Making HPV vaccines efficient: Cost-Effectiveness Analysis and the Economic Assemblage of Healthcare in Colombia

  • Oscar Javier Maldonado Castañeda Linköping University

Abstract

Cost-effectiveness analysis (CEA) is a strategy of calculation whose main objective is to compare for making decisions about the best, the most efficient solution (costs vs. benefits) to a particular problem. Cost-effectiveness analysis not only provides a framework to compare healthcare interventions which in practice seem incommensurable; it also performs a set of assumptions regarding the nature of healthcare and the behaviour of individuals. This article analyses the role of CEA as a device to produce value in the introduction of HPV vaccines in Colombia. In the different institutional pathways and decision-making scenarios cost-effectiveness has been the key issue that justified the inclusions and the exclusions that such technology entails. Cost-effectiveness has justified the definition of girls as the population target and the exclusion of boys from risks and benefits of this technology. Moreover, cost-effectiveness analysis has been a key instrument in the sexualising and de-sexualising of cervical cancer and HPV vaccines through the rationalisation of economic benefits.

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References

Adams V (ed.) (2016) Metrics. What Counts in Global Health. Durham, NC: Duke University Press.

Adams V, Murphy M and Clarke A (2009) Anticipation: Technoscience, Life, Affect, Temporality. Subjectivity 28: 246–265.
https://doi.org/10.1057/sub.2009.18

Biehl J (2012) Between the Court and the Clinic: Lawsuits for Medicines and the Right to Health in Brazil. Health and Human Rights: An International Journal 14(1): 1–17

Bielhl J and Petryna A (2011) Bodies of Rights and Therapeutic Markets. Social Research 78(2): 359–386.

Bosch FX, Lorincz A, Munoz N, Meijer C and Shah KV (2002) The Causal Relation between Human Papillomavirus and Cervical Cancer. Journal of Clinical Pathology 55(4): 244–265.
https://doi.org/10.1136/jcp.55.4.244

Çalişkan K and Callon M (2009) Economization, part 1: Shifting Attention from the Economy Towards Processes of Economization. Economy and Society 38(3): 369–398.
https://doi.org/10.1080/03085140903020580

Çalişkan K and Callon M (2010) Economization, part 2: A Research Programme for the Study of Markets. Economy and Society 39(1): 1–32.
https://doi.org/10.1080/03085140903424519

Callon M and Law J (2005) On Qualculation, Agency, and Otherness. Environment and Planning D: Society and Space 23(5): 717–733.
https://doi.org/10.1068/d343t

Cellini S and Kee J (2010) Cost-Effectiveness and Cost-Benefit Analysis. In: Wholey J, Hatry H and Newcomer K (eds) Handbook of Practical Program Evaluation, 3rd ed. San Francisco, CA: Jossey-Bass, pp. 493-530.

Clark AM (2005) New Civic Epistemologies of Quantification: Making Sense of Local and Global Indicators of Sustainability. Science, Technology & Human Values 30(3): 403–432.
https://doi.org/10.1177/0162243904273448

Collier S (2006) Global Assemblages. Theory Culture Society 23(2–3): 39–9401.
https://doi.org/10.1177/026327640602300269

Council of State (2012) Class Action. Radication No 25000 2315 000 2010 02728 01. Actor: María Teresa Tovar Rojas. Author: Doctor Marco Antonio Velilla Moreno. 16 February 2012. Bogotá: Council of State.

Desrosières A (1998) The Politics of Large Numbers: A History of Statistical Reasoning. Cambridge, MA: Harvard University Press.

Ecks S (2008) Global Pharmaceutical Markets and Corporate Citizenship: The Case of Novartis' Anti-cancer Drug Glivec. BioSocieties 3(2): 165–181.
https://doi.org/10.1017/S1745855208006091

Espeland W and Stevens M (2009) A Sociology of Quantification. European Journal of Sociology [Archives Européennes de Sociologie] 49(3): 401–436.
https://doi.org/10.1017/S0003975609000150

Fourcade M (2011) Cents and Sensibility, Economic Valuation and the Nature of 'Nature' in France and America. American Journal of Sociology 116(6): 1721–1777.
https://doi.org/10.1086/659640

Hacking I (1990) The Taming of Chance. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511819766

Hillemanns P, Breugelmans JG, Gieseking F, et al. (2008) Estimation of the Incidence of Genital Warts and the Cost of Illness in Germany: A Cross-Sectional Study. BMC Infectious Diseases 2: 8–76.
https://doi.org/10.1186/1471-2334-8-76

Jasanoff S (2004) Designs on Nature: Science and Democracy in Europe and the United States. Princeton, NJ: Princeton University Press.

