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Gauvreau CL, Schreyer L, Gibson PJ, Koo A, Ungar WJ, Regier D, Chan K, Hayeems R, Gibson J, Palmer A, Peacock S, Denburg AE. Development of a Value Assessment Framework for Pediatric Health Technologies Using Multicriteria Decision Analysis: Expanding the Value Lens for Funding Decision Making. Value Health 2024:S1098-3015(24)00127-X. [PMID: 38548179 DOI: 10.1016/j.jval.2024.03.012] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES A health technology assessment (HTA) does not systematically account for the circumstances and needs of children and youth. To supplement HTA processes, we aimed to develop a child-tailored value assessment framework using a multicriteria decision analysis approach. METHODS We constructed a multicriteria-decision-analysis-based model in multiple phases to create the Comprehensive Assessment of Technologies for Child Health (CATCH) framework. Using a modified Delphi process with stakeholders having broad disciplinary and geographic variation (N = 23), we refined previously generated criteria and developed rank-based weights. We established a criterion-pertinent scoring rubric for assessing incremental benefits of new drugs. Three clinicians independently assessed comprehension by pilotscoring 9 drugs. We then validated CATCH for 2 childhood cancer therapies through structured deliberation with an expert panel (N = 10), obtaining individual scores, consensus scores, and verbal feedback. Analyses included descriptive statistics, thematic analysis, exploratory disagreement indices, and sensitivity analysis. RESULTS The modified Delphi process yielded 10 criteria, based on absolute importance/relevance and agreed importance (median disagreement indices = 0.34): Effectiveness, Child-specific Health-related Quality of Life, Disease Severity, Unmet Need, Therapeutic Safety, Equity, Family Impacts, Life-course Development, Rarity, and Fair Share of Life. Pilot scoring resulted in adjusted criteria definitions and more precise score-scaling guidelines. Validation panelists endorsed the framework's key modifiers of value. Modes of their individual prescores aligned closely with deliberative consensus scores. CONCLUSIONS We iteratively developed a value assessment framework that captures dimensions of child-specific health and nonhealth gains. CATCH could improve the richness and relevance of HTA decision making for children in Canada and comparable health systems.
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Affiliation(s)
- Cindy L Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada
| | - Leighton Schreyer
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul J Gibson
- McMaster Children's Hospital, Hamilton, ON, Canada; Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Alicia Koo
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Dean Regier
- BC Cancer Research Institute, Vancouver, BC, Canada
| | - Kelvin Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robin Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Antonia Palmer
- Ac4orn: Advocacy for Canadian Childhood Cancer Research Network, Toronto, ON, Canada
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Avram E Denburg
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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Kabue M, Gauvreau CL, Daceney N, Bertram MM, Shissler T, Reis V, Dodo M, Garces A, Llave C, Dao B, Mohan D, Huang L. Understanding integrated HPV testing and treatment of pre-cancerous cervical cancer in Burkina Faso, Cote d'Ivoire, Guatemala and Philippines: study protocol. Reprod Health 2023; 20:167. [PMID: 37957689 PMCID: PMC10644460 DOI: 10.1186/s12978-023-01696-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Many low- and-middle-income countries are disproportionately burdened by cervical cancer, resulting in high morbidity and mortality. HPV-DNA testing coupled with treatment with thermal ablation is a recommended screening and precancer treatment strategy, but not enough is known about how this can be effectively implemented in the context of integrated services. The (Scale Up Cervical Cancer Elimination by Secondary prevention Strategy, (SUCCESS) project is conducting a study to understand this approach, integrated into existing women's health services in Burkina Faso, Cote d'Ivoire, Guatemala, and the Philippines (2020-2024). METHODS A hybrid effectiveness-implementation type III mixed-methods observational study design is used to assess feasibility, acceptability, and costs of integrated service delivery in 10 sites per country, selected considering urban/rural location, facility level, onsite/offsite laboratories, and health services type. In each country, a sample size of 2227 women aged 25-49 years will be enrolled with about 20% being women living with HIV. The primary outcome is proportion of HPV positive women completing precancer treatment, if eligible, within three months of screening. Data collection and analysis includes; facility and client exit surveys, key informant and client interviews, registries and project records extractions, and costing data analysis. Analysis includes descriptive statistics, context description, thematic analysis, and document analysis. Quantitative analyses will be stratified by participant's HIV status. DISCUSSION Recruitment of study participants started in April 2022 (Burkina Faso and Côte d'Ivoire) and August 2022 (Guatemala and the Philippines). Enrolment targets for women screened, client exit, in-depth and key informant interviews conducted were reached in Burkina Faso and Cote d'Ivoire in November 2022. Guatemala and Philippines are expected to complete enrolment by June 2023. Follow-up of study Participants 12-months post-treatment is ongoing and is expected to be completed for all countries by August 2024. In LMICs, integrating cervical cancer secondary prevention services into other health services will likely require specific rather than incidental recruitment of women for screening. Reconfiguration of laboratory infrastructure and planning for sample management must be made well in advance to meet induced demand for screening. Trail Registration ClinicalTrials.Gov ID: NCT05133661 (24/11/2021).
