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Jit M, Cook AR. Informing Public Health Policies with Models for Disease Burden, Impact Evaluation, and Economic Evaluation. Annu Rev Public Health 2024; 45:133-150. [PMID: 37871140 DOI: 10.1146/annurev-publhealth-060222-025149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Conducting real-world public health experiments is often costly, time-consuming, and ethically challenging, so mathematical models have a long-standing history of being used to inform policy. Applications include estimating disease burden, performing economic evaluation of interventions, and responding to health emergencies such as pandemics. Models played a pivotal role during the COVID-19 pandemic, providing early detection of SARS-CoV-2's pandemic potential and informing subsequent public health measures. While models offer valuable policy insights, they often carry limitations, especially when they depend on assumptions and incomplete data. Striking a balance between accuracy and timely decision-making in rapidly evolving situations such as disease outbreaks is challenging. Modelers need to explore the extent to which their models deviate from representing the real world. The uncertainties inherent in models must be effectively communicated to policy makers and the public. As the field becomes increasingly influential, it needs to develop reporting standards that enable rigorous external scrutiny.
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Affiliation(s)
- Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom;
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Health System, Singapore
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2
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Bates S, Breeze P, Thomas C, Jackson C, Church O, Brennan A. Cross-model validation of public health microsimulation models; comparing two models on estimated effects of a weight management intervention. BMC Public Health 2024; 24:764. [PMID: 38475796 DOI: 10.1186/s12889-024-18134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Health economic modelling indicates that referral to a behavioural weight management programme is cost saving and generates QALY gains compared with a brief intervention. The aim of this study was to conduct a cross-model validation comparing outcomes from this cost-effectiveness analysis to those of a comparator model, to understand how differences in model structure contribute to outcomes. METHODS The outcomes produced by two models, the School for Public Health Research diabetes prevention (SPHR) and Health Checks (HC) models, were compared for three weight-management programme strategies; Weight Watchers (WW) for 12 weeks, WW for 52 weeks, and a brief intervention, and a simulated no intervention scenario. Model inputs were standardised, and iterative adjustments were made to each model to identify drivers of differences in key outcomes. RESULTS The total QALYs estimated by the HC model were higher in all treatment groups than those estimated by the SPHR model, and there was a large difference in incremental QALYs between the models. SPHR simulated greater QALY gains for 12-week WW and 52-week WW relative to the Brief Intervention. Comparisons across socioeconomic groups found a stronger socioeconomic gradient in the SPHR model. Removing the impact of treatment on HbA1c from the SPHR model, running both models only with the conditions that the models have in common and, to a lesser extent, changing the data used to estimate risk factor trajectories, resulted in more consistent model outcomes. CONCLUSIONS The key driver of difference between the models was the inclusion of extra evidence-based detail in SPHR on the impacts of treatments on HbA1c. The conclusions were less sensitive to the dataset used to inform the risk factor trajectories. These findings strengthen the original cost-effectiveness analyses of the weight management interventions and provide an increased understanding of what is structurally important in the models.
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3
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Li X, Hodgson D, Flaig J, Kieffer A, Herring WL, Beyhaghi H, Willem L, Jit M, Bilcke J, Beutels P. Cost-Effectiveness of Respiratory Syncytial Virus Preventive Interventions in Children: A Model Comparison Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:508-518. [PMID: 36442831 DOI: 10.1016/j.jval.2022.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Model-based cost-effectiveness analyses on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs. METHODS We compared 3 static and 2 dynamic models using a common input parameter set for a hypothetical birth cohort of 100 000 infants. Year-round and seasonal programs were evaluated for MV and mAb interventions, using available evidence during the study period (eg, phase III MV and phase IIb mAb efficacy). RESULTS Three static models estimated comparable medically attended (MA) cases averted versus no intervention (MV, 1019-1073; mAb, 5075-5487), with the year-round MV directly saving ∼€1 million medical and €0.3 million nonmedical costs, while gaining 4 to 5 discounted quality-adjusted life years (QALYs) annually in <1-year-olds, and mAb resulting in €4 million medical and €1.5 million nonmedical cost savings, and 21 to 25 discounted QALYs gained. In contrast, both dynamic models estimated fewer MA cases averted (MV, 402-752; mAb, 3362-4622); one showed an age shift of RSV cases, whereas the other one reported many non-MA symptomatic cases averted, especially by MV (2014). These differences can be explained by model types, assumptions on non-MA burden, and interventions' effectiveness over time. CONCLUSIONS Our static and dynamic models produced overall similar hospitalization and death estimates, but also important differences, especially in non-MA cases averted. Despite the small QALY decrement per non-MA case, their larger number makes them influential for the costs per QALY gained of RSV interventions.
