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Jeremy Lauer

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Joe (J.G.) Manning

Yale University

Nicola Masciandaro

Brooklyn College of CUNY

Peter Griffiths

University of Southampton

Zevhinny Umbu Roga

University Of Nusa Cendana

Shuvankar Mukherjee

West Bengal University of Health Sciences

Hadassah-Hebrew University Medical Center

The Hebrew University of Jerusalem

Agnieszka Ługowska

Institute of Psychiatry and Neurology

Camelia Sultana

University of Medicine and Pharmacy "Carol Davila" Bucharest

Karen A Krogfelt

SSI

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Papers by Jeremy Lauer

Improving Lifestyles, Tackling Obesity: The Health and Economic Impact of Prevention Strategies

Overweight and obesity rates have been increasing relentlessly over recent decades in all industr... more Overweight and obesity rates have been increasing relentlessly over recent decades in all industrialised countries, as well as in many lower income countries. OECD analyses of trends over time support the grim picture drawn in the international literature and so do projections of overweight and obesity rates over the next ten years. The circumstances in which people have been leading

Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness

Lancet, 2000

The obesity epidemic is spreading to low-income and middle-income countries as a result of new di... more The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.

Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers

by Sten Zelle, Noor Tromp, and Jeremy Lauer

Cost Effectiveness and Resource Allocation, 2014

Background: The objective of this study was to develop a rating tool for policy makers to priorit... more Background: The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low-and middle-income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. Methods: First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. Results: This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales.

MEASURING OVERALL HEALTH SYSTEM PERFORMANCE FOR 191 COUNTRIES

Breastfeeding patterns and exposure to suboptimal breastfeeding among children in developing countries: Review and analysis of nationally representative surveys

BMC Medicine, 2004

Background: Suboptimal breastfeeding is associated with higher mortality among infants and young ... more Background: Suboptimal breastfeeding is associated with higher mortality among infants and young children in the developing world. We describe patterns in 'exclusive breastfeeding' and 'any breastfeeding' rates and quantify exposure to suboptimal breastfeeding among children aged two years or younger in developing countries.

PopMod: a longitudinal population model with two interacting disease states

Cost effectiveness and resource allocation : C/E, Jan 26, 2003

This article provides a description of the population model PopMod, which is designed to simulate... more This article provides a description of the population model PopMod, which is designed to simulate the health and mortality experience of an arbitrary population subjected to two interacting disease conditions as well as all other "background" causes of death and disability. Among population models with a longitudinal dimension, PopMod is unique in modelling two interacting disease conditions; among the life-table family of population models, PopMod is unique in not assuming statistical independence of the diseases of interest, as well as in modelling age and time independently. Like other multi-state models, however, PopMod takes account of "competing risk" among diseases and causes of death.PopMod represents a new level of complexity among both generic population models and the family of multi-state life tables. While one of its intended uses is to describe the time evolution of population health for standard demographic purposes (e.g. estimates of healthy life ...

World health system performance revisited: the impact of varying the relative importance of health system goals

BMC health services research, Jan 22, 2004

In 2002, the World Health Organization published a health system performance ranking for 191 memb... more In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries. We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives. By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries. Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.

Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment

Public Health Nutrition, 2006

Objective: We estimate attributable fractions, deaths and years of life lost among infants and ch... more Objective: We estimate attributable fractions, deaths and years of life lost among infants and children #2 years of age due to suboptimal breast-feeding in developing countries. Design: We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants #6 months of age and continued breast-feeding for older infants and children # 2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding. Setting: Developing countries. Subjects: Infants and children # 2 years of age. Results: Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242 000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed. Conclusions: The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.

Balancing Equity and Efficiency in Health Priorities in Ghana: The Use of Multicriteria Decision Analysis

by William Bosu, Jeremy Lauer, and Xander Koolman

Value in Health, 2008

To guide the Ministry of Health in Ghana in the priority setting of interventions by quantifying ... more

Screening, prevention and treatment of cervical cancer—A global and regional generalized cost-effectiveness analysis

Vaccine, 2009

The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, ... more

Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

PLoS ONE, 2013

In Peru, a country with constrained health resources, breast cancer control is characterized by l... more In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.