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Affiliation(s)
| | - Cindy L Gauvreau
- The Hospital for Sick Children, Research Institute, Toronto, Canada
| | | | | | | | | | | | | | | | | | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa Huang
- Expertise France, Abidjan, Côte d'Ivoire
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Gauvreau CL, Wight L, Subasri M, Palmer A, Hayeems R, Croker A, Abelson J, Fraser B, Bombard Y, Moore Hepburn C, Wilson MG, Denburg A. Access to novel drugs and therapeutics for children and youth: Eliciting citizens' values to inform public funding decisions. Health Expect 2023; 26:715-727. [PMID: 36639959 PMCID: PMC10010086 DOI: 10.1111/hex.13697] [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: 08/10/2022] [Revised: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The unique evidentiary, economic and ethical challenges associated with health technology assessment (HTA) of precision therapies limit access to novel drugs and therapeutics for children and youth, for whom such challenges are amplified. We elicited citizens' perspectives about values-based criteria relevant to the assessment of paediatric precision therapies to inform the development of a child-tailored HTA framework. METHODS We held four citizen panels virtually in May-June 2021, informed by a plain-language citizen brief summarizing global and local evidence about the challenges, policy and programmatic options and implementation strategies related to enhancing access to precision therapies for Canadian children and youth. Panellists were recruited through a nationally representative database, medical/patient networks and social media. We inductively coded and thematically analysed panel transcripts to generate themes and identify priority values. RESULTS The perspectives of panellists (n = 45) coalesced into four overlapping themes, with attendant subthemes, relevant to a child-tailored HTA framework: (1) Childhood Distinctions: vulnerability, 'fair innings', future potential, family impacts; (2) Voice: agency of children and youth; lived versus no lived experience; (3) One versus Many: disease severity, rarity, equity, unmet need and (4) Health System Governance: funding, implementation inequities, effectiveness and safety. Participants broadly agreed that childhood distinctions, particularly family impacts, justify child-tailored HTA. Dissent arose over whose voice should inform HTA and how such perspectives are best incorporated. CONCLUSIONS Citizens can offer unique insights into criteria relevant to the development or revision of HTA frameworks to capture holistic, societally responsive dimensions of value attached to unique contexts or populations, including children. Balancing the hopes and expectations of patients and caregivers for access to expensive but potential life-altering therapies against the opportunity costs borne by encompassing health systems is a fundamental challenge that will require rigorous methods to elicit, weigh and reconcile varied views. PATIENT OR PUBLIC CONTRIBUTION A patient advocate served on the steering committee of this study and co-authored this article. Key informants for the Citizen Brief included patient advocates and caregivers; a separate patient advocate reviewed the Brief before dissemination. Qualitative and quantitative data were collected from the general public and caregivers of children, with written consent.
