A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America

ilustraciones

Autores:
Castañeda-Orjuela, Carlos Andrés
Tipo de recurso:
Doctoral thesis
Fecha de publicación:
2023
Institución:
Universidad Nacional de Colombia
Repositorio:
Universidad Nacional de Colombia
Idioma:
eng
OAI Identifier:
oai:repositorio.unal.edu.co:unal/84139
Acceso en línea:
https://repositorio.unal.edu.co/handle/unal/84139
https://repositorio.unal.edu.co/
Palabra clave:
610 - Medicina y salud
330 - Economía
Vacunas
Política de salud
Vaccines
Health Policy
Immunization
Pneumococcal vaccines
Latin America and the Caribbean
Cost-effectiveness
Decision making
Vacunación
Vacunas contra neumococo
Latinoamérica y el Caribe
Costo-efectividad
Toma de decisiones
Rights
openAccess
License
Atribución-NoComercial-SinDerivadas 4.0 Internacional
id UNACIONAL2_4f6486e96b2e9a796b9b36a8c32f5803
oai_identifier_str oai:repositorio.unal.edu.co:unal/84139
network_acronym_str UNACIONAL2
network_name_str Universidad Nacional de Colombia
repository_id_str
dc.title.eng.fl_str_mv A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
dc.title.translated.spa.fl_str_mv Aproximación crítica al uso de evaluaciones de costo-efectividad para inclusión de vacunas en los programas nacionales de inmunización: el caso de la vacunación contra neumococo en Latinoamérica
title A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
spellingShingle A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
610 - Medicina y salud
330 - Economía
Vacunas
Política de salud
Vaccines
Health Policy
Immunization
Pneumococcal vaccines
Latin America and the Caribbean
Cost-effectiveness
Decision making
Vacunación
Vacunas contra neumococo
Latinoamérica y el Caribe
Costo-efectividad
Toma de decisiones
title_short A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
title_full A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
title_fullStr A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
title_full_unstemmed A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
title_sort A critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin America
dc.creator.fl_str_mv Castañeda-Orjuela, Carlos Andrés
dc.contributor.advisor.none.fl_str_mv De la Hoz-Restrepo, Fernando Pio
dc.contributor.author.none.fl_str_mv Castañeda-Orjuela, Carlos Andrés
dc.contributor.researchgroup.spa.fl_str_mv Grupo de Epidemiología y Evaluación en Salud Pública
dc.contributor.orcid.spa.fl_str_mv 0000-0002-8735-6223
dc.contributor.cvlac.spa.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001124145
dc.contributor.scopus.spa.fl_str_mv 35769124700
dc.contributor.researchgate.spa.fl_str_mv https://www.researchgate.net/profile/Carlos-Castaneda-Orjuela
dc.contributor.googlescholar.spa.fl_str_mv https://scholar.google.com/citations?user=XESiWzMAAAAJ&hl=es&oi=ao
dc.subject.ddc.spa.fl_str_mv 610 - Medicina y salud
330 - Economía
topic 610 - Medicina y salud
330 - Economía
Vacunas
Política de salud
Vaccines
Health Policy
Immunization
Pneumococcal vaccines
Latin America and the Caribbean
Cost-effectiveness
Decision making
Vacunación
Vacunas contra neumococo
Latinoamérica y el Caribe
Costo-efectividad
Toma de decisiones
dc.subject.decs.spa.fl_str_mv Vacunas
Política de salud
dc.subject.decs.eng.fl_str_mv Vaccines
dc.subject.lemb.eng.fl_str_mv Health Policy
dc.subject.proposal.eng.fl_str_mv Immunization
Pneumococcal vaccines
Latin America and the Caribbean
Cost-effectiveness
Decision making
dc.subject.proposal.spa.fl_str_mv Vacunación
Vacunas contra neumococo
Latinoamérica y el Caribe
Costo-efectividad
Toma de decisiones
description ilustraciones
publishDate 2023
dc.date.accessioned.none.fl_str_mv 2023-07-04T21:53:59Z
dc.date.available.none.fl_str_mv 2023-07-04T21:53:59Z
dc.date.issued.none.fl_str_mv 2023-06
dc.type.spa.fl_str_mv Trabajo de grado - Doctorado
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/doctoralThesis
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.coar.spa.fl_str_mv http://purl.org/coar/resource_type/c_db06
dc.type.content.spa.fl_str_mv Text
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TD
format http://purl.org/coar/resource_type/c_db06
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv https://repositorio.unal.edu.co/handle/unal/84139
dc.identifier.instname.spa.fl_str_mv Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv https://repositorio.unal.edu.co/
url https://repositorio.unal.edu.co/handle/unal/84139
https://repositorio.unal.edu.co/
identifier_str_mv Universidad Nacional de Colombia
Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv eng
language eng
dc.relation.references.spa.fl_str_mv Baker L, Birnbaum H, Geppert J, Mishol D, Moyneur E. The relationship between technology availability and health care spending. Health Aff (Millwood). 2003;Suppl Web Exclusives:3-537. [DOI:10.1377/hlthaff.w3.537] [PubMed:15506158].
Lehoux P, Blume S. Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 2000 Dec;25(6):1083-120. [DOI:10.1215/03616878-25-6-1083] [PubMed:11142053].
Lehoux P. The Problem of Health Technology: Policy Implications for Modern Health Care Systems. London: Routledge; 2006.
Orton L, Lloyd-Williams F, Taylor-Robinson D, O’Flaherty M, Capewell S. The use of research evidence in public health decision making processes: sys- tematic review. PLoS One. 2011;6(7):e21704. [PubMed Central:PMC1120888] [DOI:10.1371/journal.pone.0021704] [PubMed:15128705].
World Health Organization. Evidence, policy, impact. WHO guide for evidence-informed decision-making. World Health Organization; 2021. Accessed: 2023-06-10. https:// www.who.int/publications/i/item/9789240039872.
Brouwer WB, Koopmanschap MA. On the economic foundations of CEA. La- dies and gentlemen, take your positions! J Health Econ. 2000 Jul;19(4):439-59. [DOI:10.1016/s0167-6296(99)00038-7] [PubMed:11010234].
Drummond M, Sculpher M, Claxton K, Stoddart G, Torrance G. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.
Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, et al. GBD 2010: de- sign, definitions, and metrics. Lancet. 2012 Dec;380(9859):2063-6. [DOI:10.1016/S0140- 6736(12)61899-6] [PubMed:23245602].
Marangu D, Zar HJ. Childhood pneumonia in low-and-middle-income countries: An update. Paediatr Respir Rev. 2019 Nov;32:3-9. [PubMed Central:PMC6990397] [DOI:10.1016/j.prrv.2019.06.001] [PubMed:28282701].
Quirk SJ, Haraldsson G, Hja ́lmarsd ́ottir MA, van Tonder AJ, Hrafnkelsson B, Bentley SD, et al. Vaccination of Icelandic Children with the 10-Valent Pneumococcal Vac- cine Leads to a Significant Herd Effect among Adults in Iceland. J Clin Microbiol. 2019 Apr;57(4). [PubMed Central:PMC4688572] [DOI:10.3109/00365548.2014.980842] [PubMed:25664503].
Jauregui B, Janusz CB, Clark AD, Sinha A, Garcia AG, Resch S, et al. ProVac Glo- bal Initiative: a vision shaped by ten years of supporting evidence-based policy deci- sions. Vaccine. 2015 May;33 Suppl 1:A21-7. [DOI:10.1016/j.vaccine.2014.12.080] [Pub- Med:25919164].
Glassman A, n O, Silverman R. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America. Value Health. 2016 Dec;19(8):913-20. [PubMed Central:PMC5193154] [DOI:10.1016/j.jval.2016.04.014] [PubMed:25919155].
Agudelo CI, Castan ̃eda Orjuela C, Brandileone MCC, Echa ́niz-Aviles G, Almeida SCG, Carnalla-Barajas MN, et al. The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study. Lancet Infect Dis. 2021 03;21(3):405-17. [DOI:10.1016/S1473-3099(20)30489-8] [PubMed:32986996].
Nieto Guevara J, Borys D, DeAntonio R, Guzman-Holst A, Hoet B. In- terchangeability between pneumococcal conjugate vaccines for pediatric use: a systematic literature review. Expert Rev Vaccines. 2020 Nov;19(11):1011-22. [DOI:10.1080/14760584.2019.1688148] [PubMed:31751159].
de Oliveira LH, Trumbo SP, Ruiz Matus C, Sanwogou NJ, Toscano CM. Pneu- mococcal conjugate vaccine introduction in Latin America and the Caribbean: progress and lessons learned. Expert Rev Vaccines. 2016 Oct;15(10):1295-304. [DOI:10.1586/14760584.2016.1166961] [PubMed:26982434].
de Oliveira LH, Danovaro-Holliday MC, Sanwogou NJ, Ruiz-Matus C, Tambini G, An- drus JK. Progress in the introduction of the rotavirus vaccine in Latin America and the Caribbean: four years of accumulated experience. Pediatr Infect Dis J. 2011 Jan;30(1 Suppl):S61-6. [DOI:10.1097/INF.0b013e3181fefdd6] [PubMed:21183843].
