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Search Results: 1 - 10 of 222 matches for " Yoel Lubell "
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Malaria eradication: the economic, financial and institutional challenge
Mills Anne,Lubell Yoel,Hanson Kara
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-s1-s11
Abstract: Malaria eradication raises many economic, financial and institutional challenges. This paper reviews these challenges, drawing on evidence from previous efforts to eradicate malaria, with a special focus on resource-poor settings; summarizes more recent evidence on the challenges, drawing on the literature on the difficulties of scaling-up malaria control and strengthening health systems more broadly; and explores the implications of these bodies of evidence for the current call for elimination and intensified control. Economic analyses dating from the eradication era, and more recent analyses, suggest that, in general, the benefits of malaria control outweigh the costs, though few studies have looked at the relative returns to eradication versus long-term control. Estimates of financial costs are scanty and difficult to compare. In the 1960s, the consolidation phase appeared to cost less than $1 per capita and, in 1988, was estimated to be $2.31 per capita (both in 2006 prices). More recent estimates for high coverage of control measures suggest a per capita cost of several dollars. Institutional challenges faced by malaria eradication included limits to the rule of law (a major problem where malaria was concentrated in border areas with movement of people associated with illegal activities), the existence and performance of local implementing structures, and political sustainability at national and global levels. Recent analyses of the constraints to scaling-up malaria control, together with the historical evidence, are used to discuss the economic, financial and institutional challenges that face the renewed call for eradication and intensified control. The paper concludes by identifying a research agenda covering: ° issues of the allocative efficiency of malaria eradication, especially using macro-economic modelling to estimate the benefits and costs of malaria eradication and intensified control, and studies of the links between malaria control and economic development ° the costs and consequences of the various tools and mixes of tools employed in control and eradication ° issues concerning the extension of coverage of interventions and service delivery approaches, especially those that can reach the poorest ° research on the processes of formulating and implementing malaria control and eradication policies, at both international and national levels ° research on financing issues, at global and national levels.
An Economic Evaluation of Home Management of Malaria in Uganda: An Interactive Markov Model
Yoel Lubell,Anne J. Mills,Christopher J. M. Whitty,Sarah G. Staedke
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012439
Abstract: Home management of malaria (HMM), promoting presumptive treatment of febrile children in the community, is advocated to improve prompt appropriate treatment of malaria in Africa. The cost-effectiveness of HMM is likely to vary widely in different settings and with the antimalarial drugs used. However, no data on the cost-effectiveness of HMM programmes are available.
A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand
Pattara Leelahavarong, Usa Chaikledkaew, Suradej Hongeng, Vijj Kasemsup, Yoel Lubell, Yot Teerawattananon
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-209
Abstract: A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained.Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year.At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.Thalassemia is the most common gene-related hematological disease in Thailand. With a Thai population of 65 million, approximately 40% carry thalassemia traits and about 1% manifest the disease [1]. The incidence of severe thalassemia (i.e. Hb Bart's hydrops fetalis, β-thalassemia, and β-thalassemia/Hb E) is estimated at 4,253 patients per year [1]. Generally patients with severe thalassemia present with anemia at the first year of life. The provision of regular blood transfusion (BT) is standard practice for the treatment of severe thalassemia. Without ongoing BT, these individuals would have an expected life-span of only a few years. However, provision of BT is hampered by a shortage of blood donations, as well as the high cost of blood screening in order to reduce the residual risk of transmission of blood-borne viruses, including h
An interactive model for the assessment of the economic costs and benefits of different rapid diagnostic tests for malaria
Yoel Lubell, Heidi Hopkins, Christopher JM Whitty, Sarah G Staedke, Anne Mills
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-21