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Affiliation(s)
- Xiao Li
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - David Hodgson
- Center of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Julien Flaig
- Epidemiology and Modeling of Infectious Diseases (EPIMOD), Lyon, France
| | - Alexia Kieffer
- Health Economics and Value Assessment, Sanofi, Lyon, France
| | - William L Herring
- RTI Health Solutions, Research Triangle Park, NC, USA; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Mark Jit
- Center of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Joke Bilcke
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Zhang W, Shen X, Li T, Li N, Sun Y, Zhu S, Liu N, Song H, Tang K, Wang Y, Zhang Y, Cao H, Wu Y, Gan Y, Zhang X. Intention to Pay for Vaccination and Influencing Factors of General Residents: A National Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11154. [PMID: 36141428 PMCID: PMC9517589 DOI: 10.3390/ijerph191811154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND As an important part of the promotion of immunization programs and the suppression of infectious diseases, paid vaccines can prevent a variety of diseases and meet the needs of different populations. However, few studies focus on the public's intention to pay for vaccination. METHODS The survey was conducted from 10 July to 15 September 2021, adopting a cross-sectional survey in China. We used a multi-stage sampling strategy to recruit participators from 120 cities. Participants filled out questions which assessed their intentions to pay for vaccination. A linear regression analysis was given to identify the predictors associated with the subjects' attitudes. RESULTS There were 11,031 residents who finished our questionnaire. Chinese residents' intention to receive paid vaccines scored 74.5 points. Residents who were male (β = -0.03) and older (30-44 (β = -0.03) or 45-59 (β = -0.06) or ≥60 (β = -0.08)), living alone (β = -0.03), who had moderate to severe anxiety (β = -0.03) or severe anxiety (β = -0.03) were more likely to refuse vaccination, while those who lived in Western China (β = 0.03) who had higher PSSS scores and HLS-SF12 index might acquire the intention to pay for vaccination. CONCLUSIONS The study found that gender, age, region, living alone, anxiety, social support, and health literacy were the main influencing factors of residents' attitudes. Governments and health institutions should take targeted measures to improve the health literacy and mental health of the population in order to facilitate the implementation of vaccination withdrawal and immunization policies.
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Affiliation(s)
- Weixin Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ting Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Nan Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Yanyan Sun
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Siyu Zhu
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Nana Liu
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Huifang Song
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Kun Tang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
| | - Yujia Wang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin 150081, China
| | - Ying Zhang
- School of Public Health, Shaanxi University of Chinese Medicine, Xi’an 712046, China
| | - Hui Cao
- Department of Labor Economics and Management, Beijing Vocational College of Labour and Social Security, Beijing 100029, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100083, China
- Health Culture Research Center of Shaanxi, Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Xi’an 710016, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xinyao Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun 130012, China
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Nuvey FS, Arkoazi J, Hattendorf J, Mensah GI, Addo KK, Fink G, Zinsstag J, Bonfoh B. Effectiveness and profitability of preventive veterinary interventions in controlling infectious diseases of ruminant livestock in sub-Saharan Africa: a scoping review. BMC Vet Res 2022; 18:332. [PMID: 36056387 PMCID: PMC9438146 DOI: 10.1186/s12917-022-03428-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Agriculture in general, and livestock production in particular, serve as a livelihood source for many people in sub-Saharan Africa (SSA). In many settings, lack of control of infectious diseases hampers livestock productivity, undermining the livelihood of rural populations. This scoping review sought to identify veterinary interventions previously evaluated as well as their relative effectiveness in controlling infectious livestock diseases. To be included, papers had to be written in English, German or French, and had to describe the effectiveness and/or profitability of preventive veterinary intervention(s) against anthrax, blackleg, bovine tuberculosis, brucellosis, contagious bovine pleuropneumonia, contagious caprine pleuropneumonia, foot-and-mouth disease, goat pox, lumpy skin disease, pasteurellosis, peste des petits ruminants, and/or sheep pox in any SSA country. Of the 2748 publications initially screened, 84 met our inclusion criteria and were analyzed. Most of the studies (n = 73, 87%) evaluated the effectiveness and/or profitability of vaccination, applied exclusively, applied jointly with, or compared to strategies like deworming, antimicrobial treatment, surveillance, feed supplementation, culling and dipping in reducing morbidity and/or mortality to livestock diseases. The effectiveness and/or profitability of antimicrobial treatment (n = 5), test and slaughter (n = 5), and use of lay animal health workers (n = 1) applied exclusively, were evaluated in the other studies. Vaccination was largely found to be both effective and with positive return on investment. Ineffective vaccination was mainly due to loss of vaccine potency under unfavorable field conditions like adverse weather events, cold chain failure, and mismatch of circulating pathogen strain and the vaccines in use. In summary, vaccination is the most effective and profitable means of controlling infectious livestock diseases in SSA. However, to achieve effective control of these diseases, its implementation must integrate pathogen surveillance, and optimal vaccine delivery tools, to overcome the reported field challenges.
