title: Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region.
abstract: OBJECTIVE
  To assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region.
  
  
  METHODS
  A Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical cancer, considering the current preventive programs and treatment costs. The one-year transition probabilities were mainly based on empirical data of local and national studies. The model evaluated the addition of the vaccine to three cervical cancer-screening scenarios (0, 3 or 10 exams throughout life).
  
  
  RESULTS
  The scenario of three Pap tests resulted in satisfactory calibration (base case). The addition of HPV vaccination would reduce by 35% the incidence of cervical cancer (70% vaccination coverage). The incremental cost-effectiveness ratio was US$ 825 for each quality-adjusted life year gained. The sensitivity analysis confirms the robustness of this result, and duration of immunity was the parameter with greater variation in incremental cost-effectiveness ratio.
  
  
  CONCLUSIONS
  Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in a substantial reduction in incidence and mortality of invasive cervical cancer in the Brazilian Amazon region.
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Post-Graduate Program in Economics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address: allex.jardim@bol.com.br.
authors.forename: Allex Jardim da
authors.initials: AJ
authors.lastname: Fonseca
authors.forename: Luiz Carlos de Lima
authors.initials: LC
authors.lastname: Ferreira
authors.forename: Giacomo Balbinotto
authors.initials: GB
authors.lastname: Neto
mesh_terms: D001938:Brazil; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D032541:Mass Vaccination / Q000191:economics*; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D011788:Quality of Life; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Amazon region; Brasil; Brazil; Cervical cancer; Cost-effectiveness; Custo-efetividade; Câncer de colo de útero; Human papillomavirus; Papilomavírus humano; Região amazônica; Vaccine; Vacina