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 here

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... (more »)

Using 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.

Using 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 w... (more »)

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 1^st 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.

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 therap... (more »)

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.

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 treatabl... (more »)

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.

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, ... (more »)

In an upcoming issue of the International Journal of Cancer, former- and current CHDS researchers developed models of HPV-related infection and cervical cancer by utilizing epidemiologic data from five Eastern African countries (Kenya, Mozambique, Tanzania, Uganda and Zimbabwe), to measure the health and economic impact of HPV vaccination in pre-adolescent girls and screening in adult women.  Results showed that vaccination alone could reduce the lifetime cancer risk by between 36 and 45% across the five countries, and the addition of screening at age 35 would lead to a reduction of 43% to 51%.  The analyses also showed that cost per vaccinated girl was the most significant driver of the cost-effectiveness of potential interventions.  If the cost per girl was less than I$2 per dose, vaccination was the most cost-effective strategy and had an incremental cost-effectiveness ratio in each setting less than the country-specific per capita GDP. If the cost per vaccinated girl was between I$2 and I$5 per dose, vaccination followed by screening at age 35 with one-visit HPV DNA testing would also be considered good value for public health dollars. The analysis demonstrates the importance of making informed decisions on the appropriate use of HPV vaccine and screening in developing countries, and the benefits these technologies could provide.  

In an upcoming issue of the International Journal of Cancer, former- and current CHDS researchers developed models of HPV-related infection and cervical cancer by utilizing epidemiologic data from five Eastern African countries (Kenya, Mo... (more »)

Several new vaccines have recently become available, including vaccines targeting rotavirus, and HPV. The new vaccines tend to be far more expensive than the traditional childhood vaccines previously introduced into resource-poor settings. In this context there has been an increasing attention paid to how best to achieve a balance between efficiency, equity, and affordability, and the information that would be necessary to do so. While a growing number of model-based analyses have provided insights into these issues, independent analyses conducted for a single vaccine are often presented in different formats, making it challenging to directly compare the impact of different vaccines. In a recent study published in BMC Infectious Disease, CHDS investigators, including Director Sue J. Goldie, standardized a simple modeling approach and analytic framework to directly compare the health and economic outcomes by the rotavirus and HPV vaccines in low-income countries. The results show that while the benefits of the two new vaccines will be realized at different times, the number of lives saved with the vaccines will be quite similar. Accordingly, it would be desirable for policy makers to be able to use country-specific information, to take into account various criteria that could affect priority setting procedures, and to consider the impact on other health sectors and systems when deciding the type and timing of new vaccine(s) to introduce. The analysis showed that the approach of comparing different vaccines on different dimensions using comparable models and consistent assumptions can enrich the discussion about what attributes might be weighted most prominently in the priority-setting process. The work demonstrated how a more transparent comparison of different new vaccines might be useful to generate dialogue and debate in the priority setting process.

Several new vaccines have recently become available, including vaccines targeting rotavirus, and HPV. The new vaccines tend to be far more expensive than the traditional childhood vaccines previously introduced into resource-poor settings. In this... (more »)

CHDS Director Professor Sue Goldie has recently received the second annual Junior Faculty Mentoring Achievement Award. Nominated by CHDS faculty member Jane Kim, as well as Matthew Miller and Merdith Rosenthal, Professor Goldie was presented the award by Julio Frenk, Dean of HSPH. She was honored for her generosity in time, and commitment to treating junior colleagues as equals and promoting their success.

CHDS Director Professor Sue Goldie has recently received the second annual Junior Faculty Mentoring Achievement Award. Nominated by CHDS faculty member Jane Kim, as well as Matthew Miller and Merdith Rosenthal, Professor Goldie was presented the a... (more »)