Toscano CM, Jauregui B, Janusz CB, Sinha A, Clark AD, Sanderson C, et al. Esta- blishing a regional network of academic centers to support decision making for new vac- cine introduction in Latin America and the Caribbean: the ProVac experience. Vaccine. 2013 Jul;31 Suppl 3:C12-8. [DOI:10.1016/j.vaccine.2013.05.033] [PubMed:23777685].
de Oliveira LH, Toscano CM, Sanwogou NJ, Ruiz-Matus C, Tambini G, Roses- Periago M, et al. Systematic documentation of new vaccine introduction in selec- ted countries of the Latin American Region. Vaccine. 2013 Jul;31 Suppl 3:C114-22. [DOI:10.1016/j.vaccine.2013.05.032] [PubMed:23777684].
Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine. 2021 Apr;39(14):1897-909. [DOI:10.1016/j.vaccine.2021.02.059] [PubMed:33750592].
Kuhn TS. The Structure of Scientific Revolutions. Chicago: University of Chicago Press; 1962.
Byford S, Raftery J. Perspectives in economic evaluation. BMJ. 1998 May;316(7143):1529-30. [PubMed Central:PMC1113167] [DOI:10.1136/bmj.316.7143.1529] [PubMed:7780526].
Robinson R. Economic evaluation and health care. What does it mean? BMJ. 1993 Sep;307(6905):670-3. [PubMed Central:PMC1678982] [DOI:10.1136/bmj.307.6905.670] [PubMed:1778701].
Birch S, Gafni A. Cost-Effectiveness and Cost Utility Analyses: Methods for the Non- Economic Evaluation of Health Care Programmes and How We Can Do Better. In: Geisler E, Heller O, editors. Managing Technology in Healthcare. Boston, MA: Springer US; 2006. Consulted 2015 Oct 20. Available from: http://www.springerlink.com/ index/10.1007/978-1-4613-1415-8.
Contandriopoulos AP, Champagne F, Denis JL, Avargues MC. [Evaluation in the health sector: concepts and methods]. Rev Epidemiol Sante Publique. 2000 Dec;48(6):517-39. [PubMed:11148425].
EUnetHTA. Common questions;. Consulted 2017 Mar 25. Available from: http://www. eunethta.eu/about-us/faq#t287n73.
Institute of Medicine. Assessing Medical Technologies. Washington D.C: National Academy Press; 1985.
Hofmann B. Why not integrate ethics in HTA: identification and assessment of the reasons. GMS Health Technol Assess. 2014;10:Doc04. [PubMed Central:PMC3736275] [DOI:10.1017/S0266462308080550] [PubMed:18828936].
Diamond GA, Kaul S. Cost, effectiveness, and cost-effectiveness. Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):49-54. [DOI:10.1161/CIRCOUTCOMES.108.793406] [Pub- Med:20031812].
Weintraub WS, Cohen DJ. The limits of cost-effectiveness analysis. Circ Cardio- vasc Qual Outcomes. 2009 Jan;2(1):55-8. [DOI:10.1161/CIRCOUTCOMES.108.812321] [PubMed:20031813].
Morabia A. A History of Epidemiologic Methods and Concepts. Springer Basel AG; 2004.
Carlos Castañeda-Orjuela, Fernando De la Hoz-Restrepo. Criteria for New Vaccine Introduction in a National Expanded Program on Immunization: A Survey of Expanded Program on Immunization Managers. Value in Health Regional Issues, Volume 31, 2022, Pages 142-147, ISSN 2212-1099, https://doi.org/10.1016/j.vhri.2022.05.001 (https://www.sciencedirect.com/science/article/pii/S2212109922001169).
Carlos Castañeda-Orjuela, Mario García-Molina, Fernando De la Hoz-Restrepo. Is There Something Else Beyond Cost-Effectiveness Analysis for Public Health Decision Making? Value in Health Regional Issues. Volume 23, 2020, Pages 1-5, ISSN 2212-1099, https://doi.org/10.1016/j.vhri.2019.09.009 (https://www.sciencedirect.com/science/article/pii/S2212109919306193).
Castañeda-Orjuela C, De la Hoz-Restrepo F. How cost effective is switching universal vaccination from PCV10 to PCV13? A case study from a developing country. Vaccine (2018), ISSN 0264-410X, https://doi.org/10.1016/j.vaccine.2018.07.078 (https://www.journals.elsevier.com/vaccine).
Wahl B, O’Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Burden of Strep- tococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. Lancet Glob Health. 2018 Jul;6(7):e744-57. [PubMed Central:PMC3192903] [DOI:10.1016/S2214- 109X(18)30247-X] [PubMed:20417415].
Walter EB, Smith MJ. Prevention of pneumococcal infections in childhood: two decades of progress. Curr Opin Pediatr. 2022 Apr;34(2):140-6. [DOI:10.1097/MOP.0000000000001112] [PubMed:35232949].
Guignard A, Praet N, Jusot V, Bakker M, Baril L. Introducing new vaccines in low- and middle-income countries: challenges and approaches. Expert Rev Vaccines. 2019 02;18(2):119-31. [DOI:10.1080/14760584.2019.1574224] [PubMed:30689472].
Chaiyakunapruk N, Somkrua R, Hutubessy R, Henao AM, Hombach J, Melegaro A, et al. Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparati- ve assessment of decision-making tools. BMC Med. 2011 May;9:53. [PubMed Cen- tral:PMC1188116] [DOI:10.1136/bmj.331.7514.446] [PubMed:16110075].
Briggs A, Sculpher M, Claxton K. Decision Modelling for Health Economic Evaluation. Oxford; 2006.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ. 2013 Mar;346:f1049. [DOI:10.1136/bmj.f1049] [PubMed:23529982].
World Bank. World Bank Open Data;. Accessed: 2022-09-15. https://data. worldbank.org.
Sinha A, Constenla D, Valencia JE, O’Loughlin R, Gomez E, de la Hoz F, et al. Cost-effectiveness of pneumococcal conjugate vaccination in Latin America and the Caribbean: a regional analysis. Rev Panam Salud Publica. 2008 Nov;24(5):304-13. [DOI:10.1590/s1020-49892008001100002] [PubMed:19141172].
Constenla DO. Economic impact of pneumococcal conjugate vaccination in Bra- zil, Chile, and Uruguay. Rev Panam Salud Publica. 2008 Aug;24(2):101-12. [DOI:10.1590/s1020-49892008000800004] [PubMed:19062601].
Vespa G, Constenla DO, Pepe C, Safadi MA, Berezin E, de Moraes JC, et al. Es- timating the cost-effectiveness of pneumococcal conjugate vaccination in Brazil. Rev Panam Salud Publica. 2009 Dec;26(6):518-28. [DOI:10.1590/s1020-49892009001200007] [PubMed:20107706].
de Souza C, Ribeiro J, Moraes J, Berezin E, Monteiro R, Presa J. Ana ́lise de custo efetividade da vacina pneumoc ́ocica conjugada 7-valente, na prevenc ̧ ̃ao da doen ̧ca pneu- moc ́ocica, no cena ́rio do SSistema U ́nico de Sau ́de. J Bras Econ Sau ́de. 2009;1(1):11-7.
de Souza C, Moraes J, Berezin E, Monteiro R, Presa J, Almeida G. An ́alise de cus- to efetividade da vacina pneumoco ́cica conjugada 13-valente, na preven ̧c ̃ao da doen ̧ca pneumoco ́cica, no cena ́rio do Sistema U ́nico de Sau ́de - SUS. Ana ́lise econoˆmica da vacina pneumoco ́cica. J Bras Econ Sau ́de. 2009;1(3):103-11.
Giglio ND, Cane AD, Micone P, Gentile A. Cost-effectiveness of the CRM-based 7-valent pneumococcal conjugated vaccine (PCV7) in Argentina. Vaccine. 2010 Mar;28(11):2302- 10. [DOI:10.1016/j.vaccine.2009.12.070] [PubMed:20064478].
Talbird SE, Taylor TN, Knoll S, Frostad CR, Garc ́ıa Mart ́ı S. Outcomes and costs associated with PHiD-CV, a new protein D conjugate pneumococcal vaccine, in four countries. Vaccine. 2010 Nov;28 Suppl 6:G23-9. [DOI:10.1016/j.vaccine.2010.06.016] [PubMed:21075266].
Giachetto Larraz G, Telechea Ortiz H, Speranza Mourine N, Giglio N, Can ́e A, P ́ırez Garc ́ıa MC, et al. [Cost-effectiveness of universal pneumococcal vaccination in Uruguay]. Rev Panam Salud Publica. 2010 Aug;28(2):92-9. [DOI:10.1590/s1020- 49892010000800004] [PubMed:20963275].
Uruen ̃a A, Pippo T, Betelu MS, Virgilio F, Giglio N, Gentile A, et al. Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina. Vaccine. 2011 Jul;29(31):4963-72. [DOI:10.1016/j.vaccine.2011.04.111] [PubMed:21621575].
Mucin ̃o-Ortega E, Mould-Quevedo JF, Farkouh R, Strutton D. [Economic evaluation of an infant immunization program in Mexico, based on 13-valent pneumococcal conjuga- ted vaccines]. Value Health. 2011;14(5 Suppl 1):65-70. [DOI:10.1016/j.jval.2011.05.025] [PubMed:21839902].
Sartori AM, de Soa ́rez PC, Novaes HM. Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil. J Epidemiol Community Health. 2012 Mar;66(3):210-7. [DOI:10.1136/jech.2010.111880] [PubMed:20884668].