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Affiliation(s)
- Cindy L Gauvreau
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lisa Wight
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Mathushan Subasri
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Antonia Palmer
- Ac2orn: Advocacy for Canadian Childhood Oncology Research, Toronto, Ontario, Canada
| | - Robin Hayeems
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alysha Croker
- Centre for Policy, Pediatrics and International Collaboration, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Julia Abelson
- Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brent Fraser
- Pharmaceutical Reviews, CADTH, Ottawa, Ontario, Canada
| | - Yvonne Bombard
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute of Cancer Research, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Charlotte Moore Hepburn
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael G Wilson
- McMaster Health Forum, Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Avram Denburg
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Levin A, Yuma S, Swai E, Morgan W, Gauvreau CL, Broutet N, Yeung KHT, Hutubessy R. Comprehensive approach to costing cervical cancer prevention and control: a case study in the United Republic of Tanzania using the Cervical Cancer Prevention and Control Costing (C4P) tool. BMC Med 2022; 20:384. [PMID: 36316680 PMCID: PMC9623962 DOI: 10.1186/s12916-022-02576-x] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/22/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has developed a costing tool, the Cervical Cancer Prevention and Control Costing (C4P) tool, to estimate the comprehensive cost of cervical cancer primary, secondary and tertiary prevention in low- and middle-income countries. The tool was piloted in the United Republic of Tanzania, a country with a high incidence of cervical cancer with 62.5 cases per 100,000 women in 2020. This paper presents the costing tool methods as well as the results from the pilot in Tanzania. METHODS The C4P tool estimates the incremental costs of cervical cancer prevention and control programmes. It estimates the financial (monetary costs to the government) and economic costs (opportunity costs). For the pilot, the study team collected data on costs and programme assumptions for human papillomavirus (HPV) vaccination of 14-year-old girls and scaling up of cervical cancer screening (visual inspection with acetic acid and HPV-DNA testing) and treatment for women for 2020-2024. Assumptions were made on how vaccination coverage would increase over the 5 years as well as developing additional screening and treatment capacity through health personnel training and infrastructure strengthening. RESULTS The total financial and economic costs of the comprehensive programme during 2020-2024 are projected to be US$68 million and US$124 million, respectively. The financial and economic costs of a fully immunized girl with HPV vaccine are estimated to be US$6.68 and US$17.31, respectively, while the costs per woman screened for cervical cancer are, on average, US$4.02 and US$5.83, respectively; US$6.44 and US$9.37 for pre-cancer treatment, respectively; and US$101 and US$107 for diagnosis of invasive cancer, respectively. The cost of treating and managing invasive cancer range from US$7.05 and US$7.83 for outpatient palliative care to US$800.21 and US$893.80 for radiotherapy, respectively. CONCLUSIONS The C4P costing tool can assist national cervical cancer programmes to estimate monetary resources needed as well as opportunity costs of reducing national cervical cancer incidence through primary, secondary and tertiary prevention.
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Affiliation(s)
| | - Safina Yuma
- Ministry of Health, Dodoma, United Republic of Tanzania
| | - Edwin Swai
- World Health Organization, Dar es Salaam, United Republic of Tanzania
| | | | - Cindy L Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Karene Hoi Ting Yeung
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
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Evans WK, Gauvreau CL, Flanagan WM, Memon S, Yong JHE, Goffin JR, Fitzgerald NR, Wolfson M, Miller AB. Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model. CMAJ Open 2020; 8:E585-E592. [PMID: 32963023 PMCID: PMC7641238 DOI: 10.9778/cmajo.20190134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Low-dose computed tomography (CT) screening can reduce lung cancer mortality in people at high risk; adding a smoking cessation intervention to screening could further improve screening program outcomes. This study aimed to assess the impact of adding a smoking cessation intervention to lung cancer screening on clinical outcomes, costs and cost-effectiveness. METHODS Using the OncoSim-Lung mathematical microsimulation model, we compared the projected lifetime impact of a smoking cessation intervention (nicotine replacement therapy, varenicline and 12 wk of counselling) in the context of annual low-dose CT screening for lung cancer in people at high risk to lung cancer screening without a cessation intervention in Canada. The simulated population consisted of Canadians born in 1940-1974; lung cancer screening was offered to eligible people in 2020. In the base-case scenario, we assumed that the intervention would be offered to smokers up to 10 times; each intervention would achieve a 2.5% permanent quit rate. Sensitivity analyses varied key model inputs. We calculated incremental cost-effectiveness ratios with a lifetime horizon from the health system's perspective, discounted at 1.5% per year. Costs are in 2019 Canadian dollars. RESULTS Offering a smoking cessation intervention in the context of lung cancer screening could lead to an additional 13% of smokers quitting smoking. It could potentially prevent 12 more lung cancers and save 200 more life-years for every 1000 smokers screened, at a cost of $22 000 per quality-adjusted life-year (QALY) gained. The results were most sensitive to quit rate. The intervention would cost over $50 000 per QALY gained with a permanent quit rate of less than 1.25% per attempt. INTERPRETATION Adding a smoking cessation intervention to lung cancer screening is likely cost-effective. To optimize the benefits of lung cancer screening, health care providers should encourage participants who still smoke to quit smoking.
