CHDS Faculty Member Speaks with GlobalPost

April 15, 2013

CHDS Faculty Member Dr. Thomas A. Gaziano spoke with GlobalPost about high blood pressure in Africa http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/qa-africa-high-blood-pressure-thomas-gazianoThe purpose of the Doctoral Dissertation Award Competition is to encourage and publicize outstanding dissertation research by selecting and recognizing the best dissertations written in the past year in the decision sciences. The Elwood S. Buffa Dissertation Award will be presented to the competition winner at the annual meeting in Baltimore. Applicants for this award should submit their dissertation electronically in the required format directly to the Doctoral Dissertation Award Competition Coordinator by April 1, 2013.   Detailed instructions of the content and format of the submission are available here. Click here for past winners. Click here for a list of past recipients.  Statistician/Programmer job opening at CHDS. Looking for folks with experience anaylzing claims data or big national (US) data sets like NHANES, BRFSS, SEER. Data set experience: national US health-related data sets (NHANES, BRFSS, SEER, Medicare claims, VHA medical records, etc)Statistical software experience: (at least on the following) R, SAS, STATA, MATLABProgramming languages: (prefer applicants that also have some programming skill in a language like JAVA or C++Other experiences: (not essential, but useful) web programming, database programming, OLAP, bilingual spanish/english APPLY THROUGH THIS LINK: ow.ly/q2NaKHarvard ASPIRE system job announcement number/title: 27823BR Biostatistician While ART access has expanded, questions remain regarding continued treatment gaps and trade-offs between treatment options. As funding for HIV-programs have recently plateaued – and in some case begun to decrease – these questions have become more pressing. Motivated by specific concerns over discontinuation of ART after treatment failure, a team of investigators - including CHDS faculty - provided insight into the necessary balance between maximizing outcomes of currently treated individual patients, while continuing to provide adequate access of care at the population-level. In a recent article in Cost Effectiveness Resource Allocation, the investigators, led by April Kimmel, utilized a two-stage modeling approach. Initially, they simulated constraint-free treatment of a group of recently HIV-infected individuals. They then modeled different levels and types of treatment with varying care limitations. The results highlighted an important distinction: while treatment discontinuation negatively affected outcomes of the individual patients, it increased the total number of individuals within the cohort who received treatment, and was correlated with an increase in the overall life expectancy of the cohort. While further research is needed, these findings raise vital questions regarding tradeoffs between individual and population-level care provision, as well as issues of efficiency and equity.  Jesse Ortendahl and Zachary Gerson-Nieder were both recently awarded the Harvard University Certificate of Distinction in Teaching for their work as teaching fellows in the Spring 2012 semester. Jesse and Zach were both TFs for CHDS Director Sue J. Goldie’s course, Global Health Challenges: Complexities of Evidence-based Policy. The Derek Bok Center for Teaching and Learning awards the certificates to TFs who have received an overall rating of 4.5 or higher on their student evaluations.  Two CHDS faculty members, Professors Jane Kim and Joseph Pliskin, will recieve teaching awards at the 2012 Harvard School of Public Health Commencement.  In addition CHDS PhD Student Ankur Pandya will recieve a Teaching Assistant award.This year's AcademyHealth's annual research meeting will have many sessions with a Comparative Effectiveness Research or Patient-Centered Outcomes Research theme. The meeting will be June 24-26 in Orlando. Click here for more information.CHDS recently co-sponsored the 7th Annual Program in Ethics and Health: Identified Lives vs. Statistical Lives – Ethics and Public Policy. The conference investigated a wide variety of research questions including, "what factors trigger or explain this difference in attitude and behavior; how is it manifested when we think about global health problems, such as treatment and prevention (and “treatment as prevention”) for HIV/AIDS; does the law express such bias; is there any ethical justification for this bias, for example, as a matter of obligation toward each and every individual? Is it, alternatively, a moral error, rooted in well-known cognitive biases?" Video of panels and Q&A session can be found here.In the upcoming issue of Health Policy and Planning, CHDS researchers Natalie Carvalho and Sue Goldie, along with Afghanistan's Ministry of Public Health Ahmad Shah Salehi, use the Global Maternal Health Policy Model to estimate the health benefits and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan. The researchers find family planning to be the most effective individual intervention to reduce pregnancy-related mortality; if contraception use approaches 60%, 1 in 3 maternal deaths could be averted. Integrated strategies that improve access to high-quality intrapartum and emergency obstetrical care, coupled with family planning, were found to be highly effective and very cost-effective, with incremental cost-effectiveness ratios below $200/YLS at the national level. These integrated strategies could reduce maternal deaths in Afghanistan by 70-80%.In a recent issue of The Lancet, CHDS visiting scholar Tone Enden has investigated treatment of additional catheter-directed thrombolysis (CDT) as compared to the standard treatment for deep vein thrombosis (DVT). Dr. Enden, a cardiologist at the Oslo University Hospital, implemented a randomized controlled trial that was the first to evaluate the efficacy of CDT. A significant reduction in risk was associated with additional CDT when compared to standard treatment, albeit with a small increase in the risk of bleeding. Based on these findings, the investigators concluded that treatment should be considered for patients with DVT who had a low risk of bleeding. This study has the potential to contribute towards needed changes to treatment guidelines for DVT.In a speech titled "Creating an AIDS-Free Generation," Secretary of State Hillary Clinton cited CHDS Deputy Director Stephen Resch's ongoing research into the benefit of increased investment in AIDS treatment in both low and middle income countries. Referring to Dr. Resch's recently published article in PLoS One, Secretary Clinton said that, "A study published just last month weighed the costs and benefits and found that - I quote - "the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment." In other words, treating people will not only save lives, it will generate considerable economic returns as well." A full transcript and video of her speech can be found hereUsing cost effectiveness analysis to help drive health care decision making has long been a controversial subject in the United States, even as it has been embraced in other countries. However, large-scale cuts in federal health spending coupled with increases in mandated coverage under the Affordable Care Act (ACA), have made just this type of analysis paramount. In the New England Journal of Medicine this month, CHDS faculty member Jane Kim provides a perspective on the role of cost-effectiveness in U.S. vaccination policy. Dr. Kim highlights how the CDC’s Advisory Committee on Immunization Practices (ACIP) sets an example for how cost-effectiveness evidence can be used in establishing vaccination policy in the U.S. Importantly, the ACIP makes decisions on what vaccines should be covered by the Vaccines for Children program, a federal entitlement program, which covers nearly 50% of U.S. children up to age 18 and purchases roughly 50% of all vaccines. Over the last 30 years the number of recommended vaccines for this age group has more than doubled, and two of the newer ones licensed – human papillomavirus (HPV) and meningococcal vaccines – are also the most expensive. Explicit decisions about value for money regarding these vaccines cannot be avoided, and as Dr. Kim explains, the decision making process needs to take into account several complex factors, including vaccine price, vaccine efficacy and durability, and delivery costs. Vaccination against HPV provides a good example of this complexity, as recent analyses have shown that increasing vaccine uptake rates amongst adolescent girls may provide better value than a much discussed expansion of the vaccine program to include adolescent boys. Overall, Dr. Kim makes a clear statement that cost-effectiveness evidence should be incorporated into decision making, especially at a time when resources are becoming more and more limited.Global funding for HIV control has increased substantially over the past 10 years, and by 2008 more than $15 billion was being devoted to combatting the HIV epidemic, the majority of this funding devoted to providing care and antiretroviral therapy (ART) for HIV-infected individuals. The funding devoted to HIV treatment dwarfs the resources available for many other health concerns, yet the demand for treatment is greater still, with only around one-third of those in need of ART currently receive care. As the international economic downturn puts further pressure on the HIV control budget, treatment programs must seek to understand the costs of care and aggressively pursue efficiencies where they can be found. For this to be accomplished there is a critical need for empirical data describing the treatment costs experienced by operating treatment programs. In the most recent issue of AIDS, CHDS PhD candidate Nick Menzies has helped fill this information gap. The study is the first peer-reviewed article of its kind; in which Nick and coauthors estimate the per-patient costs of HIV treatment costs in various countries around the world. Nick’s analysis draws on a unique dataset on HIV treatment costs experienced by 43 PEPFAR-supported treatment sites across 5 countries.  He and his colleagues gathered cost data over multiple 6-month periods so as to calculate the annual economic costs for both pre- and current-ART patients and how these costs changed over time. They found that per-patient costs dropped as the treatment site matured, with nearly a 50% reduction in per-patient costs over the 1st year of operations. Additionally, their analyses revealed the non-trivial contribution of administrative and management activities to total treatment costs, and the substantial proportion of treatment costs supported by PEPFAR in the sites that it funds. The cost results were sensitive to country setting as well as showing substantial variability between sites. This research will help programs understand the cost structure of HIV treatment and undertake more precise predictions of the trajectory of HIV treatment costs in the future.Cholera is endemic in many countries in Africa and South Asia, and there have been several minor and major outbreaks reported in both regions. A recent large-scale cholera outbreak in Zimbabwe has demonstrated how a preventable and easily treatable disease can lead to disastrous outcomes in settings with weak health infrastructure and where the availability and access to basic water/sanitation is suboptimal. While there have been several studies that evaluated the impact of pre-emptive vaccination using oral cholera vaccination in endemic countries, the impact of reactive vaccination for containing ongoing breaks has rarely been documented. In order to provide potential stakeholder and policy makers with more information on the value of cholera vaccination, former CHDS researcher Sun Young-Kim and current CHDS Director Sue J. Goldie explored the potential impact of reactive vaccination using the recent outbreak in Zimbabwe. Their analysis, recently published in the South African Medical Journal, suggests that reactive vaccination has the potential to be a cost-effective measure in controlling cholera outbreaks in some vulnerable countries. However, the finding also show that the outcomes can vary widely, and caution is warranted when applying the findings to different settings, and some future clinical and economic evaluation studies may help policy makers refine this approach.We are pleased to share our summer issue of the Center for Health Decision Science Newsletter! It includes updates on recent and ongoing research being conducted by our faculty, researchers, and PhD students, as well as news on recent publications and presentations by CHDS investigators.