1 / 20

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

Designing Strategies for Neglected Disease Research: What Innovations Do We Need?. Julia Walsh MD MSc UCB School of Public Health jwalsh@berkeley.edu. What Innovations Do We Need?. Health Interventions Products & Services that promote health

boaz
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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 Source: DCP2.org Male Circumcision 0-7.50 10-40,000 Source: Fieno J; 2008 AIDS Care

  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. From Yach et al., The Global Burden of Chronic Diseases, 291 JAMA 2616 (2004).

  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 Source: Nature 2006; Determining the Global Health Impact of Improved Diagnostic Technologies for the Developing World

  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

More Related