Governance of preventive Health Intervention and On time Verification of its Efficiency: the GIOVE Study. Issue 2 (15th March 2012)

• Record Type: Journal Article
• Authors: Mennini, Francesco Saverio; Baio, Gianluca; Montagano, Giuseppe; Cauzillo, Gabriella; Locuratolo, Francesco; Becce, Gerardo; Gitto, Lara; Marcellusi, Andrea; Zweifel, Peter; Capone, Alessandro; Favato, Giampiero
• Is Part Of: BMJ open. Volume 2:Issue 2(2012)
• Publication Date: 2012-03-15
• Subjects: Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2011-000736
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: The GIOVE Study was aimed to the achievement of allocative efficiency of the budget allocated to the prevention of human papillomavirus (HPV)-induced diseases. An ex-ante determination of the most efficient allocation of resources between screening and multicohort quadrivalent immunisation programmes was followed by the ex-post assessment of the allocative efficiency actually achieved after a 12-month period. Design: A bound optimisation model was developed to determine the ex-ante allocative efficiency of resources. The alternatives compared were the screening programme alone and the quadrivalent immunisation with access to screening. A sensitivity analysis was carried out to assess the uncertainty associated with the main inputs of the model. Subsequently, a cohort of girls with a complete recorded vaccination history were enrolled in an observational retrospective study for 18 months to ensure full compliance with the recommended schedule of vaccination (0, 2, 6 months) within a 12-month time horizon. Setting: Basilicata region, in the south of Italy. Participants: 12 848 girls aged 12, 15, 18 or 25 years. Intervention: Immunisation with quadrivalent anti-HPV vaccine. Outcome measures: The vaccination coverage rate was considered to be the indicator of the best achievable benefit, given the budgetary constraints. Results: Assuming a vaccine price of €100 per dose, a vaccination coverage rate of 59.6% was required for the most effective allocation of resources. The optimal rate of coverage was initially in favour of the multicohort strategy of vaccination against HPV (72.8%±2%). When the price paid for the quadrivalent vaccine dropped to €85 per dose, the most efficient coverage rate (69.5%) shifted closer to the immunisation rate actually achieved during the 12-month observation period. Conclusions: The bound optimisation model demonstrated to be a useful approach to the ex-ante allocation and the ex-post assessment of the resources allocated to the implementation of a multicohort quadrivalent anti-HPV vaccination programme.