Feasibility of fast track systematic review for policy makers: interchangeability between pneumococcal conjugate vaccines

CIAPPONI, AGUSTÍN; LEE, A.; BARDACH, ARIEL; GLUJOVSKY, D; REY-ARES, LUCILA; CAFFERATA, MARÍA LUISA; VALANZASCA, P; GARCIA MARTÍ, SEBASTIAN

Conferencia; XIX Cochrane Colloquium. Scientific Evidence for Healthcare Quality and Patient Safety; 2011

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. PAHO asked us to perform a systematic review (SR) in order to make an evidence based decision regarding PCV?s interchangeability in the next month. 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 RCTs, economic evaluations, SR and meta-analysis evaluating antibody response, cost-effectiveness and effectiveness of the interchangeability among PCV. Study selection was performed through 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 full-text during as soon each agreement was obtained. RESULTS: 21 out of 159 studies were included. There wasn?t direct available information on the interchangeability among PCV for primary series. 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 comparison?s results varied according to price, indirect effects and indirect costs. PHiD-CV gains more QALYs 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 very much such intense process.