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Affiliation(s)
- William K Evans
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Cindy L Gauvreau
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - William M Flanagan
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Saima Memon
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Jean Hai Ein Yong
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - John R Goffin
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Natalie R Fitzgerald
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Michael Wolfson
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Anthony B Miller
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont.
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Verguet S, Tarr G, Gauvreau CL, Mishra S, Jha P, Liu L, Xiao Y, Qiu Y, Zhao K. Distributional benefits of tobacco tax and smoke-free workplaces in China: A modeling study. J Glob Health 2018; 7:020701. [PMID: 29188029 PMCID: PMC5681709 DOI: 10.7189/jogh.07.020701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Indexed: 01/24/2023] Open
Abstract
Background Tobacco taxation and smoke–free workplaces reduce smoking, tobacco–related premature deaths and associated out–of–pocket health care expenditures. We examine the distributional consequences of a price increase in tobacco products through an excise tax hike, and of an implementation of smoke–free workplaces, in China. Methods We use extended cost–effectiveness analysis (ECEA) to evaluate, across income quintiles of the male population (the large majority of Chinese smokers), the premature deaths averted, the change in tax revenues generated, and the financial risk protection procured (eg, poverty cases averted, defined as the number of individuals no longer facing tobacco–related out–of–pocket expenditures for disease treatment, that would otherwise impoverish them), that would follow a 75% increase in cigarette prices through substantial increments in excise tax fully passed onto consumers, and a nationwide total implementation of workplace smoking bans. Results A 75% increase in cigarette prices would avert about 24 million premature deaths among the current Chinese male population, with a third among the bottom income quintile, increase additional tax revenues by US$ 46 billion annually, and prevent around 9 million poverty cases, 19% of which among the bottom income quintile. Implementation of smoking bans in workplaces would avert about 12 million premature deaths, with a fifth among the bottom income quintile, decrease tax revenues by US$ 7 billion annually, and prevent around 4 million poverty cases, 12% of which among the bottom income quintile. Conclusions Increased excise taxes on tobacco products and workplace smoking bans can procure large health and economic benefits to the Chinese population, especially among the poor.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gillian Tarr
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Sujata Mishra
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lingrui Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yue Xiao
- China National Health Development Research Center, Beijing, China
| | - Yingpeng Qiu
- China National Health Development Research Center, Beijing, China
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
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Gauvreau CL, Fitzgerald NR, Memon S, Flanagan WM, Nadeau C, Asakawa K, Garner R, Miller AB, Evans WK, Popadiuk CM, Wolfson M, Coldman AJ. The OncoSim model: development and use for better decision-making in Canadian cancer control. ACTA ACUST UNITED AC 2017; 24:401-406. [PMID: 29270052 DOI: 10.3747/co.24.3850] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Canadian Partnership Against Cancer was created in 2007 by the federal government to accelerate cancer control across Canada. Its OncoSim microsimulation model platform, which consists of a suite of specific cancer models, was conceived as a tool to augment conventional resources for population-level policy- and decision-making. The Canadian Partnership Against Cancer manages the OncoSim program, with funding from Health Canada and model development by Statistics Canada. Microsimulation modelling allows for the detailed capture of population heterogeneity and health and demographic history over time. Extensive data from multiple Canadian sources were used as inputs or to validate the model. OncoSim has been validated through expert consultation; assessments of face validity, internal validity, and external validity; and model fit against observed data. The platform comprises three in-depth cancer models (lung, colorectal, cervical), with another in-depth model (breast) and a generalized model (25 cancers) being in development. Unique among models of its class, OncoSim is available online for public sector use free of charge. Users can customize input values and output display, and extensive user support is provided. OncoSim has been used to support decision-making at the national and jurisdictional levels. Although simulation studies are generally not included in hierarchies of evidence, they are integral to informing cancer control policy when clinical studies are not feasible. OncoSim can evaluate complex intervention scenarios for multiple cancers. Canadian decision-makers thus have a powerful tool to assess the costs, benefits, cost-effectiveness, and budgetary effects of cancer control interventions when faced with difficult choices for improvements in population health and resource allocation.
