sociologie, 2019, nr. 2, pp. 50-64. ISSN 1857-4130. DOI: https://doi.org/10.36004/nier.es.2019.2-05 |
| EXPORT metadate: Google Scholar Crossref CERIF DataCite Dublin Core |
| Economie şi Sociologie | ||||||
| Numărul 2 / 2019 / ISSN 1857-4130 | ||||||
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| DOI:https://doi.org/10.36004/nier.es.2019.2-05 | ||||||
| CZU: 614.2:618.1–006.52–08 | ||||||
| JEL: I18, O33, C32, C53, C54, C63 | ||||||
| Pag. 50-64 | ||||||
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Human papillomavirus (HPV) is a sexually transmittable virus infection, which is a necessary risk factor for developing cervical cancer, first killer for working women in Moldova. Since 2018 Moldova has modified the screening program and the vaccination program (mainly funded externally). To assess the performance of the mitigation policy we propose the cost-effectiveness analysis according to 2 already implemented strategies. (1) Vaccination of a single age-cohort, although vaccinating a single cohort may not have a substantial effect in other countries with distinct socio-economic situation. (2) Transition to more technologically advance screening ecosystem (changing from Romanowski to Pap smear), which might not necessary be cost-efficient in low resource settings (if GDP per capita doesn’t grow substantially at the same time). (1) We verified that single cohort vaccination is both cost-beneficial (total costs reduction will balance intervention costs around the year 2040) and cost-efficient (with incremental impact in 20 years perspective on the level of 2300 EUR/QALY). Moreover, we found out that single year cohort is more beneficial than 5-years cohort vaccination scenarios in our mathematical model. This behaviour could be explained by a transitional situation in Moldova (HPV epidemic is near outbreak threshold), still small changes of model parameters and initial conditions could cause strong effect in the epidemiology. However, a definitive answer cannot be given with the chosen methodology. (2) Transition between Romanowski -> Pap smear cytology in screening benefits unquestionably in epidemiology e.g. due to a higher specificity. However, further maintenance and higher procedure costs could exceed treatment costs, hence intervention costs would gather an unacceptable share of national resources that are limited and that are dedicated to public health. |
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| Cuvinte-cheie computational social science, epidemiology modelling, cost-effectiveness analysis, HPV and cervical cancer, științe sociale, calcul, modelare matematică, analiza cost-eficiență, HPV și cancer de col uterin, вычислительные социальные науки, Эпидемиологические моделирование, анализ экономической эффективности, ВПЧ и рак шейки матки |
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<?xml version='1.0' encoding='utf-8'?> <oai_dc:dc xmlns:dc='http://purl.org/dc/elements/1.1/' xmlns:oai_dc='http://www.openarchives.org/OAI/2.0/oai_dc/' xmlns:xsi='http://www.w3.org/2001/XMLSchema-instance' xsi:schemaLocation='http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd'> <dc:creator>Jarynowski, A.</dc:creator> <dc:date>2019-01-31</dc:date> <dc:description xml:lang='en'><p>Human papillomavirus (HPV) is a sexually transmittable virus infection, which is a necessary risk factor for developing cervical cancer, first killer for working women in Moldova. Since 2018 Moldova has modified the screening program and the vaccination program (mainly funded externally). To assess the performance of the mitigation policy we propose the cost-effectiveness analysis according to 2 already implemented strategies. (1) Vaccination of a single age-cohort, although vaccinating a single cohort may not have a substantial effect in other countries with distinct socio-economic situation. (2) Transition to more technologically advance screening ecosystem (changing from Romanowski to Pap smear), which might not necessary be cost-efficient in low resource settings (if GDP per capita doesn’t grow substantially at the same time). (1) We verified that single cohort vaccination is both cost-beneficial (total costs reduction will balance intervention costs around the year 2040) and cost-efficient (with incremental impact in 20 years perspective on the level of 2300 EUR/QALY). Moreover, we found out that single year cohort is more beneficial than 5-years cohort vaccination scenarios in our mathematical model. This behaviour could be explained by a transitional situation in Moldova (HPV epidemic is near outbreak threshold), still small changes of model parameters and initial conditions could cause strong effect in the epidemiology. However, a definitive answer cannot be given with the chosen methodology. (2) Transition between Romanowski -> Pap smear cytology in screening benefits unquestionably in epidemiology e.g. due to a higher specificity. However, further maintenance and higher procedure costs could exceed treatment costs, hence intervention costs would gather an unacceptable share of national resources that are limited and that are dedicated to public health.