GineBlog

Muchas madres están preocupadas por la posible vacunación de sus hijas para prevenir el cáncer de cuello uterino. Pero no tienen claro las ventajas e inconvenientes. La mayoría de profesionales recomiendan su aplicación a las niñas de 11 ó 12 años.

Merck ha lanzado una campaña promocionando su vacuna Gardasil, señalando a una mujer jóven y diciendo que puede ser una menos en sufrir el citado cáncer. Esta propaganda ha captado la atención de los padres. En menos de dos años más de 8 millones de jovenes han recibido la vacuna. El Dr. Nathan Litman, Director de Pediatría en el Montefiore Medical Center de New York, considera que Gardasil es un notable avance médico. Sin embargo, un editorial de la revista New England Journal of Medicine's Editorial realiza varias cautelas sobre la misma. En primer lugar, no está claro su beneficio a largo plazo dado que el cáncer tarda años en desarrollarse, y la información disponible no determina si la vacuna funciona. En segundo lugar, el efecto global de la vacuna sobre el cáncer cervical sigue siendo desconocido. Además, el impacto de la vacunación no se detectará hasta dentro de unas décadas. El precio de Gardasil es muy alto y no se sabe si serán necesarias otras dosis posteriores.

No se puede dejar de mencionar que Gardasil protege solo frente a ciertos tipos de virus del papiloma, será necesario continuar con el screening citológico, y algunos médicos consideran que la citología es más segura que la vacunación.

NEJM Volume 359:821-832		August 21, 2008

Background The cost-effectiveness of prophylactic vaccination against human papillomavirus types 16 (HPV-16) and 18 (HPV-18) is an important consideration for guidelines for immunization in the United States.

Methods We synthesized epidemiologic and demographic data using models of HPV-16 and HPV-18 transmission and cervical carcinogenesis to compare the health and economic outcomes of vaccinating preadolescent girls (at 12 years of age) and vaccinating older girls and women in catch-up programs (to 18, 21, or 26 years of age). We examined the health benefits of averting other HPV-16–related and HPV-18–related cancers, the prevention of HPV-6–related and HPV-11–related genital warts and juvenile-onset recurrent respiratory papillomatosis by means of the quadrivalent vaccine, the duration of immunity, and future screening practices.

Results On the assumption that the vaccine provided lifelong immunity, the cost-effectiveness ratio of vaccination of 12-year-old girls was $43,600 per quality-adjusted life-year (QALY) gained, as compared with the current screening practice. Under baseline assumptions, the cost-effectiveness ratio for extending a temporary catch-up program for girls to 18 years of age was $97,300 per QALY; the cost of extending vaccination of girls and women to the age of 21 years was $120,400 per QALY, and the cost for extension to the age of 26 years was $152,700 per QALY. The results were sensitive to the duration of vaccine-induced immunity; if immunity waned after 10 years, the cost of vaccination of preadolescent girls exceeded $140,000 per QALY, and catch-up strategies were less cost-effective than screening alone. The cost-effectiveness ratios for vaccination strategies were more favorable if the benefits of averting other health conditions were included or if screening was delayed and performed at less frequent intervals and with more sensitive tests; they were less favorable if vaccinated girls were preferentially screened more frequently in adulthood.

Conclusions The cost-effectiveness of HPV vaccination will depend on the duration of vaccine immunity and will be optimized by achieving high coverage in preadolescent girls, targeting initial catch-up efforts to women up to 18 or 21 years of age, and revising screening policies.