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Affiliation(s)
- C L Gauvreau
- Health Economics, Canadian Partnership Against Cancer, Toronto, ON
| | - N R Fitzgerald
- Health Economics, Canadian Partnership Against Cancer, Toronto, ON
| | - S Memon
- Health Economics, Canadian Partnership Against Cancer, Toronto, ON
| | | | - C Nadeau
- Health Analysis, Statistics Canada, Ottawa, ON
| | - K Asakawa
- Health Analysis, Statistics Canada, Ottawa, ON
| | - R Garner
- Health Analysis, Statistics Canada, Ottawa, ON
| | - A B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - W K Evans
- Department of Oncology, McMaster University, Hamilton, ON
| | - C M Popadiuk
- Faculty of Medicine, Memorial University, St. John's, NL
| | - M Wolfson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - A J Coldman
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC
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Verguet S, Jones EO, Johri M, Morris SK, Suraweera W, Gauvreau CL, Jha P, Jit M. Characterizing measles transmission in India: a dynamic modeling study using verbal autopsy data. BMC Med 2017; 15:151. [PMID: 28793891 PMCID: PMC5550950 DOI: 10.1186/s12916-017-0908-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decreasing trends in measles mortality have been reported in recent years. However, such estimates of measles mortality have depended heavily on assumed regional measles case fatality risks (CFRs) and made little use of mortality data from low- and middle-income countries in general and India, the country with the highest measles burden globally, in particular. METHODS We constructed a dynamic model of measles transmission in India with parameters that were empirically inferred using spectral analysis from a time series of measles mortality extracted from the Million Death Study, an ongoing longitudinal study recording deaths across 2.4 million Indian households and attributing causes of death using verbal autopsy. The model was then used to estimate the measles CFR, the number of measles deaths, and the impact of vaccination in 2000-2015 among under-five children in India and in the states of Bihar and Uttar Pradesh (UP), two states with large populations and the highest numbers of measles deaths in India. RESULTS We obtained the following estimated CFRs among under-five children for the year 2005: 0.63% (95% confidence interval (CI): 0.40-1.00%) for India as a whole, 0.62% (0.38-1.00%) for Bihar, and 1.19% (0.80-1.75%) for UP. During 2000-2015, we estimated that 607,000 (95% CI: 383,000-958,000) under-five deaths attributed to measles occurred in India as a whole. If no routine vaccination or supplemental immunization activities had occurred from 2000 to 2015, an additional 1.6 (1.0-2.6) million deaths for under-five children would have occurred across India. CONCLUSIONS We developed a data- and model-driven estimation of the historical measles dynamics, CFR, and vaccination impact in India, extracting the periodicity of epidemics using spectral and coherence analysis, which allowed us to infer key parameters driving measles transmission dynamics and mortality.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA.
| | - Edward O Jones
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mira Johri
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Suraweera
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
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Homenauth E, Ghiasi M, Feldman L, Arrouf N, Mallya S, Lacombe J, Pichika SC, Zhao K, Aibibula W, Krishnan R, Kajeguka D, Kaaya R, Protopopoff N, Mosha F, Desrochers R, Watts A, Kulkarni M, Saravu K, Nair S, Mukhopadhyay C, George LS, Pai M, Jiang H, Brown P, Blais L, Lefebvre G, Samoilenko M, Kulkarni M, Jolly A, Roy-Gagnon MH, Sander B, Gauvreau CL, Memon S, Popadiuk C, Flanagan WM, Nadeau C, Coldman AJ, Wolfson MC, Miller AB, Acar E, Cox J, Hamelin AM, McLinden T, Klein MB, Brassard P, Chong M, Martin J. The Canadian Society for Epidemiology and Biostatistics 2016 National Student Conference001INVESTIGATING ECOLOGICAL DETERMINANTS OF MALARIA VECTOR DISTRIBUTION IN RURAL TANZANIA “A MULTI-SCALAR INVESTIGATION”002PREVALENCE AND RISK FACTORS OF TUBERCULOSIS INFECTION AMONG