Kenny K (2015) The Biopolitics of Global Health: Life and Death in Neoliberal Time. Journal of Sociology 51(1): 9–27.
https://doi.org/10.1177/1440783314562313

Kjellberg H, Mallard A, Arjaliés DL, et al. (2013) Valuation Studies? Our Collective Two Cents. Valuation Studies 1(1): 11–30.
https://doi.org/10.3384/vs.2001-5992.131111

Lampland M (2010) False Numbers as Formalizing Practices. Social Studies of Science 40(3): 377–404.
https://doi.org/10.1177/0306312709359963

Latour B (2004) Why Has Critique Run Out of Steam? From Matter of Fact to Matters of Concern. Critical Inquiry 30(Winter): 225–248.
https://doi.org/10.1086/421123

Latour B and Woolgar S (1986) Laboratory Life: The Social Construction of Scientific Facts. Princeton, NJ: Princeton University Press.

McGoey L, Reiss J and Wahlberg A (2011) The Global Health Complex. Biosocieties 6(1): 1–9.
https://doi.org/10.1057/biosoc.2010.45

MacKenzie D (2006) An Engine, Not a Camera. How Financial Models Shape Markets. Cambridge, MA: MIT Press.
https://doi.org/10.7551/mitpress/9780262134606.001.0001

Maldonado O (2017) Evidence, sex and state paternalism. Intersecting global connections in the introduction of HPV vaccines in Colombia. In: Johnson E (ed) Gendering Drugs. Feminist Studies of Pharmaceuticals. London: Palgrave Macmillan.
https://doi.org/10.1007/978-3-319-51487-1_7

Mamo L and Epstein S (2014) The Pharmaceuticalization of Sexual Risk: Vaccine Development and the New Politics of Cancer Prevention. Social Science & Medicine 101: 155–165.
https://doi.org/10.1016/j.socscimed.2013.11.028

Ministry of Health (2012a) Meeting Minute SGC-F03. Definition of Introduction of Vaccine against HPV and Hepatitis A into Extended Programme of Immunisations. National Committee of Immunisation Practices, 3rd May. Bogotá: Ministry of Health, Republic of Colombia.

Ministry of Health (2012b) Memorandum 201221102384491. Technical Concept from Ministry of Health to Colombian Congress about Bill 260 of 2012. Bogotá: Ministry of Health, Republic of Colombia (internal communication).

Moreira T (2012a) Health Care Standards and the Politics of Singularities: Shifting In and Out of Context. Science, Technology and Human Values 37: 307–331.
https://doi.org/10.1177/0162243911414921

Moreira T (2012b) The Transformation of Contemporary Health Care. The Market, the Laboratory, and the Forum. New York and Oxford: Routledge.

Ong A and Collier S (2005) Global Assemblages, Anthropological Problems. In: Collier SJ and Ong A (eds) Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. Malden, MA: Blackwell, pp. 3-21.

Pinch T, Ashmore M and Mulkay M (2000) Cost Benefit Analysis in Practice: Option Appraisal in the UK National Health Service and the Politics of Rational Decision-Making. In: Rottenburg R, Kalthoff H and Wagener H-J (eds) Facts and Figures: Economic Representations and Practices. Ökonomie und Gesellschaft, Jahrbuch 16. Marburg: Metropolis-Verlag, pp. 87–116.

Porter T (1995) Trust in Numbers: The Pursuit of Objectivity in Science and Public Life. Princeton, NJ: Princeton University Press.

Reid BL, French PW, Singer A and Hagan BE (1978) Coppleson M. Sperm Basic Proteins in Cervical Carcinogenesis: Correlation with Socioeconomic Class. Lancet 8(2): 60–62.
https://doi.org/10.1016/S0140-6736(78)91378-8

Reubi D (2013) Health Economists, Tobacco Control and International Development: On the Economisation of Global Health beyond Neoliberal Structural Adjustment Policies. Biosocieties 8(2): 205–228.
https://doi.org/10.1057/biosoc.2013.3

Reynolds L and Tansey E (2009) History of Cervical Cancer and the Role of the Human Papillomavirus, 1960-2000. Wellcome Witnesses to Twentieth Century Medicine, vol. 38. London: Wellcome Trust.

UNAL (Universidad Nacional de Colombia) (2009) Estudio de costo-effectividad para la introducción de la vacuna contra Papiloma humano en Colombia. Bogotá: UNAL.

UNAL (Universidad Nacional de Colombia) (2011) Estudio de costo-effectividad para la introducción de la vacuna contra Papiloma humano en Colombia. Bogotá: UNAL.

Verran H (2012) The Changing Lives of Measures and Values: From Centre Stage in the Fading 'Disciplinary' Society to Pervasive Background Instrument in the Emergent 'Control' Society. The Sociological Review 59(s2): 60–72.

VSG (Victoria State Government) (2001) Victorian Burden of Disease Study. Available at: http://docs.health.vic.gov.au/docs/doc/6AEAFAB1BAE696B9CA257886000158A0/$FILE/bod_2001.pdf (accessed 5 May 2014).

Wahlberg A and Rose N (2015) The Governmentalization of Living: Calculating Global Health. Economy and Society 44(1): 60–90.
https://doi.org/10.1080/03085147.2014.983830

WHO (World Health Organization) (2012). Global Burden of Disease. Guidelines and Definitions. Available at: http://www.who.int/topics/global_burden_of_disease/en/ (accessed 2 December 2012).
Published
2018-05-15
Section
Research Papers