Rates of caesarean section: analysis of global, regional and national estimates

Paediatric and Perinatal Epidemiology, 2007

Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean ... more

Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk

The Lancet, 2003

Background: Cardiovascular disease accounts for much morbidity and mortality in developed countri... more Background: Cardiovascular disease accounts for much morbidity and mortality in developed countries and is becoming increasingly important in less developed regions. Systolic blood pressure above 115 mm Hg accounts for twothirds of strokes and almost half of ischaemic heart disease cases, and cholesterol concentrations exceeding 3·8 mmol/L for 18% and 55%, respectively. We report estimates of the population health effects and costs of selected interventions to reduce the risks associated with high cholesterol concentrations and blood pressure in areas of the world with differing epidemiological profiles.

Measuring quality: from the system to the provider

International Journal for Quality in Health Care, 2001

The literature on quality has often focused on process indicators. In this paper we outline a fra... more The literature on quality has often focused on process indicators. In this paper we outline a framework for describing and measuring the quality of health systems in terms of a set of desirable outcomes. We illustrate how it can be measured using data collected from a recent evaluation of health system performance conducted by the World Health Organization (WHO). We then explore the extent to which this framework can be used to measure quality for all components of the system; for example, regions, districts, hospitals, and providers. There are advantages and disadvantages to defining quality in terms of outcomes rather than process indicators. The advantage is that it focuses the attention of policy makers on whether systems are achieving the desired goals. In fact, without the ability to measure outcomes it is not possible to be sure that process changes actually improve attainment of socially desired goals. The disadvantage is that measuring outcomes at all levels of the system poses some problems particularly related to the sample sizes necessary to measure outcomes. WHO is exploring this, initially in relation to hospitals. The paper discusses two major challenges. The first is the question of attribution, deciding what part of the outcome is due to the component of the system under discussion. The second is the question of timing, including all the effects of current health actions now and in the future.

Titrating Theileria parva: Single stocks against combination of stocks

Experimental Parasitology, 2008

Theileria parva is the causative agent of East Coast fever (ECF), an important cattle disease in ... more Theileria parva is the causative agent of East Coast fever (ECF), an important cattle disease in East and Central Africa. One of the methods for control of ECF is 'infection and treatment', a procedure in which an animal is infected with the live parasite and at the same time treated with a long-acting oxytetracycline formulation, restraining the infection and allowing a protective cellular immune response to develop. Optimal immunizing doses were estimated using models of trichotomous response: dysimmunization (death or severe reaction during immunization), immunization failure (death or severe reaction during lethal challenge) and successful immunization (neither dysimmunization or immunization failure).

Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

Cost Effectiveness and Resource Allocation, 2010

Background: Regional generalized cost-effectiveness estimates of prevention, screening and treatm... more

Ecological study of effect of breast feeding on infant mortality in Latin America

BMJ, 2001

Objective To estimate the effect of exclusive breast feeding and partial breast feeding on infant... more Objective To estimate the effect of exclusive breast feeding and partial breast feeding on infant mortality from diarrhoeal disease and acute respiratory infections in Latin America. Design Attributable fraction analysis of national data on infant mortality and breast feeding. Setting Latin America and the Caribbean. Main outcome measures Mortality from diarrhoeal disease and acute respiratory infections and nationally representative breastfeeding rates. Results 55% of infant deaths from diarrhoeal disease and acute respiratory infections in Latin America are preventable by exclusive breast feeding among infants aged 0-3 months and partial breast feeding throughout the remainder of infancy. Among infants aged 0-3 months, 66% of deaths from these causes are preventable by exclusive breast feeding; among infants aged 4-11 months, 32% of such deaths are preventable by partial breast feeding. 13.9% of infant deaths from all causes are preventable by these breastfeeding patterns. The annual number of preventable deaths is about 52 000 for the region. Conclusions Exclusive breast feeding of infants aged 0-3 months and partial breast feeding throughout the remainder of infancy could substantially reduce infant mortality in Latin America. Interventions to promote breast feeding should target younger infants.