HEALTHCARE TRAINEES IN SOUTH INDIA003SPATIAL MODELLING OF LUNG AND THYROID CANCERS IN UNITED STATES COUNTIES004A MEDIATION ANALYSIS TO ASSESS THE IMPACT OF INHALED CORTICOSTEROIDS (ICSS) DURING PREGNANCY ON BIRTHWEIGHT005MODELLING HUMAN RISK OF WEST NILE VIRUS IN ONTARIO, 2002-2013: INCORPORATING SURVEILLANCE AND ENVIRONMENTAL DATA006EXPLORING THE HEALTH OUTCOMES OF VARIOUS PAN-CANADIAN CERVICAL CANCER SCREENING PROGRAMS USING MICROSIMULATION MODELING007INTEGRATIVE ANALYSIS OF MICRORNA AND GENE EXPRESSION DATA USING SPARSE CANONICAL CORRELATION ANALYSIS008CONDITIONAL DEPENDENCE MODELS UNDER COVARIATE MEASUREMENT ERROR009ASSOCIATION BETWEEN FOOD INSECURITY AND HIV VIRAL SUPPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS010ANTIBIOTICS VERSUS APPENDECTOMY FOR UNCOMPLICATED APPENDICITIS: A GLOBAL HEALTH PERSPECTIVE. Am J Epidemiol 2016. [DOI: 10.1093/aje/kww058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gelband H, Sankaranarayanan R, Gauvreau CL, Horton S, Anderson BO, Bray F, Cleary J, Dare AJ, Denny L, Gospodarowicz MK, Gupta S, Howard SC, Jaffray DA, Knaul F, Levin C, Rabeneck L, Rajaraman P, Sullivan T, Trimble EL, Jha P. Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition. Lancet 2016; 387:2133-2144. [PMID: 26578033 DOI: 10.1016/s0140-6736(15)00755-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Investments in cancer control--prevention, detection, diagnosis, surgery, other treatment, and palliative care--are increasingly needed in low-income and particularly in middle-income countries, where most of the world's cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities, 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.
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Affiliation(s)
- Hellen Gelband
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA.
| | | | - Cindy L Gauvreau
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | | | - Anna J Dare
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Sumit Gupta
- Hospital for Sick Children, Toronto, ON, Canada
| | - Scott C Howard
- Health Sciences Center, University of Tennessee, Memphis, TN, USA
| | | | | | | | | | | | - Terrence Sullivan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Popadiuk C, Gauvreau CL, Bhavsar M, Nadeau C, Asakawa K, Flanagan WM, Wolfson MC, Coldman AJ, Memon S, Fitzgerald N, Lacombe J, Miller AB. Using the Cancer Risk Management Model to evaluate the health and economic impacts of cytology compared with human papillomavirus DNA testing for primary cervical cancer screening in Canada. ACTA ACUST UNITED AC 2016; 23:S56-63. [PMID: 26985148 DOI: 10.3747/co.23.2991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Canada, discussion about changing from cytology to human papillomavirus (hpv) dna testing for primary screening in cervical cancer is ongoing. However, the Canadian Task Force on Preventive Health Care has not yet made a recommendation, concluding that the evidence is insufficient. METHODS We used the cervical cancer and hpv transmission models of the Cancer Risk Management Model to study the health and economic outcomes of primary cytology compared with hpv dna testing in 14 screening scenarios with varying screening modalities and intervals. Projected cervical cancer cases, deaths, colposcopies, screens, costs, and incremental cost-effectiveness were evaluated. We performed sensitivity analyses for hpv dna test costs. RESULTS Compared with triennial cytology from age 25, 5-yearly hpv dna screening alone from age 30 resulted in equivalent incident cases and deaths, but 55% (82,000) fewer colposcopies and 43% (1,195,000) fewer screens. At hpv dna screening intervals of 3 years, whether alone or in an age-based sequence with cytology, screening costs are greater, but at intervals of more than 5 years, they are lower. Scenarios on the cost-effectiveness frontier were hpv dna testing alone every 10, 7.5, 5, or 3 years, and triennial cytology starting at age 21 or 25 when combined with hpv dna testing every 3 years. CONCLUSIONS Changing from cytology to hpv dna testing as the primary screening test for cervical cancer would be an acceptable strategy in Canada with respect to incidence, mortality, screening and diagnostic test volumes.