Abstract: An interactive model based on a decision-tree structure and a cost-benefit framework was designed to compare different diagnostic strategies. Variables included in the model can be modified by users, including RDT and treatment costs, test accuracies (sensitivity and specificity), probabilities for developing severe illness, case-fatality rates, and clinician response to negative test results. To illustrate how the model can be used, a comparison is made of presumptive treatment with two available RDTs, one detecting histidine-rich protein-2 (HRP2) and one detecting Plasmodium lactate dehydrogenase (pLDH). Data inputs were obtained from a study comparing the RDTs at seven sites in Uganda.Applying the model in the illustrative Ugandan context demonstrates that if only direct expenditures are considered, the pLDH test is the preferred option for adult patients except in high transmission settings, while young children are best treated presumptively in all settings. When health outcomes are considered, the HRP2 test gains an advantage in almost all settings and for all age groups. Introducing possible adverse consequences of using an antimalarial into the analysis, such as adverse drug reactions, or the development of resistance, considerably strengthens the case for using RDTs. When the model is adjusted to account for less than complete adherence to test results, the efficiency of using RDTs drops sharply.Model output demonstrates that which test is preferable varies by location, depending on factors such as malaria transmission intensity and the costs and accuracies of the RDTs under consideration. Despite the uncertainties and complexities involved, adaptable models such as the one presented here can serve as a practical tool to assist policy makers in efficient deployment of new technologies.In sub-Saharan Africa, management of febrile patients is typically characterized by over-prescription of antimalarial drugs [1-4], as clinicians often do not have access to, o
Melioidosis Vaccines: A Systematic Review and Appraisal of the Potential to Exploit Biodefense Vaccines for Public Health Purposes
Sharon J. Peacock equal contributor,Direk Limmathurotsakul equal contributor ,Yoel Lubell,Gavin C. K. W. Koh,Lisa J. White,Nicholas P. J. Day,Richard W. Titball
PLOS Neglected Tropical Diseases , 2012, DOI: 10.1371/journal.pntd.0001488
Abstract: Background Burkholderia pseudomallei is a Category B select agent and the cause of melioidosis. Research funding for vaccine development has largely considered protection within the biothreat context, but the resulting vaccines could be applicable to populations who are at risk of naturally acquired melioidosis. Here, we discuss target populations for vaccination, consider the cost-benefit of different vaccination strategies and review potential vaccine candidates. Methods and Findings Melioidosis is highly endemic in Thailand and northern Australia, where a biodefense vaccine might be adopted for public health purposes. A cost-effectiveness analysis model was developed, which showed that a vaccine could be a cost-effective intervention in Thailand, particularly if used in high-risk populations such as diabetics. Cost-effectiveness was observed in a model in which only partial immunity was assumed. The review systematically summarized all melioidosis vaccine candidates and studies in animal models that had evaluated their protectiveness. Possible candidates included live attenuated, whole cell killed, sub-unit, plasmid DNA and dendritic cell vaccines. Live attenuated vaccines were not considered favorably because of possible reversion to virulence and hypothetical risk of latent infection, while the other candidates need further development and evaluation. Melioidosis is acquired by skin inoculation, inhalation and ingestion, but routes of animal inoculation in most published studies to date do not reflect all of this. We found a lack of studies using diabetic models, which will be central to any evaluation of a melioidosis vaccine for natural infection since diabetes is the most important risk factor. Conclusion Vaccines could represent one strand of a public health initiative to reduce the global incidence of melioidosis.
Strategies for Diagnosis and Treatment of Suspected Leptospirosis: A Cost-Benefit Analysis
Yupin Suputtamongkol ,Wirichada Pongtavornpinyo,Yoel Lubell,Chuanpit Suttinont,Siriwan Hoontrakul,Kriangsak Phimda,Kitti Losuwanaluk,Duangjai Suwancharoen,Saowaluk Silpasakorn,Wirongrong Chierakul,Nick Day
PLOS Neglected Tropical Diseases , 2010, DOI: 10.1371/journal.pntd.0000610
Abstract: Background Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients. Methods The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1) no patients tested or given antibiotic treatment; 2) all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3) lateral flow; 4) MCAT; 5) latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs. Findings Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment. Conclusions Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be the most efficient strategy.