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries

by Chantal Morel, Jeremy Lauer, and Zulfi Bhutta

BMJ, 2005

Objective To determine the costs and effectiveness of selected child health interventions-namely,... more Objective To determine the costs and effectiveness of selected child health interventions-namely, case management of pneumonia, oral rehydration therapy, supplementation or fortification of staple foods with vitamin A or zinc, provision of supplementary food with counselling on nutrition, and immunisation against measles. Design Cost effectiveness analysis. Data sources Efficacy data came from published systematic reviews and before and after evaluations of programmes. For resource inputs, quantities came from literature and expert opinion, and prices from the World Health Organization Choosing Interventions that are Cost Effective (WHO-CHOICE) database Results Cost effectiveness ratios clustered in three groups, with fortification with zinc or vitamin A as the most cost effective intervention, and provision of supplementary food and counselling on nutrition as the least cost effective. Between these were oral rehydration therapy, case management of pneumonia, vitamin A or zinc supplementation, and measles immunisation. Conclusions On the grounds of cost effectiveness, micronutrients and measles immunisation should be provided routinely to all children, in addition to oral rehydration therapy and case management of pneumonia for those who are sick. The challenge of malnutrition is not well addressed by existing interventions.

Comparative efficiency of national health systems

BMJ, 2002

To improve the evidence base for health policy by devising a method to measure and monitor the pe... more To improve the evidence base for health policy by devising a method to measure and monitor the performance of health systems. Estimation of the relation between levels of population health and the inputs used to produce health. 191 countries. Health system efficiency (performance). Estimated efficiency varied from nearly fully efficient to nearly fully inefficient. Countries with a history of civil conflict or high prevalence of HIV and AIDS were less efficient. Performance increased with health expenditure per capita. Increasing the resources for health systems is critical to improving health in poor countries, but important gains can be made in most countries by using existing resources more efficiently.

Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study

by Sten Zelle, Rob Baltussen, and Jeremy Lauer

BMJ, 2012

Objective To determine the costs and health effects of interventions to combat breast, cervical, ... more

Improving Lifestyles, Tackling Obesity: The Health and Economic Impact of Prevention Strategies

Overweight and obesity rates have been increasing relentlessly over recent decades in all industr... more Overweight and obesity rates have been increasing relentlessly over recent decades in all industrialised countries, as well as in many lower income countries. OECD analyses of trends over time support the grim picture drawn in the international literature and so do projections of overweight and obesity rates over the next ten years. The circumstances in which people have been leading

Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness

Lancet, 2000

The obesity epidemic is spreading to low-income and middle-income countries as a result of new di... more The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.

Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers

by Sten Zelle, Noor Tromp, and Jeremy Lauer

Cost Effectiveness and Resource Allocation, 2014

Background: The objective of this study was to develop a rating tool for policy makers to priorit... more Background: The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low-and middle-income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. Methods: First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. Results: This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales.

MEASURING OVERALL HEALTH SYSTEM PERFORMANCE FOR 191 COUNTRIES

Breastfeeding patterns and exposure to suboptimal breastfeeding among children in developing countries: Review and analysis of nationally representative surveys

BMC Medicine, 2004

Background: Suboptimal breastfeeding is associated with higher mortality among infants and young ... more Background: Suboptimal breastfeeding is associated with higher mortality among infants and young children in the developing world. We describe patterns in 'exclusive breastfeeding' and 'any breastfeeding' rates and quantify exposure to suboptimal breastfeeding among children aged two years or younger in developing countries.