</p></dc:description> <dc:description xml:lang='ro'><p>Virusul papiloma uman (Human Papilloma Virus sau HPV) este o infecție virală sexual transmisibilă și un factor de risc pentru dezvoltarea cancerului de col uterin – cel mai frecvent tip de boli oncologice la femeile apte de muncă din Republica Moldova. Din 2018, în Republica Moldova a fost modificat programul de screening și programul de vaccinare (finanțat în principal din exterior). Pentru a evalua performanța politicii de atenuare, propunem analiza cost-eficiență în conformitate cu 2 strategii deja implementate. (1) Vaccinarea unei singure cohorte de vârstă, deși vaccinarea unei singure cohorte nu poate avea un efect substanțial în alte țări cu o situație socio-economică distinctă. (2) Trecerea la ecosistemul de screening avansat din punct de vedere tehnologic (schimbarea de la romanowski la frotiul Papanicolau), care ar putea să nu fie necesar din punct de vedere al costurilor în cazul resurselor scăzute (dacă PIB-ul pe cap de locuitor nu va crește substanțial în acel moment). (1) Am verificat faptul că vaccinarea cu o singură cohorta este benefică atât din punctul de vedere al costurilor (reducerea totală a costurilor va echilibra costurile de intervenție în jurul anului 2040), cât și costurile (cu un impact incremental în perspectivă de 20 de ani la nivelul de 2300 EUR / QALY). Mai mult, am aflat că o cohortă unică este mai benefică decât vaccinarea continuă în modelul nostru matematic. Acest comportament poate fi explicat printr-o situație de tranziție în Republica Moldova (epidemia de HPV este aproape de pragul izbucnirii), totuși modificările mici ale parametrilor modelului și condițiile inițiale ar putea avea un efect puternic în epidemiologie. Cu toate acestea, nu se poate da un răspuns definitiv cu metodologia aleasă. (2) Tranziția între romanowski -> citoplasmă Papanicolau în screening beneficiază, fără îndoială, de epidemiologie, de ex., datorită specificității mai mari. Cu toate acestea, întreținerea ulterioară și costurile de procedură mai mari ar putea depăși costurile de tratament, prin urmare, costurile de intervenție ar aduna cote inacceptabile în întreaga gamă de resurse naționale limitate dedicate sănătății publice.</p></dc:description> <dc:description xml:lang='ru'><p>Вирус папилломы человека, или ВПЧ, передаваемый половым путем, является одним из факторов риска для развития рака шейки матки – одного из самых распространенных типов онкологических заболеваний у женщин трудоспособного возраста в Республике Молдова. С 2018 года в Республике Молдова была изменена программа скрининга и программа вакцинации, финансируемые в основном из внешних источников. Для оценки эффективности политики смягчения последствий был предложен анализ экономической эффективности в соответствии с двумя уже реализованными стратегиями. (1) Вакцинация одной возрастной группы, хотя вакцинация одной когорты может не иметь существенного эффекта в других странах с отличающейся социально-экономической ситуацией. (2) Переход к более технологически продвинутой системе скрининга (переход от мазка Романовского к Пап-мазку), который может быть необязательным с точки зрения затрат в условиях ограниченных ресурсов (если ВВП на душу населения не будет одновременно существенно расти). Результаты исследования показали: (1) вакцинация одной когорты выгодна с точки зрения затрат (снижение общих затрат позволит сбалансировать расходы на профилактику примерно к 2040 году) и эффективна с точки зрения затрат (с дополнительным воздействием через 20 лет на уровне 2300 евро / QALY). Более того, мы обнаружили, что в нашей математической модели вакцинация одиночной когорты более полезна, чем непрерывная вакцинация. Такая ситуация может быть объяснена переходной ситуацией в Республике Молдова (эпидемия ВПЧ близка к порогу вспышки), хотя небольшие изменения параметров модели и начальных условий могут оказать сильное влияние в эпидемиологии. Однако использованная методология не позволяет дать однозначный ответ. (2) Переход от мазка Романовского к цитологическому Пап-мазку при скрининге, несомненно, полезен в эпидемиологии, например, из-за более высокой специфичности. Тем не менее, дальнейшее обслуживание и более высокие затраты на процедуры могут превысить затраты на лечение, поэтому затраты на профилактику составили бы недопустимо высокую долю расхода ограниченных национальных ресурсах, предназначенных для общественного здравоохранения.</p></dc:description> <dc:identifier>10.36004/nier.es.2019.2-05</dc:identifier> <dc:source>Economie şi Sociologie (2) 50-64</dc:source> <dc:subject>computational social science</dc:subject> <dc:subject>epidemiology modelling</dc:subject> <dc:subject>cost-effectiveness analysis</dc:subject> <dc:subject>HPV and cervical cancer</dc:subject> <dc:subject>științe sociale</dc:subject> <dc:subject>calcul</dc:subject> <dc:subject>modelare matematică</dc:subject> <dc:subject>analiza cost-eficiență</dc:subject> <dc:subject>HPV și cancer de col uterin</dc:subject> <dc:subject>вычислительные социальные науки</dc:subject> <dc:subject>Эпидемиологические моделирование</dc:subject> <dc:subject>анализ экономической эффективности</dc:subject> <dc:subject>ВПЧ и рак шейки матки</dc:subject> <dc:title>Cost-effectiveness analysis for HPV mitigation strategies in the Republic of Moldova based on infectious disease modelling</dc:title> <dc:type>info:eu-repo/semantics/article</dc:type> </oai_dc:dc>
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