Article type
Year
Abstract
Background: Streptococcus pneumoniae is a leading cause of serious illness among children worldwide. Pneumococcal conjugate vaccines (PCV) including 7 to 15 serotypes have been developed but there is uncertainty about the effects of interchange schemes among them. The Pan American Health Organization (PAHO) committed us a systematic review (SR) for an evidence based decision that would be taken in the next month at an expert meeting.
Objectives: To assess the efficacy, cost-effectiveness, immunogenicity and safety of interchangeability among PCV schemes in one month.
Methods: A systematic search was conducted in December 2010 on MEDLINE, EMBASE, LILACS and CCTR. Databases containing regional proceedings were also searched. No language or temporal restriction was imposed. We included randomized controlled trials (RCTs), economic evaluations, SR and meta-analysis evaluating antibody response, cost-effectiveness and effectiveness of the interchangeability among PCV. Study selection was performed using EROS (Early Review Organizing Software), a web-based software to serve in the initial phases of a SR. Four pairs of reviewers independently selected, assessed the quality and extracted the data of the studies. Discrepancies were solved by consensus of the team. A librarian uploaded fulltext during the project as soon each agreement was obtained.
Results: 21 of 159 studies were included. Direct information on interchangeability among PCV for primary series was not available. Some studies showed similar immunogenicity and safety between PHiD-CV and PCV7. PhiD-CV and PCV13 were consistently more cost-effective than PCV7 at a constant price. PHiD-CV vs. PCV13 comparitive results varied according to price, indirect effects and indirect costs. PHiD-CV gains more quality-adjusted life years due to the prevention of more frequent yet less severe events such as otitis media; and PCV13 prevents less frequent events but more costly as invasive diseases.
Conclusions: Considering the absence of direct evidence, the PAHO meeting recommended not interchanging PHiD-CV with PCV7 unless necessary. The web-based software facilitated this intense process.
Objectives: To assess the efficacy, cost-effectiveness, immunogenicity and safety of interchangeability among PCV schemes in one month.
Methods: A systematic search was conducted in December 2010 on MEDLINE, EMBASE, LILACS and CCTR. Databases containing regional proceedings were also searched. No language or temporal restriction was imposed. We included randomized controlled trials (RCTs), economic evaluations, SR and meta-analysis evaluating antibody response, cost-effectiveness and effectiveness of the interchangeability among PCV. Study selection was performed using EROS (Early Review Organizing Software), a web-based software to serve in the initial phases of a SR. Four pairs of reviewers independently selected, assessed the quality and extracted the data of the studies. Discrepancies were solved by consensus of the team. A librarian uploaded fulltext during the project as soon each agreement was obtained.
Results: 21 of 159 studies were included. Direct information on interchangeability among PCV for primary series was not available. Some studies showed similar immunogenicity and safety between PHiD-CV and PCV7. PhiD-CV and PCV13 were consistently more cost-effective than PCV7 at a constant price. PHiD-CV vs. PCV13 comparitive results varied according to price, indirect effects and indirect costs. PHiD-CV gains more quality-adjusted life years due to the prevention of more frequent yet less severe events such as otitis media; and PCV13 prevents less frequent events but more costly as invasive diseases.
Conclusions: Considering the absence of direct evidence, the PAHO meeting recommended not interchanging PHiD-CV with PCV7 unless necessary. The web-based software facilitated this intense process.