Castan ̃eda Orjuela C, Alvis-Guzm ́an N, Velandia-Gonza ́lez M, De la Hoz- Restrepo F. Cost-effectiveness of pneumococcal conjugate vaccines of 7, 10, and 13 valences in Colombian children. Vaccine. 2012 Mar;30(11):1936-43. [DOI:10.1016/j.vaccine.2012.01.031] [PubMed:22266291].
Mart ́ı SG, Colantonio L, Bardach A, Galante J, Lopez A, Caporale J, et al. A cost- effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries. Cost Eff Resour Alloc. 2013 Aug;11(1):21. [PubMed Cen- tral:PMC3766226] [DOI:10.1186/1478-7547-11-21] [PubMed:16275962].
Gomez JA, Tirado JC, Navarro Rojas AA, Castrejon Alba MM, Topachevskyi O. Cost- effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in chil- dren of Peru. BMC Public Health. 2013 Oct;13:1025. [PubMed Central:PMC4228443] [DOI:10.1186/1471-2458-13-1025] [PubMed:21075268].
Mezones-Holgu ́ın E, Bolan ̃os-D ́ıaz R, Fiestas V, Sanabria C, Guti ́errez-Aguado A, Fies- tas F, et al. Cost-effectiveness analysis of pneumococcal conjugate vaccines in pre- venting pneumonia in Peruvian children. J Infect Dev Ctries. 2014 Dec;8(12):1552-62. [DOI:10.3855/jidc.5855] [PubMed:25500653].
Ord ́on ̃ez JE, Orozco JJ. Cost-effectiveness analysis of the available pneumococcal con- jugated vaccines for children under five years in Colombia. Cost Eff Resour Alloc. 2015;13:6. [PubMed Central:PMC4397735] [DOI:10.1186/s12962-015-0032-1] [Pub- Med:22284997].
Constenla DO. Post-introduction economic evaluation of pneumococcal conjugate vaccination in Ecuador, Honduras, and Paraguay. Rev Panam Salud Publica. 2015 Nov;38(5):388-95. [PubMed:26837524].
Kieninger MP, Caballero EG, Sosa AA, Amarilla CT, Ja ́uregui B, Janusz CB, et al. Cost-effectiveness analysis of pneumococcal conjugate vaccine introduction in Paraguay. Vaccine. 2015 May;33 Suppl 1:A143-53. [DOI:10.1016/j.vaccine.2014.12.078] [Pub- Med:25919155].
Mezones-Holguin E, Canelo-Aybar C, Clark AD, Janusz CB, Jau ́regui B, Escobedo- Palza S, et al. Cost-effectiveness analysis of 10- and 13-valent pneumo- coccal conjugate vaccines in Peru. Vaccine. 2015 May;33 Suppl 1:A154-66. [DOI:10.1016/j.vaccine.2014.12.039] [PubMed:25919156].
G ́omez JA, Villasen ̃or-Sierra A, Aguilar GM, Manjarrez RC, Cervantes-Apolinar MY. Estimaci ́on de la Relacio ́n Costo-Efectividad de las Vacunas Neumoco ́cicas Conjugadas Prevenar-13 y Synflorix®, Utilizadas en Los Programas de Vacuna- cio ́n de Poblaci ́on Infantil Mexicana. Value Health Reg Issues. 2016 Dec;11:76-84. [DOI:10.1016/j.vhri.2016.07.009] [PubMed:27986203].
Wasserman M, Palacios MG, Grajales AG, Baez/Revueltas FB, Wilson M, Mc- Dade C, et al. Modeling the sustained use of the 13-valent pneumococ- cal conjugate vaccine compared to switching to the 10-valent vaccine in Mexi- co. Hum Vaccin Immunother. 2019;15(3):560-9. [PubMed Central:PMC6605727] [DOI:10.1080/21645515.2018.1516491] [PubMed:28216181].
Pugh S, Wasserman M, Moffatt M, Marques S, Reyes JM, Prieto VA, et al. Estimating the Impact of Switching from a Lower to Higher Valent Pneumococcal Conjugate Vac- cine in Colombia, Finland, and The Netherlands: A Cost-Effectiveness Analysis. Infect Dis Ther. 2020 Jun;9(2):305-24. [PubMed Central:PMC7237584] [DOI:10.1007/s40121- 020-00287-5] [PubMed:22085813].
Garc ́ıa Farin ̃as A, Linares-P ́erez N, Clark A, Toledo-Roman ́ı M, El Omeiri N, Marre- ro Arau ́jo M, et al. Cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban national immunization programme. Int J Infect Dis. 2020 Aug;97:182-9. [DOI:10.1016/j.ijid.2020.05.078] [PubMed:32474199].
Perdrizet J, Santana CFS, Senna T, Alexandre RF, Sini de Almeida R, Spinardi J, et al. Cost-effectiveness analysis of replacing the 10-valent pneumococcal conjugate vaccine (PCV10) with the 13-valent pneumococcal conjugate vaccine (PCV13) in Brazil in- fants. Hum Vaccin Immunother. 2021 04;17(4):1162-72. [PubMed Central:PMC8018448] [DOI:10.1080/21645515.2020.1809266] [PubMed:18923713].
World Health Organization. Macroeconomics and health: investing in health for econo- mic development. Report of the Commission on Macroeconomics and Health. Washing- ton: World Health Organization; 2001.
Wasserman M, Sings HL, Jones D, Pugh S, Moffatt M, Farkouh R. Re- view of vaccine effectiveness assumptions used in economic evaluations of in- fant pneumococcal conjugate vaccine. Expert Rev Vaccines. 2018 Jan;17(1):71-8. [DOI:10.1080/14760584.2018.1409116] [PubMed:29164952].
Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ. 2022 01;376:e067975. [PubMed Central:PMC8749494] [DOI:10.1136/bmj-2021-067975] [PubMed:33728553].
Cross S, Rho Y, Reddy H, Pepperrell T, Rodgers F, Osborne R, et al. Who funded the research behind the Oxford-AstraZeneca COVID-19 vaccine? BMJ Glob Health. 2021 12;6(12). [PubMed Central:PMC8704023] [DOI:10.1136/bmjgh-2021-007321] [Pub- Med:26726926].
Huang L, Wasserman M, Grant L, Farkouh R, Snow V, Arguedas A, et al. Burden of pneumococcal disease due to serotypes covered by the 13-valent and new higher-valent pneumococcal conjugate vaccines in the United States. Vaccine. 2022 Aug;40(33):4700- 8. [DOI:10.1016/j.vaccine.2022.06.024] [PubMed:35753839].
Stacey HL, Rosen J, Peterson JT, Williams-Diaz A, Gakhar V, Sterling TM, et al. Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV-15) compared to PCV-13 in healthy older adults. Hum Vaccin Immunother. 2019;15(3):530-9. [Pub- Med Central:PMC6605726] [DOI:10.1080/21645515.2018.1532249] [PubMed:23440780].
Thompson A, Lamberth E, Severs J, Scully I, Tarabar S, Ginis J, et al. Phase 1 trial of a 20-valent pneumococcal conjugate vaccine in healthy adults. Vaccine. 2019 09;37(42):6201-7. [DOI:10.1016/j.vaccine.2019.08.048] [PubMed:31495592].
Silva PH, Va ́zquez Y, Campusano C, Retamal-D ́ıaz A, Lay MK, Mun ̃oz CA, et al. infection. Front Cell Infect Microbiol. 2022;12:949469. [PubMed Central:PMC9548657] [DOI:10.3389/fcimb.2022.949469] [PubMed:26912077].
Farkouh RA, Klok RM, Postma MJ, Roberts CS, Strutton DR. Cost-effectiveness models of pneumococcal conjugate vaccines: variability and impact of modeling as- sumptions. Expert Rev Vaccines. 2012 Oct;11(10):1235-47. [DOI:10.1586/erv.12.99] [PubMed:23170992].
Wu DB, Chaiyakunapruk N, Chong HY, Beutels P. Choosing between 7-, 10- and 13- valent pneumococcal conjugate vaccines in childhood: a review of economic evaluations (2006-2014). Vaccine. 2015 Mar;33(14):1633-58. [DOI:10.1016/j.vaccine.2015.01.081] [PubMed:25681663].
Saokaew S, Rayanakorn A, Wu DB, Chaiyakunapruk N. Cost Effectiveness of Pneu- mococcal Vaccination in Children in Low- and Middle-Income Countries: A Systematic Review. Pharmacoeconomics. 2016 Dec;34(12):1211-25. [DOI:10.1007/s40273-016-0439- 3] [PubMed:19621072].
Syeed MS, Ghule P, Le L, Veettil SK, Horn EK, Perdrizet J, et al. Pneumococcal Vaccination in Children: A Systematic Review and Meta-Analysis of Cost-effectiveness Studies. Value Health. 2022 Oct. [DOI:10.1016/j.jval.2022.10.006] [PubMed:36328324].
Chou VB, Friberg IK, Christian M, Walker N, Perry HB. Expanding the population coverage of evidence-based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST). J Glob Health. 2017 Dec;7(2):020401. [PubMed Central:PMC5592116] [DOI:10.7189/jogh.07.020401] [PubMed:23667340].
