Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil

Background Cost-effectiveness studies have been increasingly part of decision processes for incorporating new vaccines into the Brazilian National Immunisation Program. This study aimed to evaluate the cost-effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) in the universal childhood immunisation programme in Brazil. Methods A decision-tree analytical model based on the ProVac Initiative pneumococcus model was used, following 25 successive cohorts from birth until 5 years of age. Two strategies were compared: (1) status quo and (2) universal childhood immunisation programme with PCV10. Epidemiological and cost estimates for pneumococcal disease were based on National Health Information Systems and literature. A 'top-down' costing approach was employed. Costs are reported in 2004 Brazilian reals. Costs and benefits were discounted at 3%. Results 25 years after implementing the PCV10 immunisation programme, 10 226 deaths, 360 657 disability-adjusted life years (DALYs), 433 808 hospitalisations and 5 117 109 outpatient visits would be avoided. The cost of the immunisation programme would be R$10 674 478 765, and the expected savings on direct medical costs and family costs would be R$1 036 958 639 and R$209 919 404, respectively. This resulted in an incremental cost-effectiveness ratio of R$778 145/death avoided and R$22 066/DALY avoided from the society perspective. Conclusion The PCV10 universal infant immunisation programme is a cost-effective intervention (1-3 GDP per capita/DALY avoided). Owing to the uncertain burden of disease data, as well as unclear long-term vaccine effects, surveillance systems to monitor the long-term effects of this programme will be essential.

O poder da caneta: a Medida Provisória no processo legislativo estadual

A Medida Provisória (MP) brasileira é um dos instrumentos legislativos mais poderosos nas mãos do Presidente da República para alterar unilateralmente o status quo. Apesar de o judiciário ter reconhecido a competência dos governadores para instituir e adotar a MP, esta existe apenas em seis estados. O artigo procura explicar a não adoção deste instrumento legislativo pela maioria dos estados. Enfatiza-se a escassa ou marginal relevância que é dada à MP pelo governador nos seis casos que a adotaram. Defende-se, aqui, que os governadores, diferentemente dos presidentes, não necessitam de mais um instrumento legislativo ou da ampliação da delegação de prerrogativas legislativas para garantir sua agenda frente a seus respectivos legislativos, já que com ou sem poder de decreto estadual os governadores controlariam a já limitada agenda decisória nos estados.