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Affiliation(s)
- Francis Sena Nuvey
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland. .,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
| | - Jalil Arkoazi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,Faculty of Science, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Jan Hattendorf
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,Faculty of Science, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Gloria Ivy Mensah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Accra, Ghana
| | - Kennedy Kwasi Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Accra, Ghana
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,Faculty of Science, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,Faculty of Science, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, BP 1303, Côte d'Ivoire
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Lo NC, Andrejko K, Shukla P, Baker T, Sawin VI, Norris SL, Lewnard JA. Contribution and quality of mathematical modeling evidence in World Health Organization guidelines: A systematic review. Epidemics 2022; 39:100570. [PMID: 35569248 DOI: 10.1016/j.epidem.2022.100570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/23/2022] [Accepted: 04/24/2022] [Indexed: 01/13/2023] Open
Abstract
Mathematical modeling studies are frequently conducted to guide policy in global health. However, the contribution of mathematical modeling studies to World Health Organization (WHO) guideline recommendations, and the quality of evidence contributed by these studies remains unknown. We conducted a systematic review of the WHO Guidelines Review Committee database to identify guideline recommendations that included evidence from mathematical modeling studies since inception of the Guidelines Review Committee on 1 December, 2007. We included WHO guideline recommendations citing a mathematical modeling study in the primary evidence base. We defined a mathematical model as a framework that predicted epidemiologic, health or economic impact of an intervention or decision in the clinical or public health context. The primary outcome was inclusion of evidence from mathematical modeling studies in a guideline recommendation. We evaluated each unique modeling study across multiple domains of quality. Between 1 December 2007 and 1 April 2019, the WHO Guidelines Review Committee approved 154 guidelines providing 1619 guideline recommendations. Mathematical modeling studies informed 46 WHO guidelines (29.9%) and 101 unique guideline recommendations (6.2%). Modeling evidence addressed topics related to infectious diseases in 38 guidelines (82.6%) and 81 recommendations (80.2%), most commonly for HIV and tuberculosis. Evidence from modeling studies was assessed in the GRADE evidence profile for 12 recommendations (12.9%) and GRADE evidence-to-decision framework for 45 recommendations (44.6%). Modeling-informed recommendations were more likely than other recommendations within the same guidelines to be issued with a "conditional" rather than "strong" strength of recommendation (53.5% versus 37.8%), and the evidence underlying modeling-informed recommendations was more likely to be assessed as very low quality (41.6% versus 24.1%). Upon review of individual modeling studies, we estimated that 33.8% of models performed a calibration, 29.4% of models performed a validation of results, and 20.6% of models reported a change in the study conclusion in the sensitivity analysis. While policy recommendations in WHO guidelines are informed by evidence from modeling studies, the validity of modeling studies included in guidelines development is heterogeneous. Quality assessment is needed to support the evaluation and incorporation of evidence from mathematical modeling studies in guidelines development.