PopMod: a longitudinal population model with two interacting disease states

Cost effectiveness and resource allocation : C/E, Jan 26, 2003

This article provides a description of the population model PopMod, which is designed to simulate... more This article provides a description of the population model PopMod, which is designed to simulate the health and mortality experience of an arbitrary population subjected to two interacting disease conditions as well as all other "background" causes of death and disability. Among population models with a longitudinal dimension, PopMod is unique in modelling two interacting disease conditions; among the life-table family of population models, PopMod is unique in not assuming statistical independence of the diseases of interest, as well as in modelling age and time independently. Like other multi-state models, however, PopMod takes account of "competing risk" among diseases and causes of death.PopMod represents a new level of complexity among both generic population models and the family of multi-state life tables. While one of its intended uses is to describe the time evolution of population health for standard demographic purposes (e.g. estimates of healthy life ...

World health system performance revisited: the impact of varying the relative importance of health system goals

BMC health services research, Jan 22, 2004

In 2002, the World Health Organization published a health system performance ranking for 191 memb... more In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries. We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives. By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries. Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.

Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment

Public Health Nutrition, 2006

Objective: We estimate attributable fractions, deaths and years of life lost among infants and ch... more Objective: We estimate attributable fractions, deaths and years of life lost among infants and children #2 years of age due to suboptimal breast-feeding in developing countries. Design: We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants #6 months of age and continued breast-feeding for older infants and children # 2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding. Setting: Developing countries. Subjects: Infants and children # 2 years of age. Results: Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242 000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed. Conclusions: The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.

Balancing Equity and Efficiency in Health Priorities in Ghana: The Use of Multicriteria Decision Analysis

by William Bosu, Jeremy Lauer, and Xander Koolman

Value in Health, 2008

To guide the Ministry of Health in Ghana in the priority setting of interventions by quantifying ... more

Screening, prevention and treatment of cervical cancer—A global and regional generalized cost-effectiveness analysis

Vaccine, 2009

The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, ... more

Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

PLoS ONE, 2013

In Peru, a country with constrained health resources, breast cancer control is characterized by l... more In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.

Rates of caesarean section: analysis of global, regional and national estimates

Paediatric and Perinatal Epidemiology, 2007

Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean ... more

Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk

The Lancet, 2003

Background: Cardiovascular disease accounts for much morbidity and mortality in developed countri... more Background: Cardiovascular disease accounts for much morbidity and mortality in developed countries and is becoming increasingly important in less developed regions. Systolic blood pressure above 115 mm Hg accounts for twothirds of strokes and almost half of ischaemic heart disease cases, and cholesterol concentrations exceeding 3·8 mmol/L for 18% and 55%, respectively. We report estimates of the population health effects and costs of selected interventions to reduce the risks associated with high cholesterol concentrations and blood pressure in areas of the world with differing epidemiological profiles.

Measuring quality: from the system to the provider

International Journal for Quality in Health Care, 2001

The literature on quality has often focused on process indicators. In this paper we outline a fra... more The literature on quality has often focused on process indicators. In this paper we outline a framework for describing and measuring the quality of health systems in terms of a set of desirable outcomes. We illustrate how it can be measured using data collected from a recent evaluation of health system performance conducted by the World Health Organization (WHO). We then explore the extent to which this framework can be used to measure quality for all components of the system; for example, regions, districts, hospitals, and providers. There are advantages and disadvantages to defining quality in terms of outcomes rather than process indicators. The advantage is that it focuses the attention of policy makers on whether systems are achieving the desired goals. In fact, without the ability to measure outcomes it is not possible to be sure that process changes actually improve attainment of socially desired goals. The disadvantage is that measuring outcomes at all levels of the system poses some problems particularly related to the sample sizes necessary to measure outcomes. WHO is exploring this, initially in relation to hospitals. The paper discusses two major challenges. The first is the question of attribution, deciding what part of the outcome is due to the component of the system under discussion. The second is the question of timing, including all the effects of current health actions now and in the future.

