Health Care And Hpv Vaccination

Introduction

This paper criticises two articles’ vaccination techniques and their assessment models according to Drummond’s checklist. This checklist evaluate economic impacts of a healthcare programme with respect to the parameters such as cost effectiveness, success etc. This critique will give rise to a better understanding of relative value of various inventions for achieving better health, longer life in a cost effective manner. The first article is "Impact of vaccinating boys and men against HPV in the United States" performed by Elbasha, E. H. and Dasbach, E. J. (2010) that proves vaccinating boys and men against all HPV-related diseases results better public health in less investment. On the other hand "The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting" performed by Kim, J. J. Andres-Beck, B. and Goldie, S. J. (2007) states that this vaccination is also needed for pre-adeloscent girl. The next part of this paper recommends policy recommendations that may prevent risk of cancer in UK. UK government must introduce gender neutral HPV vaccinating program to eradicate the root cause of this disease that would helps people below economic level to fight against this disease.

Differences between two selected articles

Critiquing the articles

The first article “Impact of vaccinating boys and men against HPV in the United States”, by Elbasha and Dasbach (2010) states that quadrivalent HPV vaccination among boys and men and its positive impacts are analysed by using mathematical population models that accounts effectiveness of vaccination. The other article "The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting" performed by Kim, J. J. Andres-Beck, B. and Goldie, S. J. (2007) reveals the effectiveness of pre-adolescent vaccination among girls can manage cancer in a cost effective way.

Need for vaccination against human papiloma (HPV) virus in a cost effective way raises question about its positive and negative impacts in cancer management. On the other hand second article states about cervical cancer vaccination reduce in pre-adolescent girls decreases the risk of cancer by 63%. The questions provided in the programme were designed in a way those were easily answerable by the participants. Hence, it was possible to acquire better outcome of the programme.

The first article does not provide comprehensive description of the alternatives of HPV vaccination, as there was a lack of lucidity in terms of explaining the details of the methods of calibration and modelling. These mathematical models include Markov cohort model, hybrid model, agent-based model and classical transmission model. However, the second article deals with dynamic transmission model that analysed data collected from different demographics.

There was evidence to prove the effectiveness of the HPV vaccination programme. HPV infection can be caused in anogenital warts, cervical cancer, and precancerous lesions. Almost 100% cervical cancer occurs through HPV virus. In the year 2002, 493,000 cases of cervical cancer and 247,000 deaths caused by the cancer have been reported. Moreover, it is the second most common cancer found in women. In case of quadrivalent vaccination first article goes through with a comparative study and proves cost effectiveness of vaccination against all HPV associated diseases. However, in second article stochastic model is applied for projecting life time costs and benefits that indicates towards reducing cancer risk.

Not all the crucial and related costs and consequences are identified for each alternative in the first article. This was happened as the vaccination strategies and comparators differentiate over the studies. Hence, direct contrast of ICER was not applicable. Therefore, the outcome of study diverse immensely in between the studies ranging from €12,232 to €650,319 per QALY attained a 53-crease raise. However, in the second article collected data ranges from different demography and epidemiology that derives a specific cost required for this vaccination programmes.

It was difficult to measure the costs and consequences appropriately as most of the model approaches used in the study were complicated. Hence, due to lack of transparency it was not possible to make an effective comparison between various bases of case analysis. Both the articles give a clear idea about the cost and consequences in a range of possible cases.

All the costs and consequences were measured accurately in $US. The price of HPV vaccines were different in different countries ranging between €250 and €450. However, it is analysed the actual price of the vaccines should have been lower than the listed price due to tendering process and negotiation. The unit price of the vaccines is decreased by the time. Costs and consequences adjusted for differential timing. Four studies were conducted and the outcome were analysed for analysing the costs and consequences for different timings. Through the studies, the sensitivity of the price effectiveness has been measured. From this analysis, a lining relationship was identified between the relative change in ICER and the relative change in the price of vaccines.

No incremental analysis was performed. The fundamental case postulation on the effectiveness of the HPV vaccine against infection spread from medical trial data was numerically comparable across studies.

Payment was not made for uncertainty. It was difficult and complicated to assume allowance for uncertainty.

The presentation of outcomes did not include all issues of apprehension. Comparing the rates of transition between diseases progression and HPV transmission was difficult. Moreover, it was complicated in terms of estimating some rates in the calibration process. This was not explained adequately and assorted between the studies.