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Affiliation(s)
- Nathan C Lo
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA.
| | - Kristin Andrejko
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | - Poojan Shukla
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA
| | - Tess Baker
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | - Veronica Ivey Sawin
- Department of Quality of Norms and Standards, Science Division, World Health Organization, Geneva, Switzerland
| | - Susan L Norris
- Department of Quality of Norms and Standards, Science Division, World Health Organization, Geneva, Switzerland
| | - Joseph A Lewnard
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, CA, USA; Division of Infectious Diseases and Vaccinology, University of California, Berkeley, School of Public Health, Berkeley, CA, USA; Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, USA
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7
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Tran PT, Riaz M, Chen Z, Truong CB, Diaby V. An Umbrella Review of the Cost Effectiveness of Human Papillomavirus Vaccines. Clin Drug Investig 2022; 42:377-390. [PMID: 35488964 DOI: 10.1007/s40261-022-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Although many systematic reviews for the human papillomavirus vaccines cost effectiveness have been published, they vary in perspectives, methods, and quality. We aimed to condense systematically such evidence to facilitate locating, processing, and learning, not only about the consensus of findings but also how models were built and their evolution over time and across settings. METHODS We conducted an umbrella review of cost-effectiveness studies for human papillomavirus vaccines using three databases (PubMed, Embase, and Cochrane). Based on their objectives, we classified studies into three groups (human papillomavirus vaccines cost effectiveness, model characteristics, and all-type vaccines, including human papillomavirus vaccines). We used the AMTAR2 to assess the quality of the studies. Additionally, we provided a summary of study findings, discussions, and evidence gaps in the literature. RESULTS Though most studies were critically low quality and had a low quality of reporting, the human papillomavirus vaccine was consistently cost effective in young girls and men who have sex with men. Stratified analyses by rated quality did not change the results. The quality assessment of the reviews did not necessarily reflect the quality assessment of underlying studies. The human papillomavirus vaccine models became more complex over time, capturing more realistic disease transmission with different human papillomavirus strains and herd immunities. CONCLUSIONS Additional evidence is needed for vulnerable populations (e.g., childhood cancer survivors) who are at high risk for human papillomavirus vaccine-related cancers and, therefore, may be more cost effective when receiving human papillomavirus vaccines. Quantifying human papillomavirus vaccine cost effectiveness via meta-analyses is feasible if investigators can increase the homogeneity of their populations.
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Affiliation(s)
- Phuong T Tran
- Faculty of Pharmacy, HUTECH University, 475A Dien Bien Phu Street, Ward 25, Binh Thanh District, Ho Chi Minh City, 700000, Vietnam. .,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
| | - Munaza Riaz
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Ziyan Chen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Cong Bang Truong
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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8
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Lanzas C, Jara M, Tucker R, Curtis S. A review of epidemiological models of Clostridioides difficile transmission and control (2009-2021). Anaerobe 2022; 74:102541. [PMID: 35217149 DOI: 10.1016/j.anaerobe.2022.102541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 02/08/2023]
Abstract
Clostridioides difficile is the leading cause of infectious diarrhea and one of the most common healthcare-acquired infections worldwide. We performed a systematic search and a bibliometric analysis of mathematical and computational models for Clostridioides difficile transmission. We identified 33 publications from 2009 to 2021. Models have underscored the importance of asymptomatic colonized patients in maintaining transmission in health-care settings. Infection control, antimicrobial stewardship, active testing, and vaccination have often been evaluated in models. Despite active testing and vaccination being not currently implemented, they are the most commonly evaluated interventions. Some aspects of C. difficile transmission, such community transmission and interventions in health-care settings other than in acute-care hospitals, remained less evaluated through modeling.
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Affiliation(s)
- Cristina Lanzas
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA.
| | - Manuel Jara
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA
| | - Rachel Tucker
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA
| | - Savannah Curtis
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA
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- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA
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9
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McQuaid CF, Clarkson MC, Bellerose M, Floyd K, White RG, Menzies NA. An approach for improving the quality of country-level TB modelling. Int J Tuberc Lung Dis 2021; 25:614-619. [PMID: 34330345 PMCID: PMC8327628 DOI: 10.5588/ijtld.21.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Mathematical modelling is increasingly used to inform budgeting and strategic decision-making by national TB programmes. Despite the importance of these decisions, there is currently no mechanism to review and confirm the appropriateness of modelling analyses. We have developed a benchmarking, reporting, and review (BRR) approach and accompanying tools to allow constructive review of country-level TB modelling applications. This approach has been piloted in five modelling applications and the results of this study have been used to revise and finalise the approach. The BRR approach consists of 1) quantitative benchmarks against which model assumptions and results can be compared, 2) standardised reporting templates and review criteria, and 3) a multi-stage review process providing feedback to modellers during the application, as well as a summary evaluation after completion. During the pilot, use of the tools prompted important changes in the approaches taken to modelling. The pilot also identified issues beyond the scope of a review mechanism, such as a lack of empirical evidence and capacity constraints. This approach provides independent evaluation of the appropriateness of modelling decisions during the course of an application, allowing meaningful changes to be made before results are used to inform decision-making. The use of these tools can improve the quality and transparency of country-level TB modelling applications.
