Jeroen Luyten

Costing Infectious Disease Outbreaks for Economic Evaluation: A Review for Hepatitis A

AbstractWith the aim to understand and estimate the economic impact of outbreaks of community-acquired infections, we performed a review focusing on hepatitis A outbreaks, and retained 13 papers that had collected relevant cost information during such outbreaks.All costs in this article are expressed in

Public preferences for prioritizing preventive and curative health care interventions: A discrete choice experiment

US, year 2007 values. The costs of hepatitis A outbreaks ranged from

The Social Value Of Vaccination Programs: Beyond Cost-Effectiveness

US140 000 to

The Sexual Ethics of HPV Vaccination for Boys

US36 million, and the costs per case in an outbreak situation ranged from

Imputing QALYs from Single Time Point Health State Descriptions on the EQ-5D and the SF-6D: A Comparison of Methods for Hepatitis A Patients

US3824 to

Cost-effectiveness of hepatitis A vaccination for adults in Belgium

US200 480. These costs were typically found to be substantially higher than estimates from cost-of-illness studies (i.e. costs for sporadic cases) and estimates used in cost-effectiveness analyses, mostly because of costly outbreak-control measures. Post-exposure prophylaxis is a major cost factor, especially for food-borne outbreaks. As a result of the increasing proportion of those susceptible to hepatitis A in low-incidence countries, future outbreaks could, on average, increase in size. The increasing occurrence of hepatitis A cases in outbreak situations and the associated control costs should appropriately be accounted for in economic evaluations of vaccination programmes in low-incidence countries. In order to do this, more studies documenting such outbreak-control strategies in terms of costs and resource use are needed.

Economic evaluation of mental health interventions: an introduction to cost-utility analysis

BACKGROUND Setting fair health care priorities counts among the most difficult ethical challenges our societies are facing. OBJECTIVE To elicit through a discrete choice experiment the Belgian adult populations (18-75 years; N = 750) preferences for prioritizing health care and investigate whether these preferences are different for prevention versus cure. METHODS We used a Bayesian D-efficient design with partial profiles, which enables considering a large number of attributes and interaction effects. We included the following attributes: 1) type of intervention (cure vs. prevention), 2) effectiveness, 3) risk of adverse effects, 4) severity of illness, 5) link between the illness and patients health-related lifestyle, 6) time span between intervention and effect, and 7) patients age group. RESULTS All attributes were statistically significant contributors to the social value of a health care program, with patients lifestyle and age being the most influential ones. Interaction effects were found, showing that prevention was preferred to cure for disease in young adults, as well as for severe and lethal disease in people of any age. However, substantial differences were found in the preferences of respondents from different age groups, with different lifestyles and different health states. CONCLUSIONS Our study suggests that according to the Belgian public, contextual factors of health gains such as patients age and health-related lifestyle should be considered in priority setting decisions. The studies, however, revealed substantial disagreement in opinion between different population subgroups.

Cost-effectiveness of ovarian stimulation with gonadotrophin and clomiphene citrate in an intrauterine insemination programme for subfertile couples

In the current global environment of increased strain on health care budgets, all medical interventions have to compete for funding. Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines. In this article we also argue that socioethical contributions such as effects on health equity, sustaining the public good of herd immunity, and social integration of minority groups are neglected in cost-effectiveness analysis. Evaluations of vaccination programs require broad and multidimensional perspectives that can account for their social, ethical, and economic impact as well as their cost-effectiveness.

egocentric vaccination: the authors reply

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.

0459 Productivity estimation in economic evaluations of occupational health and safety interventions: a systematic review

OBJECTIVES To explore the impact of applying different non-standardized analytical choices for quality of life measurement to obtain quality-adjusted life years (QALYs). In addition to more widely discussed issues such as the choice of instrument (e.g. EQ-5D or SF-6D?) researchers must also choose between different recall periods, scoring algorithms and interpolations between points of measurement. METHODS A prospective survey was made among 114 Belgian patients with acute hepatitis A illness. Using non-parametric tests and generalized linear models (GLMs), we compared four different methods to estimate QALY losses, two based on the EQ-5D (administered during the period of illness without recall period) and two based on the SF-6D (administered after illness with 4 weeks recall period). RESULTS We found statistically significant differences between all methods, with the non-parametric SF-6D-based method yielding the highest median QALY impact (0.032 QALYs). This is more than five times as high as the EQ-5D-based method with linear health improvement, which yields the lowest median QALY impact (0.006 QALYs). CONCLUSIONS Economic evaluations of health care technologies predominantly use QALYs to quantify health benefits. Non-standardised analytical choices can have a decision-changing impact on cost-effectiveness results, particularly if morbidity takes up a substantial part of the total QALY loss. Yet these choices are rarely subjected to sensitivity analysis. Researchers and decision makers should be aware of the influence of these somewhat arbitrary choices on their results.