Cervical Vaccination to Proceed/Colon Screening Planned

Vorsprung

MARTIN WALL
Up to 30,000 girls in first year at secondary school are to be offered the human papilloma virus (HPV) vaccine against cervical cancer by this summer.

In 2008, the Government said it was not in a position to introduce the vaccine on cost grounds. However, Minister for Health Mary Harney said this afternoon that following talks with pharmaceutical companies the price for the vaccine has been "quashed".

She said originally the cost of introducing the HPV vaccine scheme was estimated at €16 million but the new price was €3 million.

"The vaccine will be offered free of charge this year for approximately 30,000 girls who are now in first year of secondary school," Ms Harney said. "This is the same group of girls who would have received the vaccine under the previous plan for 2009."

The minister also announced plans to establish a national colorectal screening service.

She said that detailed preparations would commence immediately and screening would be introduced from 2012.

Research published last year by the Health Information and Quality Authority (Hiqa) found that the vaccination scheme was the most cost-effective strategy option in the Irish healthcare setting regarding the prevention of HPV types 16 and 18, which account for 70 per cent of all cervical cancers.

Evidence from the European Cervical Cancer Association (ECCA) concerning the vaccination’s effectiveness shows that a nationwide free school-based programme is vital to achieve coverage of more than 85 per cent of the target population.

Fine Gael this afternoon welcomed the decision to introduce the cervical cancer vaccine programme and colorectal cancer screening

“It is not often that I have cause to commend the health minister but I am happy to do so without reservation on her announcement today. A wrong has been righted and lives will be saved as a result of this initiative,” said health spokesman Dr James Reilly.

“It was always my view that this vital health measure could be introduced affordably through negotiation with the pharmaceutical companies and I am glad to see that this has now come to pass."

Senator Phil Prendergast of the Labour Party praised the savings secured by the Minister.

“She should be applauded for squeezing a better deal from these companies, but the question now arises, that if she was able to play hardball with these multi-national companies in December 2009, why was she not able to do so in October 2008?”

Liz Hoctor, president of the Irish Pharmacy Union, said these were "very positive developments for patients and will lead to the early detection and treatment of colorectal cancer and reduce the risk of cervical cancer among women".

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I suppose fair play for getting better value for money, but €15m is a small amount when you're talking about saving the lives of 50 women per year. 50 women will die in about 30-50 years because Harney saved 12 million, that's scandalous.

On the bowel screening plan, it's pretty funny that the HSE/DoH are planning on cutting 1000 beds, but in the same breath wants to get thousands of additional colonoscopies done per year? Where?!?! And if all your gastro/colorectal trainees are off looking for a better deal in other countries (as per a recent IT article), who is going to do all these scopes?!

On the cost note, I hope that the HSE will start playing hardball on the cost of drugs. Does anyone know if the HSE bulk-buy meds, or are they just bought by individual pharmacies within the separate hospitals?

bleg

Well it's not that much of a saving.

The original cost of the vaccine was 10 million euro, not 16 million as now claimed by the Minister.

The plan now is to only vaccinate 1st year girls, instead of 1st, 2nd and 3rd year girls. So effectively only 1 third of the people who were originally going to be vaccinated are now going to be vaccinated.

So the cost is 30% of what it was but 33% of the people who were going to be vaccinated are now going to be protected.

locum-motion

Vorsprung wrote: »

On the bowel screening plan, it's pretty funny that the HSE/DoH are planning on cutting 1000 beds, but in the same breath wants to get thousands of additional colonoscopies done per year? Where?!?! And if all your gastro/colorectal trainees are off looking for a better deal in other countries (as per a recent IT article), who is going to do all these scopes?!

I'm open to correction here, but doesn't the screening they're talking about involve doing FOB's* rather than Colonoscopies?


*:(Faecal Occult Blood; a test to see if the faeces contains 'hidden' or partially-digested blood, for those in the happy position of not knowing what it means!)

bleg

BTW thanks goes to locum for the info.