In a recent study published in PLoS One, CHDS researchers Ankur Pandya, Milton Weinstein, and Thomas Gaziano assessed the exchangeability of a simple non-laboratory-based risk score to four commonly-used laboratory-based risk scores (common versions of the Framingham and SCORE risk functions) and found that the simple score characterized and discriminated CVD risk similarly compared to the laboratory-based approaches.  The appeal of non-laboratory-based risk assessment is that individual-level CVD risk predictions can be determined faster and at lower cost compared to more intensive, laboratory-based scores.   In this study, which utilized the NHANES III population as a representative external validation cohort, the agreement in dichotomous risk characterization between the simple score and the laboratory-based scores ranged from 92-96%, and each of the risk scores discriminated 10-year CVD death well (all c-statistics >0.77), with little or no statistical difference between the laboratory-based and simple scores.  Based on these findings, the implication for primary CVD screening guidelines is that simple non-laboratory-based risk assessment can serve as a useful proxy for more expensive, laboratory-based scores in resource-limited settings. 

In a recent study published in PLoS One, CHDS researchers Ankur Pandya, Milton Weinstein, and Thomas Gaziano assessed the exchangeability of a simple non-laboratory-based risk score to four commonly-used laboratory-based risk scores (common versio... (more »)

Jesse Ortendahl received the HSPH Teaching Assistant Award as part of the 2011 Commencement. Jesse, a researcher and distributive computing coordinator, was one of four teaching assistants conferred the award for his quality of teaching and overall effectiveness. Congratulations Jesse!

Jesse Ortendahl received the HSPH Teaching Assistant Award as part of the 2011 Commencement. Jesse, a researcher and distributive computing coordinator, was one of four teaching assistants conferred the award for his quality of teaching and ove... (more »)

Society can potentially save money by actively implementing cost-effective psychotherapy interventions for patients with personality disorders and conducting further research to get more information in this area.

Personality disorders (PD) are quite common, affecting approximately one in every 10 people. The study by Soeteman et al., published in the March issue of Value in Health, found that psychotherapy interventions are likely to benefit patients with PD and can actually save society money. This cost savings will come from implementing cost-effective treatments into clinical practice, preventing patients from being treated with unnecessarily expensive treatments.

In addition, the study found that society can also save money by investing in research on psychotherapy, leading to, in particular, a better understanding of which dosages in terms of setting and duration are the most viable financially. Says Dr. Soeteman, “Of course research costs money, but these costs are quickly recovered if the research results in a more accurate determination of how we can best help patients at a reasonable cost.”

The research was conducted among more than 900 patients with PD from six different mental healthcare institutes in The Netherlands. Clinical and economic patient-level data were incorporated in a simulation model in order to indicate the treatment that generates the highest health gains given the budget constraint and the value of both additional information and implementation efforts. This study has the potential to contribute to improving the efficiency of healthcare provision in The Netherlands.  

Society can potentially save money by actively implementing cost-effective psychotherapy interventions for patients with personality disorders and conducting further research to get more information in this area.

Personality disorders (PD) ... (more »)

In an upcoming issue of The British Journal of Obstetrics and Gynecology (BJOG), CHDS researchers Monisha Sharma, Jesse Ortendahl, Steven Sy and Jane Kim utilized a decision-analytic model of cervical cancer incidence to evaluate the cost-effectiveness of various combinations of HPV vaccination and cervical cancer screening in Thailand.  Assuming 60% screening and 80% vaccination coverage in Thailand, pre-adolescent vaccination and HPV DNA testing five times per lifetime, starting at age 35 years, reduced the lifetime cervical cancer risk by 70%.  This strategy had a cost-effectiveness ratio less than Thailand’s GDP per capita (I$8100), provided the cost per vaccinated girl was I$200 or less.  In the absence of vaccination, screening five times per lifetime with HPV DNA was found to be the most efficient screening strategy, reducing cervical cancer burden by 55%.

In an upcoming issue of The British Journal of Obstetrics and Gynecology (BJOG), CHDS researchers Monisha Sharma, Jesse Ortendahl, Steven Sy and Jane Kim utilized a decision-analytic model of cervical cancer incidence to evaluate the cost... (more »)

The Royal Australian and New Zealand College of Psychiatrists has presented their 2011 Young Psychiatrist Award to CHDS visiting scholar Dan Siskind for his paper on Cost-effectiveness of improved primary care treatment of depression in women in Chile, which was co-authored by CHDS faculty member Jane Kim.

Congratulations to both on receiving this award!