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Affiliation(s)
- C F McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - M C Clarkson
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - M Bellerose
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - K Floyd
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - R G White
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - N A Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA, Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
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10
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Silal SP. Operational research: A multidisciplinary approach for the management of infectious disease in a global context. EUROPEAN JOURNAL OF OPERATIONAL RESEARCH 2021; 291:929-934. [PMID: 32836716 PMCID: PMC7377991 DOI: 10.1016/j.ejor.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/04/2020] [Accepted: 07/19/2020] [Indexed: 05/04/2023]
Abstract
Infectious diseases, both established and emerging, impose a significant burden globally. Successful management of infectious diseases requires considerable effort and a multidisciplinary approach to tackle the complex web of interconnected biological, public health and economic systems. Through a wide range of problem-solving techniques and computational methods, operational research can strengthen health systems and support decision-making at all levels of disease control. From improved understanding of disease biology, intervention planning and implementation, assessing economic feasibility of new strategies, identifying opportunities for cost reductions in routine processes, and informing health policy, this paper highlights areas of opportunity for operational research to contribute to effective and efficient infectious disease management and improved health outcomes.
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Affiliation(s)
- Sheetal Prakash Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
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11
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James LP, Salomon JA, Buckee CO, Menzies NA. The Use and Misuse of Mathematical Modeling for Infectious Disease Policymaking: Lessons for the COVID-19 Pandemic. Med Decis Making 2021; 41:379-385. [PMID: 33535889 PMCID: PMC7862917 DOI: 10.1177/0272989x21990391] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
Mathematical modeling has played a prominent and necessary role in the current coronavirus disease 2019 (COVID-19) pandemic, with an increasing number of models being developed to track and project the spread of the disease, as well as major decisions being made based on the results of these studies. A proliferation of models, often diverging widely in their projections, has been accompanied by criticism of the validity of modeled analyses and uncertainty as to when and to what extent results can be trusted. Drawing on examples from COVID-19 and other infectious diseases of global importance, we review key limitations of mathematical modeling as a tool for interpreting empirical data and informing individual and public decision making. We present several approaches that have been used to strengthen the validity of inferences drawn from these analyses, approaches that will enable better decision making in the current COVID-19 crisis and beyond.
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Affiliation(s)
| | - Joshua A. Salomon
- Center for Health Policy and Center
for Primary Care and Outcomes Research, Stanford University,
Stanford, CA, USA
| | - Caroline O. Buckee
- Center for Communicable Disease
Dynamics, Harvard T. H. Chan School of Public Health, Boston,
MA, USA
| | - Nicolas A. Menzies
- Department of Global Health and
Population, Harvard T. H. Chan School of Public Health, Boston,
MA, USA
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Vardavas C, Nikitara K, Zisis K, Athanasakis K, Phalkey R, Leonardi-Bee J, Johnson H, Tsolova S, Ciotti M, Suk JE. Cost-effectiveness of emergency preparedness measures in response to infectious respiratory disease outbreaks: a systematic review and econometric analysis. BMJ Open 2021; 11:e045113. [PMID: 33926982 PMCID: PMC8094385 DOI: 10.1136/bmjopen-2020-045113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Respiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019. SETTING Respiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies. PRIMARY AND SECONDARY OUTCOME MEASURES Direct and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured. RESULTS Overall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention. CONCLUSIONS Our cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks.
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Affiliation(s)
| | | | | | - Konstantinos Athanasakis
- Department of Public Health Policy, School of Public Health, University of West Attica, Egaleo, Greece
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Helen Johnson
- Epidemiological Methods, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Svetla Tsolova
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Massimo Ciotti
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
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Buchy P, Chen J, Zhang XH, Benninghoff B, Lee C, Bibera GL. A review of rotavirus vaccine use in Asia and the Pacific regions: challenges and future prospects. Expert Rev Vaccines 2021; 20:1499-1514. [PMID: 33275065 DOI: 10.1080/14760584.2020.1853532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Rotavirus infection causes a significant proportion of diarrhea disease burden in children <5 years of age in Asia and the Pacific regions. The World Health Organization recommends that rotavirus vaccination should be included in national immunization programs to prevent rotavirus gastroenteritis (RVGE).Areas covered: A literature review was performed to identify and summarize published evidence on RVGE epidemiology and status of rotavirus vaccine use, including the impact and cost-effectiveness of rotavirus vaccination programs in Asia and the Pacific regions (49 countries) during the period 2000-2018.Expert opinion: Rotavirus vaccination programs have successfully reduced the burden of RVGE in many countries. However, such programs still do not exist in most Asia-Pacific countries, and therefore the burden of RVGE remains high in children <5 years of age. Challenges to vaccine implementation include a lack of surveillance data; safety concerns around intussusception; a general lack of awareness about RVGE disease epidemiology and vaccines among physicians, policy-makers, and parents; insufficient cost-effectiveness analyses; and potential issues with vaccine affordability including vaccination costs and lack of political will. Recommendations to overcome these challenges include developing cost-effectiveness analyses for more diverse national and regional settings, providing non-governmental support for low-income countries, and improving advocacy efforts.Plain language summaryWhat is the context?• Rotavirus (RV) infection causes acute gastroenteritis (GE) in children under 5 years of age.• Rotavirus vaccination (RVV) implementation has been slow in Asia and the Pacific (AP) regions, which could be responsible for the region falling behind in their fight against RVGE.What is new?• RVV via national immunization programs (NIPs) is available in 8/49 countries and through the private market or non-governmental support in other countries. Coverage rates vary between countries, possibly driven by the mechanism through which RVV is available.• A substantial positive impact of RVV on RVGE disease burden with a very low risk of intestinal intussusception for up to 7 days after RVV has been documented in the AP regions.• Economic evaluation studies, mainly cost-effectiveness analyses, predict a significant reduction in treatment costs related to RVGE and its complications showing that RVV is good value for money.What is the impact?• The prospect of continued safe and effective use of RVV in the AP regions is promising.• Challenges to RVV implementation include establishing evidence of burden of disease, poor awareness of rotavirus vaccines, limited evidence from cost-effectiveness analyses from several countries, issues of affordability of the vaccine and a lack of political will.• Recommendations for RVV implementation into the NIPs include conducting clinical and cost-effectiveness studies in countries where these are not available, establishing reliable surveillance mechanisms, providing non-governmental support for low-income countries and improving advocacy efforts.• Maintenance of high vaccination coverage is needed in countries that have implemented national RVV programs.Graphical abstract[Formula: see text].
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Realising the broader value of vaccines in the UK. Vaccine X 2021; 8:100096. [PMID: 33997762 PMCID: PMC8099625 DOI: 10.1016/j.jvacx.2021.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 02/04/2023] Open
Abstract
Many health technology assessment (HTA) agencies limit their assessments of vaccines to the health benefits for the vaccinated individual, the costs associated with vaccine administration and the disease avoided. However, because the value of vaccines tends to accrue to a large extent beyond the vaccinated individual, they are systematically undervalued in many current HTA processes. This is also the case in the UK, where the Joint Committee on Vaccination and Immunisation (JCVI) is in charge of assessing preventative vaccines, while therapeutic vaccines fall in the realm of the National Institute for Clinical Excellence (NICE). To contribute to a forward-looking perspective, we designed a framework to capture the broader value of vaccination. We reviewed the current state of the global vaccines pipeline and selected seven preventative and three therapeutic vaccines that are likely to enter the UK market within five years. We assessed on which value elements the selected vaccines would potentially generate value, and compared those against the novel broader value framework. A review of the current value elements considered by the JCVI and NICE allowed identifying the critical gaps between potential value generation and value recognition. To our knowledge, this is the first time that the broader value of vaccination has been pro-actively assessed for pipeline vaccinations. Our findings show that the existing narrow evaluation frameworks are likely to systematically undervalue the value of potential future vaccines coming to the UK market. This is particularly relevant, where their impact on AMR and other health interventions, and on the productivity of the workforce is of concern. Recommendations to overcome this include an explicit and more consistent inclusion of, and data collection on, the impact of vaccines on AMR and other health interventions by JCVI and NICE; the consideration of a societal perspective and the fiscal impact of vaccines to societies.