Titrating Theileria parva: Single stocks against combination of stocks

Experimental Parasitology, 2008

Theileria parva is the causative agent of East Coast fever (ECF), an important cattle disease in ... more Theileria parva is the causative agent of East Coast fever (ECF), an important cattle disease in East and Central Africa. One of the methods for control of ECF is 'infection and treatment', a procedure in which an animal is infected with the live parasite and at the same time treated with a long-acting oxytetracycline formulation, restraining the infection and allowing a protective cellular immune response to develop. Optimal immunizing doses were estimated using models of trichotomous response: dysimmunization (death or severe reaction during immunization), immunization failure (death or severe reaction during lethal challenge) and successful immunization (neither dysimmunization or immunization failure).

Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

Cost Effectiveness and Resource Allocation, 2010

Background: Regional generalized cost-effectiveness estimates of prevention, screening and treatm... more

Ecological study of effect of breast feeding on infant mortality in Latin America

BMJ, 2001

Objective To estimate the effect of exclusive breast feeding and partial breast feeding on infant... more Objective To estimate the effect of exclusive breast feeding and partial breast feeding on infant mortality from diarrhoeal disease and acute respiratory infections in Latin America. Design Attributable fraction analysis of national data on infant mortality and breast feeding. Setting Latin America and the Caribbean. Main outcome measures Mortality from diarrhoeal disease and acute respiratory infections and nationally representative breastfeeding rates. Results 55% of infant deaths from diarrhoeal disease and acute respiratory infections in Latin America are preventable by exclusive breast feeding among infants aged 0-3 months and partial breast feeding throughout the remainder of infancy. Among infants aged 0-3 months, 66% of deaths from these causes are preventable by exclusive breast feeding; among infants aged 4-11 months, 32% of such deaths are preventable by partial breast feeding. 13.9% of infant deaths from all causes are preventable by these breastfeeding patterns. The annual number of preventable deaths is about 52 000 for the region. Conclusions Exclusive breast feeding of infants aged 0-3 months and partial breast feeding throughout the remainder of infancy could substantially reduce infant mortality in Latin America. Interventions to promote breast feeding should target younger infants.

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries

by Chantal Morel, Jeremy Lauer, and Zulfi Bhutta

BMJ, 2005

Objective To determine the costs and effectiveness of selected child health interventions-namely,... more Objective To determine the costs and effectiveness of selected child health interventions-namely, case management of pneumonia, oral rehydration therapy, supplementation or fortification of staple foods with vitamin A or zinc, provision of supplementary food with counselling on nutrition, and immunisation against measles. Design Cost effectiveness analysis. Data sources Efficacy data came from published systematic reviews and before and after evaluations of programmes. For resource inputs, quantities came from literature and expert opinion, and prices from the World Health Organization Choosing Interventions that are Cost Effective (WHO-CHOICE) database Results Cost effectiveness ratios clustered in three groups, with fortification with zinc or vitamin A as the most cost effective intervention, and provision of supplementary food and counselling on nutrition as the least cost effective. Between these were oral rehydration therapy, case management of pneumonia, vitamin A or zinc supplementation, and measles immunisation. Conclusions On the grounds of cost effectiveness, micronutrients and measles immunisation should be provided routinely to all children, in addition to oral rehydration therapy and case management of pneumonia for those who are sick. The challenge of malnutrition is not well addressed by existing interventions.

Comparative efficiency of national health systems

BMJ, 2002

To improve the evidence base for health policy by devising a method to measure and monitor the pe... more To improve the evidence base for health policy by devising a method to measure and monitor the performance of health systems. Estimation of the relation between levels of population health and the inputs used to produce health. 191 countries. Health system efficiency (performance). Estimated efficiency varied from nearly fully efficient to nearly fully inefficient. Countries with a history of civil conflict or high prevalence of HIV and AIDS were less efficient. Performance increased with health expenditure per capita. Increasing the resources for health systems is critical to improving health in poor countries, but important gains can be made in most countries by using existing resources more efficiently.

Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study

by Sten Zelle, Rob Baltussen, and Jeremy Lauer

BMJ, 2012

Objective To determine the costs and health effects of interventions to combat breast, cervical, ... more