Moberg J, Oxman AD, Rosenbaum S, nemann HJ, Guyatt G, Flottorp S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst. 2018 May;16(1):45. [PubMed Central:PMC5148903] [DOI:10.1186/s13012-016-0530-3] [PubMed:27938409].
Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine. 2021 Apr;39(14):1897-909. [DOI:10.1016/j.vaccine.2021.02.059] [PubMed:33750592].
Zhou T, Xie F. Sponsorship bias in oncology cost effectiveness analysis. J Clin Epide- miol. 2023 Feb. [DOI:10.1016/j.jclinepi.2023.02.011] [PubMed:36773749].
Syeed MS, Ghule P, Le L, Veettil SK, Horn EK, Perdrizet J, et al. Pneumococcal Vaccination in Children: A Systematic Review and Meta-Analysis of Cost-effectiveness Studies. Value Health. 2022 Oct. [DOI:10.1016/j.jval.2022.10.006] [PubMed:36328324].
World Health Organization. WHO position paper: Pneumococcal conjugate vaccines in infants and children under 5 years of age. WER. 2019 02;94(8):85-104.
Jauregui B, Sinha A, Clark AD, Bolanos BM, Resch S, Toscano CM, et al. Strengthe- ning the technical capacity at country-level to make informed policy decisions on new vaccine introduction: lessons learned by PAHO’s ProVac Initiative. Vaccine. 2011 Jan;29(5):1099-106. [DOI:10.1016/j.vaccine.2010.11.075] [PubMed:21144916].
Cohen JT, Wong JB. Can Economic Model Transparency Improve Provider Interpre- tation of Cost-Effectiveness Analysis? A Response. Med Care. 2017 Nov;55(11):912-4. [DOI:10.1097/MLR.0000000000000811] [PubMed:29028754].
Glassman A, n O, Silverman R. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America. Value Health. 2016 Dec;19(8):913-20. [PubMed Central:PMC5193154] [DOI:10.1016/j.jval.2016.04.014] [PubMed:25919155].
Ochalek J, Lomas J, Claxton K. Estimating health opportunity costs in low- income and middle-income countries: a novel approach and evidence from cross- country data. BMJ Glob Health. 2018;3(6):e000964. [PubMed Central:PMC6041503] [DOI:10.1016/j.healthpol.2018.04.011] [PubMed:29759682].
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.license.spa.fl_str_mv Atribución-NoComercial-SinDerivadas 4.0 Internacional
dc.rights.uri.spa.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.accessrights.spa.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv Atribución-NoComercial-SinDerivadas 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.extent.spa.fl_str_mv xxi, 42 páginas
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.publisher.spa.fl_str_mv Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv Bogotá - Medicina - Doctorado en Salud Pública
dc.publisher.department.spa.fl_str_mv Doctorado Interfacultades en Salud Pública
dc.publisher.faculty.spa.fl_str_mv Facultad de Medicina
dc.publisher.place.spa.fl_str_mv Bogotá,Colombia
dc.publisher.branch.spa.fl_str_mv Universidad Nacional de Colombia - Sede Bogotá
institution Universidad Nacional de Colombia
bitstream.url.fl_str_mv https://repositorio.unal.edu.co/bitstream/unal/84139/1/license.txt
https://repositorio.unal.edu.co/bitstream/unal/84139/2/Tesis_PhD_Salud_P%c3%bablica%20Carlos%20Casta%c3%b1eda-Orjuela_Rev.pdf
https://repositorio.unal.edu.co/bitstream/unal/84139/3/Tesis_PhD_Salud_P%c3%bablica%20Carlos%20Casta%c3%b1eda-Orjuela_Rev.pdf.jpg
bitstream.checksum.fl_str_mv eb34b1cf90b7e1103fc9dfd26be24b4a
480746cd4bbcba46c8fddfdaaea45c6c
f9017204fe74688e2abd83cd35c84603
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
repository.name.fl_str_mv Repositorio Institucional Universidad Nacional de Colombia
repository.mail.fl_str_mv repositorio_nal@unal.edu.co
_version_ 1814090200937136128
spelling Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2De la Hoz-Restrepo, Fernando Pioa4ff4711f1654f6ce6ed74b0af24ba87Castañeda-Orjuela, Carlos Andrésd28b552ea14eba5afabeb720ec5d3912Grupo de Epidemiología y Evaluación en Salud Pública0000-0002-8735-6223https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=000112414535769124700https://www.researchgate.net/profile/Carlos-Castaneda-Orjuelahttps://scholar.google.com/citations?user=XESiWzMAAAAJ&hl=es&oi=ao2023-07-04T21:53:59Z2023-07-04T21:53:59Z2023-06https://repositorio.unal.edu.co/handle/unal/84139Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustracionesBackground: Worldwide, vaccination is considered a very successful and cost-effective pu- blic health strategy to prevent a wide range of communicable diseases, especially in children. New vaccines are available but at higher costs than those originally included in the basic Expanded Program on Immunization (EPI). Latin American and the Caribbean (LAC) is a region with a great commitment with the inclusion of new vaccines, supported mainly by the Pan American Health Organization (PAHO), however, budget impact of universal immunization is still a challenge for national EPIs. The present research considered both po- sitive and normative dimensions of decision making (DM) in health, particularly in settings with limited resources such as LAC countries, to explore the key rationalities considered to make investment decisions in public health. Pneumococcal conjugated vaccines (PCVs) were selected for the case study to approximate the way in that DM are done at national EPIs with public funds. The exploration of DM frameworks in public health, particularly in low- and middle-income countries (LMIC) settings, is very scarce in the scientific litera- ture, but health-care system around the world are continuously choosing and financing new interventions. It is important to approach to the rationalities involved in the DM process, to evaluate the knowledge of the stakeholders about the arguments and evaluations exposed in the discussion, and to propose improvements in the DM from a democratic perspective. An advance in this sense could give to public health practitioners several tools to guarantee better decisions and more points of view to be included in the discussion, as well as identify potential pitfalls of the available methods, most of them from an utilitarian perspective, to inform the DM in public health. Aim: To critically address how PCVs have been included in the EPIs and the role played by the economic evaluations of their introduction in low- and middle-income countries from the LAC region. Methods: A combination of methodologies was performed to carry out the present research project: 1) A proposal of conceptual reference framework to identify the potential utility of cost-effectiveness analyses (CEAs) in a DM was discussed from our experience of its use in developing countries at the national EPIs. 2) A systematic review of literature about the PCVs’ CEAs in children from LAC countries to understand how they informed the DM about their inclusion in national EPIs was carried out. We evaluated several characteristics and quality of the published CEAs as well as the recommendations of introductions generated by the authors. 3) A survey to EPI managers, participants at National Immunization Advisory Groups (NITAGs), was carried out to review the DM process for new vaccine introduction in LAC, evaluating the role and knowledge about CEAs. 4) In addition, a CEA of switch to PCV13 versus continue PCV10 in Colombian children was run as update of previous one, now including more recent evidence and new serotype distribution after the initial adoption of PCV10. 5) Finally, a cost-effectiveness re-estimation for the identified PCVs’ CEAs in LAC was performed integrating information provided in published analyses and additional data from international databases for demographic and mortality parameters, making the comparison in a competitive scenario, guaranteeing the theoretical approach, and validating the conclusions reached by the authors in the original CEA. A narrative synthesis of the findings was performed and recommendations generated according with the dialogue with the published evidence and results of diverse analyses performed. Results: According to implemented methodologies the main findings were: 1) CEAs are valuable inputs in the negotiation process between different actors with different legitimate interests (i.e., producers of health technologies finding profits and decision makers at the health system investing public resources to reach maximize the population well-being). New vaccine introduction is a good example to approximate the use of CEA in DM, and LAC countries are the setting where the approach of inform the DM with economic evaluations is encouraged by several stakeholders: PAHO, national authorities and donors. 