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Affiliation(s)
- C Popadiuk
- Department of Women's Health, Memorial University, St. John's, NL
| | - C L Gauvreau
- Canadian Partnership Against Cancer, Toronto, ON
| | - M Bhavsar
- Canadian Partnership Against Cancer, Toronto, ON
| | | | | | | | | | - A J Coldman
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Memon
- Canadian Partnership Against Cancer, Toronto, ON
| | - N Fitzgerald
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Lacombe
- Canadian Partnership Against Cancer, Toronto, ON
| | - A B Miller
- Dalla Lana School of Public Health, Toronto, ON
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Verguet S, Gauvreau CL, Mishra S, MacLennan M, Murphy SM, Brouwer ED, Nugent RA, Zhao K, Jha P, Jamison DT. The consequences of tobacco tax on household health and finances in rich and poor smokers in China: an extended cost-effectiveness analysis. Lancet Glob Health 2015; 3:e206-16. [PMID: 25772692 DOI: 10.1016/s2214-109x(15)70095-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In China, there are more than 300 million male smokers. Tobacco taxation reduces smoking-related premature deaths and increases government revenues, but has been criticised for disproportionately affecting poorer people. We assess the distributional consequences (across different wealth quintiles) of a specific excise tax on cigarettes in China in terms of both financial and health outcomes. METHODS We use extended cost-effectiveness analysis methods to estimate, across income quintiles, the health benefits (years of life gained), the additional tax revenues raised, the net financial consequences for households, and the financial risk protection provided to households, that would be caused by a 50% increase in tobacco price through excise tax fully passed onto tobacco consumers. For our modelling analysis, we used plausible values for key parameters, including an average price elasticity of demand for tobacco of -0·38, which is assumed to vary from -0·64 in the poorest quintile to -0·12 in the richest, and we considered only the male population, which constitutes the overwhelming majority of smokers in China. FINDINGS Our modelling analysis showed that a 50% increase in tobacco price through excise tax would lead to 231 million years of life gained (95% uncertainty range 194-268 million) over 50 years (a third of which would be gained in the lowest income quintile), a gain of US$703 billion ($616-781 billion) of additional tax revenues from the excise tax (14% of which would come from the lowest income quintile, compared with 24% from the highest income quintile). The excise tax would increase overall household expenditures on tobacco by $376 billion ($232-505 billion), but decrease these expenditures by $21 billion (-$83 to $5 billion) in the lowest income quintile, and would reduce expenditures on tobacco-related disease by $24·0 billion ($17·3-26·3 billion, 28% of which would benefit the lowest income quintile). Finally, it would provide financial risk protection worth $1·8 billion ($1·2-2·3 billion), mainly concentrated (74%) in the lowest income quintile. INTERPRETATION Increased tobacco taxation can be a pro-poor policy instrument that brings substantial health and financial benefits to households in China. FUNDING Bill & Melinda Gates Foundation and Dalla Lana School of Public Health.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Cindy L Gauvreau
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sujata Mishra
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mary MacLennan
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shane M Murphy
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rachel A Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Dean T Jamison
- Global Health Sciences, University of California, San Francisco, CA, USA
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Verguet S, Johri M, Morris SK, Gauvreau CL, Jha P, Jit M. Controlling measles using supplemental immunization activities: a mathematical model to inform optimal policy. Vaccine 2014; 33:1291-6. [PMID: 25541214 PMCID: PMC4336184 DOI: 10.1016/j.vaccine.2014.11.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/17/2014] [Accepted: 11/27/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Measles & Rubella Initiative, a broad consortium of global health agencies, has provided support to measles-burdened countries, focusing on sustaining high coverage of routine immunization of children and supplementing it with a second dose opportunity for measles vaccine through supplemental immunization activities (SIAs). We estimate optimal scheduling of SIAs in countries with the highest measles burden. METHODS We develop an age-stratified dynamic compartmental model of measles transmission. We explore the frequency of SIAs in order to achieve measles control in selected countries and two Indian states with high measles burden. Specifically, we compute the maximum allowable time period between two consecutive SIAs to achieve measles control. RESULTS Our analysis indicates that a single SIA will not control measles transmission in any of the countries with high measles burden. However, regular SIAs at high coverage levels are a viable strategy to prevent measles outbreaks. The periodicity of SIAs differs between countries and even within a single country, and is determined by population demographics and existing routine immunization coverage. CONCLUSIONS Our analysis can guide country policymakers deciding on the optimal scheduling of SIA campaigns and the best combination of routine and SIA vaccination to control measles.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mira Johri
- International Health Unit (USI), University of Montreal Hospital Research Centre (CR-CHUM), Montreal, Québec, Canada; Department of Health Administration, School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Center for Global Health Research, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Cindy L Gauvreau
- Center for Global Health Research, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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