Economic evaluations: health interventions in Bangladesh

Cost Effectiveness and Resource Allocation
(accessed 25 July 2011)
http://www.resource-allocation.com/

Review
A systematic review of economic evaluations of health and health-related interventions in Bangladesh
Hoque ME, Khan JAM, Hossain SSA, Gazi R, Rashid H, Koehlmoos TP and Walker DG Cost Effectiveness and Resource Allocation 2011, 9:12 (20 July 2011)

Abstract (provisional)
Background
Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh.

Methods
Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Result: Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER). Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context.

Conclusion
Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis of knowledge in the area. The most frequently applied economic evaluation is cost-effectiveness analysis. The majority of the studies did not follow the scientific method of economic evaluation process, which consequently resulted into lack of robustness of the analyses. Capacity building on economic evaluation of health and health-related programs should be enhanced.

Europe’s neglected infections of poverty

International Journal of Infectious Diseases
http://www.sciencedirect.com/science/journal/12019712

[In Press]
Europe’s neglected infections of poverty
In Press, Corrected Proof, Available online 16 July 2011
Peter J. Hotez, Meredith Gurwith

Summary
Objectives
To review the prevalence, incidence, and geographic distribution of the major neglected infections of poverty in Europe as a basis for future policy recommendations.

Methods
We reviewed the literature from 1999 to 2010 for neglected tropical diseases listed by PLoS Neglected Tropical Diseases (http://www.plosntds.org/static/scope.action) and the geographic regions and countries of (continental) Europe. Reference lists of identified articles and reviews were also hand searched, as were World Health Organization databases.

Results
In Eastern Europe, the soil-transmitted helminth infections (especially ascariasis, trichuriasis, and toxocariasis), giardiasis, and toxoplasmosis remain endemic. High incidence rates of selected food-borne helminthiases including trichinellosis, opisthorchiasis, taeniasis, and echinococcosis also occur, while brucellosis and leptospirosis represent important bacterial zoonoses. Turmoil and economic collapse following the war in the Balkans, the fall of Communism, and Europe’s recent recession have helped to promote their high prevalence and incidence rates. In Southern Europe, vector-borne zoonoses have emerged, including leishmaniasis and Chagas disease, and key arboviral infections. Additional vulnerable populations include the Roma, orphans destined for international adoption, and some immigrant groups.

Conclusions
Among the policy recommendations are increased efforts to determine the prevalence, incidence, and geographic distribution of Europe’s neglected infections, epidemiological studies to understand the ecology and mechanisms of disease transmission, and research and development for new control tools.

Comment: The vaccine paradox

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Comment
The vaccine paradox
Richard Horton, Pamela Das

Preview
The next decade will likely bring astonishing successes in vaccine biology, discovery, and delivery. Justifiable confidence in this proposition led the Bill & Melinda Gates Foundation last year to pledge US$10 billion to a new Decade of Vaccines. For the world’s largest and most influential health foundation, vaccines are the number one priority. The foundation estimates that if vaccine coverage could be scaled up to 90%, the lives of 7·6 million children younger than 5 years could be saved between 2010 and 2019.

Comment: A call to action for the new decade of vaccines

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Comment
A call to action for the new decade of vaccines
E Richard Moxon, Pamela Das, Brian Greenwood, David L Heymann, Richard Horton, Orin S Levine, Stanley Plotkin, Gus Nossal

Preview
No medical intervention has such an unambiguous track record of preventing morbidity and mortality from infectious diseases than that of vaccines.1 The type of vaccine-preventable diseases ranges from the acute (eg, measles or meningitis) to the chronic (eg, liver and cervical cancers). Further reduction of deaths and disability from infections remains a major challenge. Few would deny that there is a moral imperative to make vaccines widely available on an equitable basis, but governments are frustratingly slow to grasp a different and compelling argument: vaccines create wealth.

Editorial: Time to mandate influenza vaccination in health-care workers

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Perspectives
Time to mandate influenza vaccination in health-care workers
Arthur Caplan

Preview
Earlier this year, I had the opportunity to chat with David Salisbury, National Director for Immunisation at the UK’s Department of Health. He told me how proud he was of the success that had been achieved in getting people living in the UK to get their influenza shots. I mentioned that one group that had proven very tough to vaccinate in the USA was health-care workers. He rolled his eyes and confided that doctors in the UK were a hard lot to get vaccinated as well…

Lancet Series – The next decade of vaccines: societal and scientific challenges

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Series
The next decade of vaccines: societal and scientific challenges
E Richard Moxon, Claire-Anne Siegrist

Summary
Vaccines against microbial diseases have improved the health of millions of people. In the next decade and beyond, many conceptual and technological scientific advances offer extraordinary opportunities to expand the portfolio of immunisations against viral and bacterial diseases and to pioneer the first vaccines against human parasitic and fungal diseases. Scientists in the public and private sectors are motivated as never before to bring about these innovations in immunisation. Many societal factors threaten to compromise realisation of the public health gains that immunisation can achieve in the next decade and beyond—understanding these factors is imperative. Vaccines are typically given to healthy individuals and safety issues loom high on the list of public concerns. The public needs to regain confidence in immunisation and trust the organisations responsible for the research, development, and implementation of vaccines. In the past, by use of a judicious amalgam of knowledge and empiricism, successful vaccines were largely developed by microbiologists who identified antigens that induced immune responses to conserved pathogen components. In the future, vaccines need to be developed against deadly diseases for which this strategy is often not feasible because of the extensive antigenic variability of relevant pathogens. High microbial diversity means that immunity after natural infection is often ineffective for prevention of disease on subsequent exposure, for example in HIV infection and malaria. Additionally, vaccines need to be generated to protect the people who are most vulnerable because of age or underlying diseases. Thus, in the future, a much deeper understanding of the immunological challenges—including the diversifying role of host genetics and environmental factors, leading perhaps to more personalised approaches—will be the touchstone for rational design and development of adjuvants that result in novel safe and effective vaccines.

Lancet Series: Vaccine discovery and translation of new vaccine technology

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Series
Vaccine discovery and translation of new vaccine technology
Rino Rappuoli, Steven Black, Paul Henri Lambert

Summary
An unprecedented increase in new vaccine development has occurred over the past three decades. This activity has resulted in vaccines that protect against an increased range of vaccine-preventable diseases, vaccines that reduce the number of required injections, and vaccines with improved safety and purity. New methods of discovery, such as reverse vaccinology, structural biology, and systems biology, promise new vaccines for different diseases and efficient development pathways for these vaccines.    We expect development of vaccines not only for infectious diseases in children but also for healthy adults, pregnant women, and elderly people, and for new indications such as autoimmune disease and cancer. We have witnessed a concomitant development of new technology for assessment of vaccine safety to rapidly identify potential safety issues. Success of these new approaches will depend on effective implementation of vaccination programmes, creative thinking on the part of manufacturers and regulators as to how best to ensure that safe and effective vaccines are available in a timely manner, and improvement of public awareness about the benefits and risks of new vaccines in a way that encourages confidence in vaccines.