2) The sys- tematic review of literature evidenced that more than a half of published PCVs’ CEAs in LAC were sponsored by pharmaceutical industry with some potential bias in the results and recommendations provided. We arise concerns about quality and conflict of interest involved in the realization of CEAs to inform DM about the selection between PCV10 and PCV13, with contradictory results, for example in countries with simultaneous CEAs performed of industry and independent researchers. Nevertheless, cost-effectiveness profiles of PCVs intro- duction in LAC children showed that it is a good value for money investment of public funds. To inform the best economic profile for different vaccine formulation (10 vs. 13 valences) re- quires include unbiased parameters in the model, and discusses the normative framework such as the agreement about the willingness to pay (WTP) threshold to DM. 3) The survey to EPI managers shows that introduction of new vaccine in national EPIs from the region is a process of discussion with participation of several actors where economic rationalities had a high role in the DM, but limitations in the technical capacity was identified and many of the local key parameters to performed a CEA were reported as lacking. 4) The upda- ted analysis of PCVs CEA in Colombian evidenced that a national immunization strategy based in Switch-to PCV13 was found to be good value for money and prevent additional burden of pneumococcal disease saving additional treatment costs, when compared with to Keep-PCV10. 5) The effort to validate the published CEAs from the original parameters and replicating the models used showed that implemented evaluations correspond in many cases to black-boxes hard to replicate and in a half of cases obtaining recommendations different to originally reported by the authors. Conclusion: The relevance of rationalities beyond economical are highlighted in the DM ans particularly for new vaccine introduction in nationals EPIs from LAC region, but also noted the centrality that CEAs has been gained in the recent years, with different technical capacities in the countries. Interests such as pharmaceuticals should be kept away in the evaluation and discussion of PCVs CEAs, because today the industry is the main sponsor of CEAs in the region, potentially biasing the discussion to their interests. It is necessary to strengthen the technical capacity to understand economical inputs to inform DM and advocate to include other rationalities as important in the discussion. However additional criteria to decision making must be taken into account. (Texto tomado de la fuente)Introducción: En todo el mundo, la vacunación se considera una estrategia de salud pública muy exitosa y rentable para prevenir una amplia gama de enfermedades transmisibles, especialmente en los niños. Las vacunas nuevas están disponibles, pero a costos más altos que aquellas incluidos originalmente en el Programa Ampliado de Inmunizaciones (PAI) básico. América Latina y el Caribe (ALC) es una región con un gran compromiso con la inclusión de nuevas vacunas, apoyada principalmente por la Organización Panamericana de la Salud (OPS), sin embargo, el impacto presupuestal de la inmunización universal sigue siendo un desafío para los PAI nacionales. La presente investigación consideró las dimensiones tanto positiva como normativa de la toma de decisiones en salud, particularmente en entornos con recursos limitados como los países de ALC, para explorar las racionalidades clave consideradas para tomar decisiones de inversión en salud pública. Las vacunas conjugadas contra neumococo (VCN) fueron seleccionadas para el estudio de caso para aproximarnos a la forma en que se realizan la toma de decisiones en los PAI nacionales financiados con fondos públicos. La exploración de los marcos de toma de decisiones en salud pública, particularmente en escenarios de países de bajos y medianos ingresos (LMIC, por sus siglas en inglés), es muy escasa en la literatura científica, pero los sistemas de atención de la salud en todo el mundo eligen y financian continuamente nuevas intervenciones. Es importante acercarse a las racionalidades involucradas en el proceso de DM, evaluar el conocimiento de los actores sobre los argumentos y valoraciones expuestos en la discusión, y proponer mejoras en la toma de decisión desde una perspectiva democrática. Un avance en este sentido podría dar a los profesionales de la salud pública varias herramientas para garantizar mejores decisiones y más puntos de vista para ser incluidos en la discusión, así como identificar posibles escollos de los métodos disponibles, la mayoría de ellos desde una perspectiva utilitaria, para informar la toma de decisiones en salud pública. Objetivo: Abordar críticamente la forma en que se han incluido las vacunas antineumocócicas conjugadas en los PAI y el papel que han jugado las evaluaciones económicas en su introducción en países de ingresos bajos y medios de la región de ALC. Métodos: Se realizó una combinación de metodologías para el desarrollo de la presente investigación. 1) Se discutió una propuesta de marco de referencia conceptual para identificar la utilidad potencial de los análisis de costo-efectividad (ACE) en la toma de decisiones a partir de nuestra experiencia de su uso en los PAI nacionales de países en desarrollo. 2) Se realizó una revisión sistemática de la literatura sobre los ACE de las VCN en niños de países de ALC para entender cómo informaban a la toma de decisiones sobre su inclusión en los PAI nacionales. Evaluamos varias características y la calidad de los ACE publicados, así como las recomendaciones de introducciones generadas por los autores. 3) Se realizó una encuesta a los gerentes del PAI, participantes de los Grupos Asesores Nacionales de Inmunización (CNPI por su sigla en Colombia), para revisar el proceso de toma de decisiones para la introducción de nuevas vacunas en ALC, evaluando el rol y el conocimiento de los ACE. 4) Además, se realizó un ACE del cambio a VCN13 versus continuar con VCN10 en niños colombianos como actualización del anterior ACE, incluyendo evidencia más reciente y la nueva distribución de serotipos después de la adopción inicial de VCN10. 5) Finalmente, se realizó una reestimación de la costo-efectividad de los ACE de las VCN identificadas en ALC integrando información proporcionada en análisis publicados y datos adicionales de bases de datos internacionales para parámetros demográficos y de mortalidad, haciendo la comparación en un escenario competitivo, garantizando el enfoque teórico y validando las conclusiones alcanzadas por los autores en el ACE original. Se realizó una síntesis narrativa de los hallazgos y se generaron recomendaciones de acuerdo con el diálogo con la evidencia publicada y los resultados de los diversos análisis realizados. Resultados: Con respecto a los enfoques metodológicos implementados se encontró que: 1) los ACE son insumos valiosos en el proceso de negociación entre diferentes actores con diferentes intereses legítimos (productores de tecnologías sanitarias que encuentran ganancias y tomadores de decisiones en el sistema de salud que invierten recursos públicos para alcanzar el máximo bienestar de la población). La introducción de nuevas vacunas es un buen ejemplo para aproximarse a comprender el uso de ACE en la toma de decisiones y los países de ALC son el escenario donde el enfoque (informar al tomador de decisiones con evaluaciones económicas) es alentado por varias partes interesadas: OPS, autoridades nacionales y donantes. 2) La revisión sistemática de la literatura evidenció que más de la mitad de los ACE de VCN publicados en ALC fueron patrocinados por la industria farmacéutica con algún sesgo potencial en los resultados y recomendaciones proporcionadas. Surgen inquietudes sobre la calidad y el conflicto de intereses involucrado en la realización de los ACE para informar la toma decisiones sobre la selección entre VCN10 y VCN13, con resultados contradictorios, por ejemplo, en países con ACE simultáneos realizados por la industria e investigadores independientes. Sin embargo, los perfiles de costo-efectividad de la introducción de VCN en niños de ALC es una inversión de fondos públicos con una buena eficiencia. Para informar el mejor perfil económico para diferentes formulaciones de vacunas (10 frente a 13 valencias) es necesario incluir parámetros imparciales en el modelo y analizar la dimensión normativa de la evaluación (valores inmersos), como la definición del umbral de disposición a pagar para la toma de decisiones. 3) La encuesta a los gerentes del PAI muestra que la introducción de nuevas vacunas en los PAI nacionales de la región es un proceso de discusión con participación de varios actores donde las racionalidades económicas jugaron un papel importante en la toma de decision, pero se identificaron limitaciones en la capacidad técnica y muchas de las autoridades informaron que faltaban parámetros clave para realizar un ACE. 4) El análisis actualizado del ACE de las VCN en Colombia evidenció que una estrategia de inmunización nacional basada en cambiar a VCN13 resultó tener una buena relación costo-efectividad en prevenir una carga adicional de enfermedad neumocócica ahorrando costos de tratamiento adicionales, en comparación con mantener VCN10. 