Ensaios sobre a economia do câncer de colo de útero : teorias e evidências para o caso de Roraima

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

2011

RESUMO

Invasive cervical cancer (ICC) is one of the most damaging that affect women, especially in developing countries, where preventive programs (based on the Pap smear) haven¿t achieved effectiveness. HPV vaccines have recently been proposed as primary prevention of ICC. They show good efficacy and safety, but a high cost for its acquisition. Objectives: The objective of this dissertation is to evaluate the incidence of ICC in Roraima, its economic impact, and the socioeconomic profile of ICC carriers assisted in the public health system, and to perform a costeffectiveness and cost-utility analysis of adding HPV vaccination to current preventive programs. In the first essay, all histopathologic and cytologic reports issued in Roraima in 2009 were reviewed, along with the medical records of all patients diagnosed with ICC. All therapeutic and diagnostic procedures performed in 2009 in women with ICC cervix carcinoma were recorded. These patients were argued prospectively, addressing socio-economic topics. We registered 90 cases of cervical cancer in Roraima in 2009. The incidence corresponded to 46.2 new cases per 100,000 women. Carriers of the ICC showed unfavorable economic profile, social exclusion, deficient knowledge on ICC prevention and low adherence to the screening preventive programs. The annual impact of the ICC in Roraima is over R$ 8,000 per case. This essay highlights the inequity of access to preventive programs in Roraima, that excludes the subgroup of the population who would mostly benefit from screening, resulting in elevated costs. The second essay conducted economic evaluations of the incorporation of HPV vaccine to preventive programs in Roraima. A Markov cohort model was developed as an analytic tool to simulate the natural history of HPV and its progress to ICC, considering the current preventive programs. Transition probabilities were based mainly on empirical data of local and national studies. After satisfactory calibration values and considering the base case, the addition of HPV vaccination would reduce by 35% the incidence of ICC, in a scenario of three Pap tests throughout life. The incremental ratio of cost-effectiveness was R$ 2,556 for each year of quality-adjusted life (QALY) saved. The sensitivity analysis confirms the robustness of this result. Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in substantial reduction in incidence and mortality of ICC in Roraima.

ASSUNTO(S)

cervical cancer saúde pública roraima economic impact prevenção de doenças análise econômica vaccine human papillomavirus economia da saúde costeffectiveness cost utility health economics

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