The first article collects data from public data sources, literature reviews while the second one deals with data from different demographics that can consider a large range of variations in statistical analysis.

Economic Valuation

It can be inferred from the study that if the eagerness to pay is $20,000 / QALY, vaccinating only women and girls is cost effective in all the imitations. However, this can be declined by 23% if men and boys are also be added to the programme. Hence, the readiness to pay inclines about $50,000 / QALY. The study also indicated that ICER of vaccinating women and girls are declined with high effectiveness by consuming 2 doses, lesser vaccine cost. Nevertheless, the case was not similar with the men and boys. Moreover, if both men and women are vaccinated in that case, with lower effectiveness, the cost-effectiveness of vaccinating enhances. Cost utility analysis is referred to a financial analysis carried out in the health care organisation to take sound decisions as per the procurement. This analysis is utilised in the pharma-economy to settle on the cost in the form of usefulness, particularly amount and superiority of life. For identifying the available vaccination, system available to UK the study was done with a team of twelve-year-old schoolchildren. This has shown the 80% infection can be decreased if vaccines are provided timely. As per the Department Of Health the children belong to the age group of 12-13 is the appropriate time to provide the vaccines.

Whenever any treatment policy is designed it is always kept into mind that if these treatment would be fruitful to everyone or not. Increased treatment costs influence a majority of people with low economic status for availing those. A cost effectiveness analysis illustrated in the second article reveals that vaccinating girls alone gives more benefits than vaccinate those including boys. Brazil is a country that has resource-constrained setting or low-resource setting. Result detects that prioritisation of vaccinating pre-adolescent girls can reduce cervical cancer mortality that leads to increase the rate of survival in cancer. The first article also states that eradication of HPV vaccines among girls show higher rate of success than in boys and men. The study also reveals the mean cost effective ratio of this strategy was less if all HPV associated disease would be vaccinated at once.

Policy Recommendation for the UK

HPV is a DNA virus that becomes a major reason for generating different types of cancer. Among them HPV 16 and 18 are the principle strength that form cervical cancer. Therefore, vaccination against HPV associated disease help to reduce risk of cancer. This virus transmitted from host’s body to healthy controls by sexual attachment. It is reported that in every year nearly 20,000 people get affected of this viruses and among them percentage of girls is high. UK government starts HPV vaccination programme to eradicate HPV virus and reduce the risk of cancer. Vaccinating girls also reduce the risk of spreading cancer in men. For reducing expenditure cost government provided this programmes only for girls. However, men who are having sex with infected women possess a large chance of being affected by HPV. Hence, government initiatives and eradication programmes need immediate modification. These programmes have to also be available for men. The effectiveness of this programme will be achieved if vaccination is done among 12-13 years aged people when immune response shows greater activity in them. Thus, government have to take necessary steps to mandate vaccination without gender discrimination.

From article one UK government can be recommended to provide vaccination against all HPV associated disease instead of vaccinating people only against HPV 16 and 18. Other strains of HPV may be responsible for cancer. It is proved by mathematical modelling that cost of programmes will be also reduced by above vaccination. From this study it is clear that cost of vaccinating per person is 50USD, whether cost of treatment is remarkably higher.

Some other questions still remains unanswered even after this thorough critical analysis of these two articles. Effectiveness of this vaccination is successful for what extent that is not found in this study. Both the paper cannot give any solution in case of generating any hazards due to this vaccination. Number of data collected is from public or from different epidemiology. However, they are unable to give understanding of vaccination and its mechanism in controlling HPV virus. By answering these questions more rational policy can be formulated that could be reduce the risk of cancer in manifolds.

Conclusion

From the above discussion it can be concluded that Drummond checklist can effectively evaluate the importance of introducing cost effectiveness in vaccination programme. The positive and negative impacts of both types of vaccinations are also analysed by this report. It is also found that vaccinating pre-adolescence girls help to eradicate HPV viruses in a more effective approach. Both the articles failed to cover all incremental analysis that can reveal underpinning factors. Elaborated discussion cannot be gone through with those mentioned articles hence; some unanswered issues still remain for future consideration. Finally, some recommendations can improve government initiatives that can manage cancer. Moreover, it is found that the UK government must exclude gender discrimination in HPV vaccination program.

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Reference

• Elbasha, E. H. and Dasbach, E. J. (2010). "Impact of vaccinating boys and men against HPV in the United States".
• Kim, J. J. Andres-Beck, B. and Goldie, S. J. (2007). "The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting".