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Hagens A, Sloof AC, Janghorban R. Using a Dynamic Model to Estimate the Cost-Effectiveness of HPV Vaccination in Iran. Vaccines (Basel) 2024; 12:438. [PMID: 38675821 PMCID: PMC11054652 DOI: 10.3390/vaccines12040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to determine the cost-effectiveness of vaccination against HPV. An age-sex structured dynamic disease transmission model was created to estimate the spread of HPV and the HPV-related incidence of cervical cancer (CC) in Iran. Sixteen age groups of men and women were incorporated to reflect the differences in sexual preferences, vaccination uptake, and disease-related outcomes. Three scenarios were evaluated by using an Incremental Cost-Effectiveness Ratio (ICER) with gained quality-adjusted life years (QALYs). ICER values below one gross domestic product (GDP) per capita are evaluated as highly cost-effective. Vaccination reduces the number of infections and CC-related mortality. Over time, the vaccinated group ages and older age groups experience protection. An initial investment is required and savings in treatment spending reduce the impact over time. Vaccinating girls only was found to be cost-effective, with an ICER close to once the GDP per capita. Vaccinating both sexes was shown to be less cost-effective compared to girls only, and vaccinating boys only was not found to be cost-effective, with an ICER between once and three times, and greater than three times the GDP per capita, respectively. The estimates are conservative since societal cost-saving and the impact of other HPV-related illnesses were not considered and would likely reduce the ICERs.
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Affiliation(s)
- Arnold Hagens
- Department of Health Sciences, University Medical Center Groningen, University of Groningen (RUG), 9713 AV Groningen, The Netherlands
- Triangulate Health Ltd., Doncaster DN11 9QU, UK
| | | | - Roksana Janghorban
- Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz 71936-13119, Iran;
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Hagens A, Cordova-Pozo K, Postma M, Wilschut J, Zino L, van der Schans J. Reconstructing the Effectiveness of Policy Measures to Avoid Next-Wave COVID-19 Infections and Deaths Using a Dynamic Simulation Model: Implications for Health Technology Assessment. Front Med Technol 2022; 3:666581. [PMID: 35156083 PMCID: PMC8825500 DOI: 10.3389/fmedt.2021.666581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Objective The goal of this study was to dynamically model next-wave scenarios to observe the impact of different lockdown measures on the infection rates (IR) and mortality for two different prototype countries, mimicking the 1st year of the COVID-19 pandemic in Europe. Methods A dynamic simulation SIRD model was designed to assess the effectiveness of policy measures on four next-wave scenarios, each preceded by two different lockdowns. The four scenarios were (1) no-measures, (2) uniform measures, (3) differential measures based on isolating > 60 years of age group, and (4) differential measures with additional contact reduction measures for the 20–60 years of age group. The dynamic simulation model was prepared for two prototype European countries, Northwestern (NW) and Southern (S) country. Both prototype countries were characterized based on age composition and contact matrix. Results The results show that the outcomes of the next-wave scenarios depend on number of infections of previous lockdowns. All scenarios reduce the incremental deaths compared with a no-measures scenario. Differential measures show lower number of deaths despite an increase of infections. Additionally, prototype S shows overall more deaths compared with prototype NW due to a higher share of older citizens. Conclusion This study shows that differential measures are a worthwhile option for controlling the COVID-19 epidemic. This may also be the case in situations where relevant parts of the population have taken up vaccination. Additionally, the effectiveness of interventions strongly depends on the number of previously infected individuals. The results of this study may be useful when planning and forecasting the impact of non-pharmacological interventions and vaccination campaigns.
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Affiliation(s)
- Arnold Hagens
- Department of Health Sciences, University of Groningen (RUG), University Medical Center Groningen, Groningen, Netherlands
- *Correspondence: Arnold Hagens
| | - Kathya Cordova-Pozo
- Department of Health Sciences, University of Groningen (RUG), University Medical Center Groningen, Groningen, Netherlands
- Institute for Management Research, Radboud University, Nijmegen, Netherlands
| | - Maarten Postma
- Department of Health Sciences, University of Groningen (RUG), University Medical Center Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia
| | - Jan Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lorenzo Zino
- Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands
| | - Jurjen van der Schans
- Department of Health Sciences, University of Groningen (RUG), University Medical Center Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
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Rose SM, Paterra M, Isaac C, Bell J, Stucke A, Hagens A, Tyrrell S, Guterbock M, Nuzzo JB. Analysing COVID-19 outcomes in the context of the 2019 Global Health Security (GHS) Index. BMJ Glob Health 2021; 6:bmjgh-2021-007581. [PMID: 34893478 PMCID: PMC9065770 DOI: 10.1136/bmjgh-2021-007581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The Global Health Security Index benchmarks countries’ capacities to carry out the functions necessary to prevent, detect and respond to biological threats. The COVID-19 pandemic served as an opportunity to evaluate whether the Index contained the correct array of variables that influence countries’ abilities to respond to these threats; assess additional variables that may influence preparedness; and examine how the impact of preparedness components change during public health crises. Methods Linear regression models were examined to determine the relationship between excess mortality per capita for the first 500 days of countries’ COVID-19 pandemic and internal Index variables, as well as external variables including social cohesion; island status; perceived corruption; elderly population size; previous epidemic experience; stringency of non-pharmaceutical interventions; and social and political polarisation. Results COVID-19 outcomes were significantly associated with sociodemographic, political and governance variables external to the 2019 Index: social cohesion, reduction in social polarisation and reduced perceptions of corruption were consistently correlated with reduced excess mortality throughout the pandemic. The association of other variables assessed by the Index, like epidemiological workforce robustness, changed over time. Fixed country features, including geographic connectedness, larger elderly population and lack of prior coronavirus outbreak experience were detrimental to COVID-19 outcomes. Finally, there was evidence that countries that lacked certain capacities were able to develop these over the course of the pandemic. Conclusions Additional sociodemographic, political and governance variables should be included in future indices to improve their ability to characterise preparedness. Fixed characteristics, while not directly addressable, are useful for establishing countries’ inherent risk profile and can motivate those at greater risk to invest in preparedness. Particular components of preparedness vary in their impact on outcomes over the course of the pandemic, which may inform resource direction during ongoing crises. Future research should seek to further characterise time-dependent impacts as additional COVID-19 outcome data become available.
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Affiliation(s)
- Sophie M Rose
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA .,Johns Hopkins Center for Health Security, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | - Jennifer B Nuzzo
- Johns Hopkins Center for Health Security, Baltimore, Maryland, USA
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Postma M, Boersma C, Hagens A, van der Schans J. The Evolving HTAi Statement on COVID-19 Vaccines. Eur J Public Health 2021. [PMCID: PMC8574820 DOI: 10.1093/eurpub/ckab164.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Developments in COVID-19 have gone unprecedently fast, and HTAs have tried to keep pace, for example, in HTA-committees like the Joint Committee of Vaccination & Immunization. Necessarily, HTAs of COVID-19 related issues have been numerous and of a dynamic character to adequately cope with the rapidly changing landscape. HTAi drafted a statement on COVID-19 vaccines in the 2nd half of 2020 and an update in the 1st half of 2021. Here, we will address the role of real-world data (RWD) on effectiveness, safety and benefit/risk coming from the close monitoring programs around implementation in selected countries. Notably, an abundance of data came from Israel and the United Kingdom. Where the initial vaccination programs were designed based on clinical trials, HTA-committees continuously monitored observational data and dynamically re-designed the programs based on these. RWD have sometimes enhanced an increasing generic view on the vaccines, for example, concerning the use in older adults, as well as prioritizing specific ones for specific groups. RWD clearly show the effects of the vaccination programs on hospitalizations and deaths, in particular in those countries with an early kick-start of vaccination. Typically, cost-effectiveness analysis has so far not played any role in HTAs within crisis situations. We will address this in our presentation, illustrating potential value-for-money of the current vaccines in various country-specific settings looking at dynamic modelling and extensive data needs underlying economic assessments. Correspondingly, these models were initially populated with clinical trial data and are currently undergoing continuous updates as RWD come. Increasing interest in cost-effectiveness, dynamic pricing, tiered pricing in different parts of the world and enhanced competition will further shift attention to the economic aspects, further illustrating the dynamic character of HTAs in this field and HTAi's statement as an overall concept.
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Affiliation(s)
- M Postma
- University of Groningen, Groningen, Netherlands
- Open University, Heerlen, Netherlands
| | - C Boersma
- University of Groningen, Groningen, Netherlands
- Open University, Heerlen, Netherlands
| | - A Hagens
- University of Groningen, Groningen, Netherlands
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Cordova-Pozo K, Hoopes AJ, Cordova F, Vega B, Segura Z, Hagens A. Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis. Reprod Health 2018; 15:24. [PMID: 29422099 PMCID: PMC5806234 DOI: 10.1186/s12978-018-0461-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants. METHODS We reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results. RESULTS Strengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions. CONCLUSIONS This analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.
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Affiliation(s)
| | - Andrea J. Hoopes
- Kaiser Permanente Washington, 13451 SE 36th, Bellevue, WA 98006 USA
| | - Freddy Cordova
- South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Bernardo Vega
- University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Zoyla Segura
- Instituto Centroamericano de la Salud, Reparto Los Robles, Restaurante La Marsellaise 1 c. al norte 1 c. al este, casa #, 77 Managua, Nicaragua
| | - Arnold Hagens
- South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
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Córdova Pozo K, Chandra-Mouli V, Decat P, Nelson E, De Meyer S, Jaruseviciene L, Vega B, Segura Z, Auquilla N, Hagens A, Van Braeckel D, Michielsen K. Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress. Reprod Health 2015; 12:11. [PMID: 25616439 PMCID: PMC4320614 DOI: 10.1186/1742-4755-12-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented.This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose.
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Affiliation(s)
- Kathya Córdova Pozo
- />South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Venkatraman Chandra-Mouli
- />Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH - 1211 Geneva 27, Switzerland
| | - Peter Decat
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
| | - Erica Nelson
- />Center for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
| | - Sara De Meyer
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
| | - Lina Jaruseviciene
- />Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, 44307 Lithuania
| | - Bernardo Vega
- />University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Zoyla Segura
- />Instituto Centroamericano de la Salud, Reparto Los Robles, Restaurante La Marsellaise 1 c. al norte 1 c. al este, casa # 77, Managua, Nicaragua
| | - Nancy Auquilla
- />University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Arnold Hagens
- />South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Dirk Van Braeckel
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
| | - Kristien Michielsen
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
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