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Designing Strategies for Neglected Disease Research: What Innovations Do We Need

What Innovations Do We Need? . Health Interventions Products

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Designing Strategies for Neglected Disease Research: What Innovations Do We Need

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    1. Designing Strategies for Neglected Disease Research: What Innovations Do We Need? Julia Walsh MD MSc UCB School of Public Health jwalsh@berkeley.edu

    2. What Innovations Do We Need? Health Interventions Products & Services that promote health How do we promote R&D for New Interventions for the Major Diseases of Poor Countries?

    3. Types of Interventions 1 Health care dependent Drugs Diagnostics Vaccines Others (e.g. male circumcision, behavior change)

    4. Types of Interventions 2 Health care Independent Environment Water, Sanitation Air pollution - Indoor & Outdoor Safety Vector Control Behavior Change Others?

    5. Types of Health Interventions 3 Mechanisms for Health Care Independent Interventions Budget allocation Tax incentives/Disincentives Subsidies Regulations/Laws Information, Education, Communication Research

    6. Myriad Possible Interventions: How set Priorities Goal of the health system - maximize health of the population Limits - scarce resources Decisions and choices necessary Best choice - maximize health with fewest resources Therefore - must compare costs of strategies with outcomes Cost-Effectiveness Analysis

    7. Examples of Cost-Effectiveness Analysis Population 1Million people $10Million available for health investment Two Research Programs A & B both cost $10M Program A will potentially avert 10,000 deaths or $1,000/death averted ($10M/1000deaths) Program B 25,000 deaths or $400/death averted ($10M/25,000) Which is More Cost-effective?

    8. The Amount of Health $1Million Will Buy - Reducing Under-Five Mortality

    9. The Amount of Health $1Million Will Buy HIV Prevention & Treatment

    10. The Amount of Health $1Million Will Buy Noncommunicable Disease

    11. What makes an intervention cost-effective? Averts large number of deaths +/or DALYs Highly Efficacious Very Inexpensive Health care - Easy to use & distribute One or small # doses Heat stable No electricity, technology, maintenance, pure water Use by unskilled health workers Lightweight, easily carried to homes or rural clinics Feasible in poor countries (?regulations against use of trans fats?) More cost-effective than the next best intervention for that condition

    12. Focus on high mortality countries Feasible interventions Focus on high mortality countries Feasible interventions

    13. For what causes of death are better interventions needed in LDC: Respiratory Infections HIV Perinatal Conditions Diarrheal Diseases TB Childhood Diseases ???? Malaria Maternal Conditions

    14. Health Care Interventions Infectious Diseases & childhood illness control usually most cost-effective Biotechnologies Diagnostic tests Vaccines Treatments Others e.g., preventive measures Microbicides Female condoms

    15. Priorities for Development of New Diagnostics Gates Process: Health impact Market potential & demand Willingness to Pay Clients, donors, governments

    16. Gates Priorities for New Diagnostics Health Impact - No DALYs! Tuberculosis Sexually transmitted Infections in women In Comercial Sex Workers: Gonorrhea & Chlamydia In antenatal care: Syphilis Malaria in Children Acute Lower Repiratory Tract Infections in Children Bacterial etiology & needing antibiotics Severe disease requiring hospitalization HIV in infants Stunting in children: Enteroaggregative E.coli, Giardia lamblia, Cryptosporidium parvum

    17. Vaccines for the 21st Century: A Tool for DecisionMaking Institute of Medicine 2000 US Based Method: Cost-effectiveness assessment of health benefits vs. costs of care Assumption of availability within 20 years

    18. Results IOM Vaccines for 21st Century Level I Most Favorable Saves $ & QALYs Cytomegalovirus administered to 12 year olds Influenza virus vaccine for the general population (once per person every 5 year or 20% of the population per year) Insulin-dependent diabetes mellitus therapeutic vaccine Multiples sclerosis therapeutic vaccine Rheumatoid arthritis therapeutic vaccine Group B Strep vaccine for pregnant women and high risk Streptococcus pneumonia vaccine for infants and elderly

    19. Health Impact of Tropical Diseases trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, intestinal nematode infections, Japanese encephalitis, dengue, and leprosy TOTAL 177,000 deaths worldwide in 2002, mostly in sub-Saharan Africa, 20 million DALYs, or 1.3% of the global burden of disease and injuries.

    20. Conclusion Many new health innovations will save lives and DALYs/QALYs Work on the big problems

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