Maria Lucia Gomes Ferraz; Patrícia Marinho de Oliveira; Virgínia Maria Figueiredo; Vitorio Luis Kemp; Adauto Castelo Filho; Antonio Eduardo Benedito Silva
RESUMO
Com o objetivo de racionalizar o emprego de recursos econômicos em programas de vacinação contra hepatite B, em profissionais da área de saúde, foram estudados dois aspectos distintos: necessidade ou não de triagem sorológica pré-vacinação e viabilidade da utilização de doses reduzidas de vacina por via intradérmica (ID). A análise econômica de custo-minimização demonstrou que com prevalência de imunes na população a ser vacinada superior a 11% (o que ocorreu em nosso estudo apenas no grupo de funcionários) passou a ser economicamente viável a triagem sorológica, diferentemente do grupo de alunos e médicos, nos quais a vacina sem triagem foi a melhor opção estratégica. Quanto ao esquema a ser utilizado, o emprego de três doses por via intramuscular (IM) (esquema A) foi comparado com dois esquemas alternativos: 1) esquema B, utilizando primeira dose via ID e duas via IM e 2) esquema C, empregando as duas primeiras doses via ID e a terceira via IM. Após a terceira dose, as taxas de soroconversão nos esquemas Ae B (92% e 93%, respectivamente) e os títulos médios geométricos de antiHBs (1278 Ul/L e 789,6UI/L) foram semelhantes entre os dois grupos, e apresentaram diferença significante em relação ao esquema C, demonstrando que esquemas alternativos podem ser custo-efetivos.
Palavras-chave: Hepatite B. Imunização. Vacina contra HBV. Profissionais da área de saúde. Economia em saúde.
ABSTRACT
In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers’, two different aspects were studied: the need of a prevaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost- minimization study) showed that when the prevalence of immune individuals is higher than 11% it is more cost-effective to perform prevaccination screening. This situation was obsemed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92% and 93%, respectively) and geometric mean titers of antiHBs (1278 UI/I and 789.6 UI/l) were similar, and both were different from group A (p< 0.05), showing that alternative vaccination schedules may be cost-effective.
Keyworks: Hepatitis B. Immunization. Hepatitis B vaccine. Health care workers. Health economics.
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Recebido para publicação em 10/02/95.
Disciplinas dc Gastroenterologia e de Doenças Infecciosas e Parasitárias da Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, SP.
Endereço para correspondência:
Profa Maria Lucia Gomes Ferraz.
R. Machado Bittencourt 413/81, Vl. Clementino,
04044-001
São Paulo, SE
Tel: (011) 549-1711;
Fax: (011) 572-5945.