5) El esfuerzo por validar los ACE publicados a partir de los parámetros originales y replicando los modelos utilizados mostró que las evaluaciones implementadas corresponden en muchos casos a cajas negras difíciles de replicar y en la mitad de los casos obtienen recomendaciones diferentes a las reportadas originalmente por los autores. Conclusión: Se destaca la relevancia de las racionalidades más allá de la económica en la toma de decisiones y particularmente para la introducción de nuevas vacunas en los EPI nacionales de la región de ALC, pero también se señala la centralidad que han ganado los CEA en los últimos años, con diferentes capacidades técnicas en los países. Intereses como los de la industria farmacéuticos deben mantenerse alejados en la evaluación y discusión de los CEA de las VCN, porque hoy en día la industria es la principal fundadora de los ACE en la región, lo que potencialmente sesga la discusión a favor de sus intereses. Es necesario fortalecer la capacidad técnica para comprender los insumos económicos para informar la toma de decisiones y abogar por incluir otras racionalidades igualmente importantes en la discusión, sin embargo, se deben tener en cuenta criterios adicionales para la toma de decisiones.Esta tesis corresponde a una compilación de artículos publicados y por publicar en revistas indexadasThis thesis is a compilation of research papers published and to be published in indexed journals.DoctoradoDoctor en Salud PúblicaSe realizó una combinación de metodologías para el desarrollo de la presente investigación. 1) Se discutió una propuesta de marco de referencia conceptual para identificar la utilidad potencial de los análisis de costo-efectividad (ACE) en la toma de decisiones a partir de nuestra experiencia de su uso en los PAI nacionales de países en desarrollo. 2) Se realizó una revisión sistemática de la literatura sobre los ACE de las VCN en niños de países de ALC para entender cómo informaban a la toma de decisiones sobre su inclusión en los PAI nacionales. Evaluamos varias características y la calidad de los ACE publicados, así como las recomendaciones de introducciones generadas por los autores. 3) Se realizó una encuesta a los gerentes del PAI, participantes de los Grupos Asesores Nacionales de Inmunización (CNPI por su sigla en Colombia), para revisar el proceso de toma de decisiones para la introducción de nuevas vacunas en ALC, evaluando el rol y el conocimiento de los ACE. 4) Además, se realizó un ACE del cambio a VCN13 versus continuar con VCN10 en niños colombianos como actualización del anterior ACE, incluyendo evidencia más reciente y la nueva distribución de serotipos después de la adopción inicial de VCN10. 5) Finalmente, se realizó una reestimación de la costo-efectividad de los ACE de las VCN identificadas en ALC integrando información proporcionada en análisis publicados y datos adicionales de bases de datos internacionales para parámetros demográficos y de mortalidad, haciendo la comparación en un escenario competitivo, garantizando el enfoque teórico y validando las conclusiones alcanzadas por los autores en el ACE original. Se realizó una síntesis narrativa de los hallazgos y se generaron recomendaciones de acuerdo con el diálogo con la evidencia publicada y los resultados de los diversos análisis realizados.Economía de la Saludxxi, 42 páginasapplication/pdfengUniversidad Nacional de ColombiaBogotá - Medicina - Doctorado en Salud PúblicaDoctorado Interfacultades en Salud PúblicaFacultad de MedicinaBogotá,ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud330 - EconomíaVacunasPolítica de saludVaccinesHealth PolicyImmunizationPneumococcal vaccinesLatin America and the CaribbeanCost-effectivenessDecision makingVacunaciónVacunas contra neumococoLatinoamérica y el CaribeCosto-efectividadToma de decisionesA critical approximation to the use of cost-effectiveness evaluation for Vaccines inclusion in Immunization Programs: the case of pneumococcal vaccines in Latin AmericaAproximación crítica al uso de evaluaciones de costo-efectividad para inclusión de vacunas en los programas nacionales de inmunización: el caso de la vacunación contra neumococo en LatinoaméricaTrabajo de grado - Doctoradoinfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/coar/resource_type/c_db06Texthttp://purl.org/redcol/resource_type/TDBaker L, Birnbaum H, Geppert J, Mishol D, Moyneur E. The relationship between technology availability and health care spending. Health Aff (Millwood). 2003;Suppl Web Exclusives:3-537. [DOI:10.1377/hlthaff.w3.537] [PubMed:15506158].Lehoux P, Blume S. Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 2000 Dec;25(6):1083-120. [DOI:10.1215/03616878-25-6-1083] [PubMed:11142053].Lehoux P. The Problem of Health Technology: Policy Implications for Modern Health Care Systems. London: Routledge; 2006.Orton L, Lloyd-Williams F, Taylor-Robinson D, O’Flaherty M, Capewell S. The use of research evidence in public health decision making processes: sys- tematic review. PLoS One. 2011;6(7):e21704. [PubMed Central:PMC1120888] [DOI:10.1371/journal.pone.0021704] [PubMed:15128705].World Health Organization. Evidence, policy, impact. WHO guide for evidence-informed decision-making. World Health Organization; 2021. Accessed: 2023-06-10. https:// www.who.int/publications/i/item/9789240039872.Brouwer WB, Koopmanschap MA. On the economic foundations of CEA. La- dies and gentlemen, take your positions! J Health Econ. 2000 Jul;19(4):439-59. [DOI:10.1016/s0167-6296(99)00038-7] [PubMed:11010234].Drummond M, Sculpher M, Claxton K, Stoddart G, Torrance G. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, et al. GBD 2010: de- sign, definitions, and metrics. Lancet. 2012 Dec;380(9859):2063-6. [DOI:10.1016/S0140- 6736(12)61899-6] [PubMed:23245602].Marangu D, Zar HJ. Childhood pneumonia in low-and-middle-income countries: An update. Paediatr Respir Rev. 2019 Nov;32:3-9. [PubMed Central:PMC6990397] [DOI:10.1016/j.prrv.2019.06.001] [PubMed:28282701].Quirk SJ, Haraldsson G, Hja ́lmarsd ́ottir MA, van Tonder AJ, Hrafnkelsson B, Bentley SD, et al. Vaccination of Icelandic Children with the 10-Valent Pneumococcal Vac- cine Leads to a Significant Herd Effect among Adults in Iceland. J Clin Microbiol. 2019 Apr;57(4). [PubMed Central:PMC4688572] [DOI:10.3109/00365548.2014.980842] [PubMed:25664503].Jauregui B, Janusz CB, Clark AD, Sinha A, Garcia AG, Resch S, et al. ProVac Glo- bal Initiative: a vision shaped by ten years of supporting evidence-based policy deci- sions. Vaccine. 2015 May;33 Suppl 1:A21-7. [DOI:10.1016/j.vaccine.2014.12.080] [Pub- Med:25919164].Glassman A, n O, Silverman R. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America. Value Health. 2016 Dec;19(8):913-20. [PubMed Central:PMC5193154] [DOI:10.1016/j.jval.2016.04.014] [PubMed:25919155].Agudelo CI, Castan ̃eda Orjuela C, Brandileone MCC, Echa ́niz-Aviles G, Almeida SCG, Carnalla-Barajas MN, et al. The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study. Lancet Infect Dis. 2021 03;21(3):405-17. [DOI:10.1016/S1473-3099(20)30489-8] [PubMed:32986996].Nieto Guevara J, Borys D, DeAntonio R, Guzman-Holst A, Hoet B. In- terchangeability between pneumococcal conjugate vaccines for pediatric use: a systematic literature review. Expert Rev Vaccines. 2020 Nov;19(11):1011-22. [DOI:10.1080/14760584.2019.1688148] [PubMed:31751159].de Oliveira LH, Trumbo SP, Ruiz Matus C, Sanwogou NJ, Toscano CM. Pneu- mococcal conjugate vaccine introduction in Latin America and the Caribbean: progress and lessons learned. Expert Rev Vaccines. 2016 Oct;15(10):1295-304. [DOI:10.1586/14760584.2016.1166961] [PubMed:26982434].de Oliveira LH, Danovaro-Holliday MC, Sanwogou NJ, Ruiz-Matus C, Tambini G, An- drus JK. Progress in the introduction of the rotavirus vaccine in Latin America and the Caribbean: four years of accumulated experience. Pediatr Infect Dis J. 2011 Jan;30(1 Suppl):S61-6. [DOI:10.1097/INF.0b013e3181fefdd6] [PubMed:21183843].Toscano CM, Jauregui B, Janusz CB, Sinha A, Clark AD, Sanderson C, et al. Esta- blishing a regional network of academic centers to support decision making for new vac- cine introduction in Latin America and the Caribbean: the ProVac experience. Vaccine. 2013 Jul;31 Suppl 3:C12-8. [DOI:10.1016/j.vaccine.2013.05.033] [PubMed:23777685].de Oliveira LH, Toscano CM, Sanwogou NJ, Ruiz-Matus C, Tambini G, Roses- Periago M, et al. Systematic documentation of new vaccine introduction in selec- ted countries of the Latin American Region. Vaccine. 