Making HPV vaccines efficient: Cost-effectiveness analysis and the economic assemblage of healthcare in Colombia

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 benefit.