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Lecrenier N, Marijam A, Olbrecht J, Soumahoro L, Nieto Guevara J, Mungall B. Ten years of experience with the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (Synflorix) in children. Expert Rev Vaccines 2020; 19:247-265. [DOI: 10.1080/14760584.2020.1738226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abbas KM, van Zandvoort K, Brisson M, Jit M. Effects of updated demography, disability weights, and cervical cancer burden on estimates of human papillomavirus vaccination impact at the global, regional, and national levels: a PRIME modelling study. LANCET GLOBAL HEALTH 2020; 8:e536-e544. [PMID: 32105613 PMCID: PMC7083230 DOI: 10.1016/s2214-109x(20)30022-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/01/2020] [Accepted: 01/10/2020] [Indexed: 12/17/2022]
Abstract
Background The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) has been used around the world to assess the health impact and cost-effectiveness of human papillomavirus (HPV) vaccination in girls. We updated PRIME with new data and methods for demography, disability weights, and cervical cancer burden, and generated revised estimates of the health impact of HPV vaccination at the global, regional, and national levels for 177 countries. Methods PRIME was updated with population demography of the UN World Population Prospects (UNWPP) 2019 revision, disability weights of the Global Burden of Disease (GBD) 2017 study, and cervical cancer burden from the Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2018 database. We estimated the lifetime health benefits for bivalent or quadrivalent and nonavalent vaccination of 9-year-old and 12-year-old girls at 90% coverage during 2020–29 in 177 countries. Health impact was presented in terms of cervical cancer cases, deaths, or disability-adjusted life-years (DALYs) averted per 1000 vaccinated girls in comparison with the counterfactual scenario of no vaccination, and the number of girls needed to be vaccinated to prevent a single case, death, or DALY. Findings In estimating the health impact of HPV vaccination of 9-year-old girls, the combined updates to demography, disability weights, cervical cancer burden estimates resulted in a 26% increase in the estimated number of cases averted, a 51% increase in deaths averted, and a 72% increase in DALYs averted per 1000 vaccinated girls for both the bivalent or quadrivalent and nonavalent vaccines, compared with previous estimates. With the updated model, the bivalent or quadrivalent HPV vaccine was estimated to avert 15 cases, 12 deaths, and 243 DALYs per 1000 vaccinated girls, and the nonavalent HPV vaccine was estimated to avert 19 cases, 14 deaths, and 306 DALYs per 1000 vaccinated girls. The health benefits of vaccination of 12-year-old girls were estimated to be similar but slightly decreased in comparison with vaccination of 9-year-old girls. Interpretation HPV vaccination provides greater health benefits and is more cost-effective than was previously estimated. The demography update, which incorporates population aging, has the largest effect on the health impact estimates. The WHO African region is expected to gain the greatest health benefits and should be prioritised for HPV vaccination. Funding Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kaja M Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kevin van Zandvoort
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Marc Brisson
- Centre de recherche du CHU de Québec and Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK; School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
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Procurement of Category 2 Vaccines in China. Vaccines (Basel) 2019; 7:vaccines7030097. [PMID: 31450855 PMCID: PMC6789637 DOI: 10.3390/vaccines7030097] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022] Open
Abstract
Internationally, vaccine pricing is relatively opaque, although many low- or lower-middle-income countries belong to international consortiums that jointly procure vaccines. China procures vaccines domestically, and vaccines that require payment from the public (“category 2 vaccines”), have undergone several regulatory changes over the past 15 years. This study aims to describe the vaccine procurement method changes in China since 2005 and to analyze how the procurement method impacted vaccine price. This review of vaccine procurement reforms found that a shift to provincial-level Group Purchasing Organizations after 2016 was accompanied by an increase in most prices. There was more variability in vaccine prices across provinces for vaccines with only one supplier, and these vaccines have a higher price than what is found in United Nations Children’s Fund (UNICEF)-supported countries. China’s current procurement system for non-mandatory vaccines leaves these vaccines costing several-fold more than in other countries, and in particular those supported by Gavi, the Vaccine Alliance. Exploring a variety of methods to reduce vaccine purchase prices will not only directly benefit the general population, but also the government, as they aim to implement more programs to benefit public health in a cost-effective manner.