2013 Jul;31 Suppl 3:C114-22. [DOI:10.1016/j.vaccine.2013.05.032] [PubMed:23777684].Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine. 2021 Apr;39(14):1897-909. [DOI:10.1016/j.vaccine.2021.02.059] [PubMed:33750592].Kuhn TS. The Structure of Scientific Revolutions. Chicago: University of Chicago Press; 1962.Byford S, Raftery J. Perspectives in economic evaluation. BMJ. 1998 May;316(7143):1529-30. [PubMed Central:PMC1113167] [DOI:10.1136/bmj.316.7143.1529] [PubMed:7780526].Robinson R. Economic evaluation and health care. What does it mean? BMJ. 1993 Sep;307(6905):670-3. [PubMed Central:PMC1678982] [DOI:10.1136/bmj.307.6905.670] [PubMed:1778701].Birch S, Gafni A. Cost-Effectiveness and Cost Utility Analyses: Methods for the Non- Economic Evaluation of Health Care Programmes and How We Can Do Better. In: Geisler E, Heller O, editors. Managing Technology in Healthcare. Boston, MA: Springer US; 2006. Consulted 2015 Oct 20. Available from: http://www.springerlink.com/ index/10.1007/978-1-4613-1415-8.Contandriopoulos AP, Champagne F, Denis JL, Avargues MC. [Evaluation in the health sector: concepts and methods]. Rev Epidemiol Sante Publique. 2000 Dec;48(6):517-39. [PubMed:11148425].EUnetHTA. Common questions;. Consulted 2017 Mar 25. Available from: http://www. eunethta.eu/about-us/faq#t287n73.Institute of Medicine. Assessing Medical Technologies. Washington D.C: National Academy Press; 1985.Hofmann B. Why not integrate ethics in HTA: identification and assessment of the reasons. GMS Health Technol Assess. 2014;10:Doc04. [PubMed Central:PMC3736275] [DOI:10.1017/S0266462308080550] [PubMed:18828936].Diamond GA, Kaul S. Cost, effectiveness, and cost-effectiveness. Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):49-54. [DOI:10.1161/CIRCOUTCOMES.108.793406] [Pub- Med:20031812].Weintraub WS, Cohen DJ. The limits of cost-effectiveness analysis. Circ Cardio- vasc Qual Outcomes. 2009 Jan;2(1):55-8. [DOI:10.1161/CIRCOUTCOMES.108.812321] [PubMed:20031813].Morabia A. A History of Epidemiologic Methods and Concepts. Springer Basel AG; 2004.Carlos Castañeda-Orjuela, Fernando De la Hoz-Restrepo. Criteria for New Vaccine Introduction in a National Expanded Program on Immunization: A Survey of Expanded Program on Immunization Managers. Value in Health Regional Issues, Volume 31, 2022, Pages 142-147, ISSN 2212-1099, https://doi.org/10.1016/j.vhri.2022.05.001 (https://www.sciencedirect.com/science/article/pii/S2212109922001169).Carlos Castañeda-Orjuela, Mario García-Molina, Fernando De la Hoz-Restrepo. Is There Something Else Beyond Cost-Effectiveness Analysis for Public Health Decision Making? Value in Health Regional Issues. Volume 23, 2020, Pages 1-5, ISSN 2212-1099, https://doi.org/10.1016/j.vhri.2019.09.009 (https://www.sciencedirect.com/science/article/pii/S2212109919306193).Castañeda-Orjuela C, De la Hoz-Restrepo F. How cost effective is switching universal vaccination from PCV10 to PCV13? A case study from a developing country. Vaccine (2018), ISSN 0264-410X, https://doi.org/10.1016/j.vaccine.2018.07.078 (https://www.journals.elsevier.com/vaccine).Wahl B, O’Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Burden of Strep- tococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. Lancet Glob Health. 2018 Jul;6(7):e744-57. [PubMed Central:PMC3192903] [DOI:10.1016/S2214- 109X(18)30247-X] [PubMed:20417415].Walter EB, Smith MJ. Prevention of pneumococcal infections in childhood: two decades of progress. Curr Opin Pediatr. 2022 Apr;34(2):140-6. [DOI:10.1097/MOP.0000000000001112] [PubMed:35232949].Guignard A, Praet N, Jusot V, Bakker M, Baril L. Introducing new vaccines in low- and middle-income countries: challenges and approaches. Expert Rev Vaccines. 2019 02;18(2):119-31. [DOI:10.1080/14760584.2019.1574224] [PubMed:30689472].Chaiyakunapruk N, Somkrua R, Hutubessy R, Henao AM, Hombach J, Melegaro A, et al. Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparati- ve assessment of decision-making tools. BMC Med. 2011 May;9:53. [PubMed Cen- tral:PMC1188116] [DOI:10.1136/bmj.331.7514.446] [PubMed:16110075].Briggs A, Sculpher M, Claxton K. Decision Modelling for Health Economic Evaluation. Oxford; 2006.Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ. 2013 Mar;346:f1049. [DOI:10.1136/bmj.f1049] [PubMed:23529982].World Bank. World Bank Open Data;. Accessed: 2022-09-15. https://data. worldbank.org.Sinha A, Constenla D, Valencia JE, O’Loughlin R, Gomez E, de la Hoz F, et al. Cost-effectiveness of pneumococcal conjugate vaccination in Latin America and the Caribbean: a regional analysis. Rev Panam Salud Publica. 2008 Nov;24(5):304-13. [DOI:10.1590/s1020-49892008001100002] [PubMed:19141172].Constenla DO. Economic impact of pneumococcal conjugate vaccination in Bra- zil, Chile, and Uruguay. Rev Panam Salud Publica. 2008 Aug;24(2):101-12. [DOI:10.1590/s1020-49892008000800004] [PubMed:19062601].Vespa G, Constenla DO, Pepe C, Safadi MA, Berezin E, de Moraes JC, et al. Es- timating the cost-effectiveness of pneumococcal conjugate vaccination in Brazil. Rev Panam Salud Publica. 2009 Dec;26(6):518-28. [DOI:10.1590/s1020-49892009001200007] [PubMed:20107706].de Souza C, Ribeiro J, Moraes J, Berezin E, Monteiro R, Presa J. Ana ́lise de custo efetividade da vacina pneumoc ́ocica conjugada 7-valente, na prevenc ̧ ̃ao da doen ̧ca pneu- moc ́ocica, no cena ́rio do SSistema U ́nico de Sau ́de. J Bras Econ Sau ́de. 2009;1(1):11-7.de Souza C, Moraes J, Berezin E, Monteiro R, Presa J, Almeida G. An ́alise de cus- to efetividade da vacina pneumoco ́cica conjugada 13-valente, na preven ̧c ̃ao da doen ̧ca pneumoco ́cica, no cena ́rio do Sistema U ́nico de Sau ́de - SUS. Ana ́lise econoˆmica da vacina pneumoco ́cica. J Bras Econ Sau ́de. 2009;1(3):103-11.Giglio ND, Cane AD, Micone P, Gentile A. Cost-effectiveness of the CRM-based 7-valent pneumococcal conjugated vaccine (PCV7) in Argentina. Vaccine. 2010 Mar;28(11):2302- 10. [DOI:10.1016/j.vaccine.2009.12.070] [PubMed:20064478].Talbird SE, Taylor TN, Knoll S, Frostad CR, Garc ́ıa Mart ́ı S. Outcomes and costs associated with PHiD-CV, a new protein D conjugate pneumococcal vaccine, in four countries. Vaccine. 2010 Nov;28 Suppl 6:G23-9. [DOI:10.1016/j.vaccine.2010.06.016] [PubMed:21075266].Giachetto Larraz G, Telechea Ortiz H, Speranza Mourine N, Giglio N, Can ́e A, P ́ırez Garc ́ıa MC, et al. [Cost-effectiveness of universal pneumococcal vaccination in Uruguay]. Rev Panam Salud Publica. 2010 Aug;28(2):92-9. [DOI:10.1590/s1020- 49892010000800004] [PubMed:20963275].Uruen ̃a A, Pippo T, Betelu MS, Virgilio F, Giglio N, Gentile A, et al. Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina. Vaccine. 2011 Jul;29(31):4963-72. [DOI:10.1016/j.vaccine.2011.04.111] [PubMed:21621575].Mucin ̃o-Ortega E, Mould-Quevedo JF, Farkouh R, Strutton D. [Economic evaluation of an infant immunization program in Mexico, based on 13-valent pneumococcal conjuga- ted vaccines]. Value Health. 2011;14(5 Suppl 1):65-70. [DOI:10.1016/j.jval.2011.05.025] [PubMed:21839902].Sartori AM, de Soa ́rez PC, Novaes HM. Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil. J Epidemiol Community Health. 2012 Mar;66(3):210-7. [DOI:10.1136/jech.2010.111880] [PubMed:20884668].Castan ̃eda Orjuela C, Alvis-Guzm ́an N, Velandia-Gonza ́lez M, De la Hoz- Restrepo F. Cost-effectiveness of pneumococcal conjugate vaccines of 7, 10, and 13 valences in Colombian children. Vaccine. 2012 Mar;30(11):1936-43. [DOI:10.1016/j.vaccine.2012.01.031] [PubMed:22266291].Mart ́ı SG, Colantonio L, Bardach A, Galante J, Lopez A, Caporale J, et al. A cost- effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries. Cost Eff Resour Alloc. 2013 Aug;11(1):21. [PubMed Cen- tral:PMC3766226] [DOI:10.1186/1478-7547-11-21] [PubMed:16275962].Gomez JA, Tirado JC, Navarro Rojas AA, Castrejon Alba MM, Topachevskyi O. Cost- effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in chil- dren of Peru. BMC Public Health. 2013 Oct;13:1025. [PubMed Central:PMC4228443] [DOI:10.1186/1471-2458-13-1025] [PubMed:21075268].Mezones-Holgu ́ın E, Bolan ̃os-D ́ıaz R, Fiestas V, Sanabria C, Guti ́errez-Aguado A, Fies- tas F, et al. Cost-effectiveness analysis of pneumococcal conjugate vaccines in pre- venting pneumonia in Peruvian children. J Infect Dev Ctries. 2014 Dec;8(12):1552-62. [DOI:10.3855/jidc.5855] [PubMed:25500653].Ord ́on ̃ez JE, Orozco JJ. Cost-effectiveness analysis of the available pneumococcal con- jugated vaccines for children under five years in Colombia. Cost Eff Resour Alloc. 2015;13:6. [PubMed Central:PMC4397735] [DOI:10.1186/s12962-015-0032-1] [Pub- Med:22284997].Constenla DO. Post-introduction economic evaluation of pneumococcal conjugate vaccination in Ecuador, Honduras, and Paraguay. Rev Panam Salud Publica. 