Ethics, Economics, and the Use of Primaquine to Reduce Falciparum Malaria Transmission in Asymptomatic Populations
Yoel Lubell ,Lisa White,Sheila Varadan,Tom Drake,Shunmay Yeung,Phaik Yeong Cheah,Richard J. Maude,Arjen Dondorp,Nicholas P. J. Day,Nicholas J. White,Michael Parker
PLOS Medicine , 2014, DOI: 10.1371/journal.pmed.1001704
Privacy Accountability Model and Policy for Security Organizations  [PDF]
Yoel Raban
iBusiness (IB) , 2012, DOI: 10.4236/ib.2012.42020
Abstract: This paper describes a new model of privacy accountability and associates its dimensions with elements of the proposed European Commission regulation on the protection of individuals with regard to the processing and free movement of personal data. The model is applied to the security industry with special emphasis on the video surveillance and biometrics sectors. The use of the specific dimension and indicators described in the model enables security organizations to provide privacy accountability to customers such that the principles of data protection regulation and self-regulation are met.
Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa
Lubell,Yoel; Riewpaiboon,Arthorn; Dondorp,Arjen M; Seidlein,Lorenz von; Mokuolu,Olugbenga A; Nansumba,Margaret; Gesase,Samwel; Kent,Alison; Mtove,George; Olaosebikan,Rasaq; Ngum,Wirichada Pan; Fanello,Caterina I; Hendriksen,Ilse; Day,Nicholas PJ; White,Nicholas J; Yeung,Shunmay;
Bulletin of the World Health Organization , 2011, DOI: 10.2471/BLT.11.085878
Abstract: objective: to explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets. methods: the costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the african quinine artesunate malaria treatment trial, conducted with over 5400 children. the drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. the data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (daly) averted and the cost per death averted. findings: the mean cost of treating severe malaria patients was similar in the two study groups: 63.5 united states dollars (us$) (95% confidence interval, ci: 61.7-65.2) in the quinine arm and us$ 66.5 (95% ci: 63.7-69.2) in the artesunate arm. children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 dalys per patient; quinine arm: 3.0 dalys per patient). compared with quinine as a baseline, artesunate showed an incremental cost per daly averted and an incremental cost per death averted of us$ 3.8 and us$ 123, respectively. conclusion: artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. the budgetary implications of adopting artesunate for routine use in hospital-based care are negligible.
Estimating the True Accuracy of Diagnostic Tests for Dengue Infection Using Bayesian Latent Class Models
Wirichada Pan-ngum, Stuart D. Blacksell, Yoel Lubell, Sasithon Pukrittayakamee, Mark S. Bailey, H. Janaka de Silva, David G. Lalloo, Nicholas P. J. Day, Lisa J. White, Direk Limmathurotsakul
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0050765
Abstract: Background Accuracy of rapid diagnostic tests for dengue infection has been repeatedly estimated by comparing those tests with reference assays. We hypothesized that those estimates might be inaccurate if the accuracy of the reference assays is not perfect. Here, we investigated this using statistical modeling. Methods/Principal Findings Data from a cohort study of 549 patients suspected of dengue infection presenting at Colombo North Teaching Hospital, Ragama, Sri Lanka, that described the application of our reference assay (a combination of Dengue IgM antibody capture ELISA and IgG antibody capture ELISA) and of three rapid diagnostic tests (Panbio NS1 antigen, IgM antibody and IgG antibody rapid immunochromatographic cassette tests) were re-evaluated using Bayesian latent class models (LCMs). The estimated sensitivity and specificity of the reference assay were 62.0% and 99.6%, respectively. Prevalence of dengue infection (24.3%), and sensitivities and specificities of the Panbio NS1 (45.9% and 97.9%), IgM (54.5% and 95.5%) and IgG (62.1% and 84.5%) estimated by Bayesian LCMs were significantly different from those estimated by assuming that the reference assay was perfect. Sensitivity, specificity, PPV and NPV for a combination of NS1, IgM and IgG cassette tests on admission samples were 87.0%, 82.8%, 62.0% and 95.2%, respectively. Conclusions Our reference assay is an imperfect gold standard. In our setting, the combination of NS1, IgM and IgG rapid diagnostic tests could be used on admission to rule out dengue infection with a high level of accuracy (NPV 95.2%). Further evaluation of rapid diagnostic tests for dengue infection should include the use of appropriate statistical models.
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