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den Boon S, Jit M, Brisson M, Medley G, Beutels P, White R, Flasche S, Hollingsworth TD, Garske T, Pitzer VE, Hoogendoorn M, Geffen O, Clark A, Kim J, Hutubessy R. Guidelines for multi-model comparisons of the impact of infectious disease interventions. BMC Med 2019; 17:163. [PMID: 31422772 PMCID: PMC6699075 DOI: 10.1186/s12916-019-1403-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the increasing popularity of multi-model comparison studies and their ability to inform policy recommendations, clear guidance on how to conduct multi-model comparisons is not available. Herein, we present guidelines to provide a structured approach to comparisons of multiple models of interventions against infectious diseases. The primary target audience for these guidelines are researchers carrying out model comparison studies and policy-makers using model comparison studies to inform policy decisions. METHODS The consensus process used for the development of the guidelines included a systematic review of existing model comparison studies on effectiveness and cost-effectiveness of vaccination, a 2-day meeting and guideline development workshop during which mathematical modellers from different disease areas critically discussed and debated the guideline content and wording, and several rounds of comments on sequential versions of the guidelines by all authors. RESULTS The guidelines provide principles for multi-model comparisons, with specific practice statements on what modellers should do for six domains. The guidelines provide explanation and elaboration of the principles and practice statements as well as some examples to illustrate these. The principles are (1) the policy and research question - the model comparison should address a relevant, clearly defined policy question; (2) model identification and selection - the identification and selection of models for inclusion in the model comparison should be transparent and minimise selection bias; (3) harmonisation - standardisation of input data and outputs should be determined by the research question and value of the effort needed for this step; (4) exploring variability - between- and within-model variability and uncertainty should be explored; (5) presenting and pooling results - results should be presented in an appropriate way to support decision-making; and (6) interpretation - results should be interpreted to inform the policy question. CONCLUSION These guidelines should help researchers plan, conduct and report model comparisons of infectious diseases and related interventions in a systematic and structured manner for the purpose of supporting health policy decisions. Adherence to these guidelines will contribute to greater consistency and objectivity in the approach and methods used in multi-model comparisons, and as such improve the quality of modelled evidence for policy.
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Affiliation(s)
- Saskia den Boon
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- School of Public Health, University of Hong Kong, Hong Kong, SAR China
| | - Marc Brisson
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
| | - Graham Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Richard White
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- TB Modelling Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Tini Garske
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT 06511 USA
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Oliver Geffen
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Kim
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
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Bedard B, Pettit P, Messmer ME. Pharmacy and local health department partnership to increase community immunizations. J Am Pharm Assoc (2003) 2019; 59:305. [PMID: 30803916 DOI: 10.1016/j.japh.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Brenden Bedard
- Genesee and Orleans County Health Departments, Albion, NY; The College at Brockport, Public Health, Brockport, NY; Nazareth College, Public Health, Pittsford, NY.
| | - Paul Pettit
- Genesee and Orleans County Health Departments, Albion, NY; The College at Brockport, Public Health, Brockport, NY
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Krishnaswamy S, Lambach P, Giles ML. Key considerations for successful implementation of maternal immunization programs in low and middle income countries. Hum Vaccin Immunother 2019; 15:942-950. [PMID: 30676250 PMCID: PMC6605837 DOI: 10.1080/21645515.2018.1564433] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
The Maternal Neonatal Tetanus Elimination program is proof of concept for the feasibility and potential for maternal immunization to reduce neonatal mortality particularly in low and middle-income countries. Introduction of any additional vaccine into the antenatal space, such as Influenza and Pertussis, and potentially Respiratory Syncytial Virus and Group B Streptococcus vaccines in the future, requires strengthening of antenatal care and immunization services. Successful implementation also requires robust disease surveillance in pregnant women and neonates and active surveillance for adverse events following immunization to monitor the impact and ensure the safe use of the vaccine. This review outlines five key elements essential for successful implementation of a maternal immunization program focusing particularly on low and middle-income countries. These include; relevant considerations in supporting a decision to undertake a maternal immunization program including knowledge of local disease epidemiology, involvement of the consumer, healthcare provider recommendation, equitable access to maternal vaccination, and systems for disease surveillance, program evaluation and safety monitoring.
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Affiliation(s)
- Sushena Krishnaswamy
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Michelle L. Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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