2015 Nov;38(5):388-95. [PubMed:26837524].Kieninger MP, Caballero EG, Sosa AA, Amarilla CT, Ja ́uregui B, Janusz CB, et al. Cost-effectiveness analysis of pneumococcal conjugate vaccine introduction in Paraguay. Vaccine. 2015 May;33 Suppl 1:A143-53. [DOI:10.1016/j.vaccine.2014.12.078] [Pub- Med:25919155].Mezones-Holguin E, Canelo-Aybar C, Clark AD, Janusz CB, Jau ́regui B, Escobedo- Palza S, et al. Cost-effectiveness analysis of 10- and 13-valent pneumo- coccal conjugate vaccines in Peru. Vaccine. 2015 May;33 Suppl 1:A154-66. [DOI:10.1016/j.vaccine.2014.12.039] [PubMed:25919156].G ́omez JA, Villasen ̃or-Sierra A, Aguilar GM, Manjarrez RC, Cervantes-Apolinar MY. Estimaci ́on de la Relacio ́n Costo-Efectividad de las Vacunas Neumoco ́cicas Conjugadas Prevenar-13 y Synflorix®, Utilizadas en Los Programas de Vacuna- cio ́n de Poblaci ́on Infantil Mexicana. Value Health Reg Issues. 2016 Dec;11:76-84. [DOI:10.1016/j.vhri.2016.07.009] [PubMed:27986203].Wasserman M, Palacios MG, Grajales AG, Baez/Revueltas FB, Wilson M, Mc- Dade C, et al. Modeling the sustained use of the 13-valent pneumococ- cal conjugate vaccine compared to switching to the 10-valent vaccine in Mexi- co. Hum Vaccin Immunother. 2019;15(3):560-9. [PubMed Central:PMC6605727] [DOI:10.1080/21645515.2018.1516491] [PubMed:28216181].Pugh S, Wasserman M, Moffatt M, Marques S, Reyes JM, Prieto VA, et al. Estimating the Impact of Switching from a Lower to Higher Valent Pneumococcal Conjugate Vac- cine in Colombia, Finland, and The Netherlands: A Cost-Effectiveness Analysis. Infect Dis Ther. 2020 Jun;9(2):305-24. [PubMed Central:PMC7237584] [DOI:10.1007/s40121- 020-00287-5] [PubMed:22085813].Garc ́ıa Farin ̃as A, Linares-P ́erez N, Clark A, Toledo-Roman ́ı M, El Omeiri N, Marre- ro Arau ́jo M, et al. Cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban national immunization programme. Int J Infect Dis. 2020 Aug;97:182-9. [DOI:10.1016/j.ijid.2020.05.078] [PubMed:32474199].Perdrizet J, Santana CFS, Senna T, Alexandre RF, Sini de Almeida R, Spinardi J, et al. Cost-effectiveness analysis of replacing the 10-valent pneumococcal conjugate vaccine (PCV10) with the 13-valent pneumococcal conjugate vaccine (PCV13) in Brazil in- fants. Hum Vaccin Immunother. 2021 04;17(4):1162-72. [PubMed Central:PMC8018448] [DOI:10.1080/21645515.2020.1809266] [PubMed:18923713].World Health Organization. Macroeconomics and health: investing in health for econo- mic development. Report of the Commission on Macroeconomics and Health. Washing- ton: World Health Organization; 2001.Wasserman M, Sings HL, Jones D, Pugh S, Moffatt M, Farkouh R. Re- view of vaccine effectiveness assumptions used in economic evaluations of in- fant pneumococcal conjugate vaccine. Expert Rev Vaccines. 2018 Jan;17(1):71-8. [DOI:10.1080/14760584.2018.1409116] [PubMed:29164952].Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ. 2022 01;376:e067975. [PubMed Central:PMC8749494] [DOI:10.1136/bmj-2021-067975] [PubMed:33728553].Cross S, Rho Y, Reddy H, Pepperrell T, Rodgers F, Osborne R, et al. Who funded the research behind the Oxford-AstraZeneca COVID-19 vaccine? BMJ Glob Health. 2021 12;6(12). [PubMed Central:PMC8704023] [DOI:10.1136/bmjgh-2021-007321] [Pub- Med:26726926].Huang L, Wasserman M, Grant L, Farkouh R, Snow V, Arguedas A, et al. Burden of pneumococcal disease due to serotypes covered by the 13-valent and new higher-valent pneumococcal conjugate vaccines in the United States. Vaccine. 2022 Aug;40(33):4700- 8. [DOI:10.1016/j.vaccine.2022.06.024] [PubMed:35753839].Stacey HL, Rosen J, Peterson JT, Williams-Diaz A, Gakhar V, Sterling TM, et al. Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV-15) compared to PCV-13 in healthy older adults. Hum Vaccin Immunother. 2019;15(3):530-9. [Pub- Med Central:PMC6605726] [DOI:10.1080/21645515.2018.1532249] [PubMed:23440780].Thompson A, Lamberth E, Severs J, Scully I, Tarabar S, Ginis J, et al. Phase 1 trial of a 20-valent pneumococcal conjugate vaccine in healthy adults. Vaccine. 2019 09;37(42):6201-7. [DOI:10.1016/j.vaccine.2019.08.048] [PubMed:31495592].Silva PH, Va ́zquez Y, Campusano C, Retamal-D ́ıaz A, Lay MK, Mun ̃oz CA, et al. infection. Front Cell Infect Microbiol. 2022;12:949469. [PubMed Central:PMC9548657] [DOI:10.3389/fcimb.2022.949469] [PubMed:26912077].Farkouh RA, Klok RM, Postma MJ, Roberts CS, Strutton DR. Cost-effectiveness models of pneumococcal conjugate vaccines: variability and impact of modeling as- sumptions. Expert Rev Vaccines. 2012 Oct;11(10):1235-47. [DOI:10.1586/erv.12.99] [PubMed:23170992].Wu DB, Chaiyakunapruk N, Chong HY, Beutels P. Choosing between 7-, 10- and 13- valent pneumococcal conjugate vaccines in childhood: a review of economic evaluations (2006-2014). Vaccine. 2015 Mar;33(14):1633-58. [DOI:10.1016/j.vaccine.2015.01.081] [PubMed:25681663].Saokaew S, Rayanakorn A, Wu DB, Chaiyakunapruk N. Cost Effectiveness of Pneu- mococcal Vaccination in Children in Low- and Middle-Income Countries: A Systematic Review. Pharmacoeconomics. 2016 Dec;34(12):1211-25. [DOI:10.1007/s40273-016-0439- 3] [PubMed:19621072].Syeed MS, Ghule P, Le L, Veettil SK, Horn EK, Perdrizet J, et al. Pneumococcal Vaccination in Children: A Systematic Review and Meta-Analysis of Cost-effectiveness Studies. Value Health. 2022 Oct. [DOI:10.1016/j.jval.2022.10.006] [PubMed:36328324].Chou VB, Friberg IK, Christian M, Walker N, Perry HB. Expanding the population coverage of evidence-based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST). J Glob Health. 2017 Dec;7(2):020401. [PubMed Central:PMC5592116] [DOI:10.7189/jogh.07.020401] [PubMed:23667340].Moberg J, Oxman AD, Rosenbaum S, nemann HJ, Guyatt G, Flottorp S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst. 2018 May;16(1):45. [PubMed Central:PMC5148903] [DOI:10.1186/s13012-016-0530-3] [PubMed:27938409].Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine. 2021 Apr;39(14):1897-909. [DOI:10.1016/j.vaccine.2021.02.059] [PubMed:33750592].Zhou T, Xie F. Sponsorship bias in oncology cost effectiveness analysis. J Clin Epide- miol. 2023 Feb. [DOI:10.1016/j.jclinepi.2023.02.011] [PubMed:36773749].Syeed MS, Ghule P, Le L, Veettil SK, Horn EK, Perdrizet J, et al. Pneumococcal Vaccination in Children: A Systematic Review and Meta-Analysis of Cost-effectiveness Studies. Value Health. 2022 Oct. [DOI:10.1016/j.jval.2022.10.006] [PubMed:36328324].World Health Organization. WHO position paper: Pneumococcal conjugate vaccines in infants and children under 5 years of age. WER. 2019 02;94(8):85-104.Jauregui B, Sinha A, Clark AD, Bolanos BM, Resch S, Toscano CM, et al. Strengthe- ning the technical capacity at country-level to make informed policy decisions on new vaccine introduction: lessons learned by PAHO’s ProVac Initiative. Vaccine. 2011 Jan;29(5):1099-106. [DOI:10.1016/j.vaccine.2010.11.075] [PubMed:21144916].Cohen JT, Wong JB. Can Economic Model Transparency Improve Provider Interpre- tation of Cost-Effectiveness Analysis? A Response. Med Care. 2017 Nov;55(11):912-4. [DOI:10.1097/MLR.0000000000000811] [PubMed:29028754].Glassman A, n O, Silverman R. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America. Value Health. 2016 Dec;19(8):913-20. [PubMed Central:PMC5193154] [DOI:10.1016/j.jval.2016.04.014] [PubMed:25919155].Ochalek J, Lomas J, Claxton K. Estimating health opportunity costs in low- income and middle-income countries: a novel approach and evidence from cross- country data. BMJ Glob Health. 2018;3(6):e000964. [PubMed Central:PMC6041503] [DOI:10.1016/j.healthpol.2018.04.011] [PubMed:29759682].Aproximación crítica al uso de evaluaciones de costo-efectividad para inclusión de vacunas en los programas nacionales de inmunización: el caso de la vacunación contra neumococo en Latinoamérica.Universidad Nacional de ColombiaEstudiantesGrupos comunitariosInvestigadoresMaestrosMedios de comunicaciónPúblico generalResponsables políticosLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/84139/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINALTesis_PhD_Salud_Pública Carlos Castañeda-Orjuela_Rev.pdfTesis_PhD_Salud_Pública Carlos Castañeda-Orjuela_Rev.pdfTesis de Doctorado en Salud Públicaapplication/pdf4914295https://repositorio.unal.edu.co/bitstream/unal/84139/2/Tesis_PhD_Salud_P%c3%bablica%20Carlos%20Casta%c3%b1eda-Orjuela_Rev.pdf480746cd4bbcba46c8fddfdaaea45c6cMD52THUMBNAILTesis_PhD_Salud_Pública Carlos Castañeda-Orjuela_Rev.pdf.jpgTesis_PhD_Salud_Pública Carlos Castañeda-Orjuela_Rev.pdf.jpgGenerated Thumbnailimage/jpeg5001https://repositorio.unal.edu.co/bitstream/unal/84139/3/Tesis_PhD_Salud_P%c3%bablica%20Carlos%20Casta%c3%b1eda-Orjuela_Rev.pdf.jpgf9017204fe74688e2abd83cd35c84603MD53unal/84139oai:repositorio.unal.edu.co:unal/841392024-08-13 23:36:58.55Repositorio Institucional Universidad Nacional de Colombiarepositorio_nal@unal.edu.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

Publicaciones similares