Traumadoc

Hopefully , women will realise that the vaccine is not fully protective and not avoid screening just because they have been vaccinated.

DrIndy

Traumadoc wrote: »

Hopefully , women will realise that the vaccine is not fully protective and not avoid screening just because they have been vaccinated.

Very true - the vaccination protects against the most troublesome strain of HPV, not all HPV and you can still get cervical cancer and still need smears - however, the smears are more likely to be normal once vaccinated.

RobFowl

locum-motion wrote: »

I'm open to correction here, but doesn't the screening they're talking about involve doing FOB's* rather than Colonoscopies?


*:(Faecal Occult Blood; a test to see if the faeces contains 'hidden' or partially-digested blood, for those in the happy position of not knowing what it means!)

As i understand it thats exactly the case. From the medical press its going to be be a pretty much self administered screening test.
It's a relative high false positive and not insignificant false negative but due to the high occurance of the disease is backed up by the evidence (please don't ask for a reference as I'm racing tomorrow and should really be asleep already !).

Both are a good thing IMO.

Vorsprung

Didn't realise it was just FOBs, thought there would be problems with that - false negative issues as mentioned above. Still, there is going to be a huge increase in workload with all the false postivies, and if people have symptoms and no bleeding, they'll need investigating too.

Sitric

I thought the spokesman for the Irish cancer soc on the news yesterday, said the reason it would take until 2012 to roll out was the need to develop sufficient colonoscopy capacity? (To a world class level blah blah blah)

It definitely implied that it was to be a scope screening test

DrIndy

No - all the plans for population screening involve FOB and then colonoscopy if positive. 3 samples are taken to ensure accuracy.

It is simply not feasible outside of the private sector like the USA to offer straight up colonoscopies. In New York, its cafe conversation about when they had their colonoscopy done!

Remember colonoscopies are not like blood tests or x-rays. They need well trained staff not to miss things, very expensive equipment and facilities and do carry a very small but very real risk of rupturing your bowel. The risks and benefits as well as making it affordable are important.

On balance if it costs €1,000,000 per early cancer caught - would the money not be better spent on other things which would yield better results like stroke prevention?

Sitric

€1,000,000 for treatment? I'm sorry, I just don't know how that figure is calculated.

Cost of program/no detected = €1,000,000??

Stroke prevention may be more cost effective, It might be good to establish rapid treatment similar to the cardiac assessment and treatment set ups. I think that's a worldwide thing though, rapid assessment and interventions were just more straight forward for cardiac rather than cerebral events.

Though do we have 24hr angioplasty/intervention outside Dublin yet? In Dublin even?

DrIndy

Sitric wrote: »

€1,000,000 for treatment? I'm sorry, I just don't know how that figure is calculated.

Cost of program/no detected = €1,000,000??

Stroke prevention may be more cost effective, It might be good to establish rapid treatment similar to the cardiac assessment and treatment set ups. I think that's a worldwide thing though, rapid assessment and interventions were just more straight forward for cardiac rather than cerebral events.

Though do we have 24hr angioplasty/intervention outside Dublin yet? In Dublin even?

Apologies - I was drawing a random number to demonstrate in extreme case that screening tests which are too expensive for what is captured could be money better spent elsewhere. I don't imply at all that this is the actual cost.

This is where other screening programs have come under scrutiny for effectiveness and value for money and QALY (Quality of Life Year Gained) per € spent. Cognisance of this is very important and I don't question the need at all for national screening but we all need to be aware of the costs and how money is spent at the same time.

Dublin has 24 hour cath labs in the Mater and St. James's. I'm not sure about beaumont. They do primary PCI there rather than thrombolysis for heart attacks.

SDTimeout

Very pleased with this as i'm a member of Dail na Nog. We met with the drug companies prior to them meeting Mary Harney and had let slip that the government had never made contact with them in the first place. Even though the media had been let to believe other wise. We met her yesterday at our meeting and was extremley thankful for our efforts with the drug companys. But it just seemed like the timing was bad she announced this on the friday and met us on the saturday. Making all our arguments and negative comments void :pac: