Studies of the costs and effects of national prevention programmes such as vaccination campaigns could be significantly improved by using other calculation models. That’s what PhD student Robin de Vries writes in his thesis. The health economist, who will be awarded a PhD by the University of Groningen in early January, compared the results achieved with various types of models.
Pressure on health budgets is immense and is increasing. That means that the decisions on how to spend the available money are not only becoming more important, but also more complicated. In academia, ‘health economics’ is the science that studies these choices. ‘Pharmacoeconomics’ is that part of this science that concentrates exclusively on medications.
Partly due to budgetary pressures, in recent years the demand for such pharmacoeconomics evaluations has increased sharply. The results of these studies are also being included in national and international decision-making on implementation, reimbursement or inclusion in guidelines. Since 2005, for example, manufacturers in the Netherlands must present a thorough pharmacoeconomic analysis before a medication can be considered for placement on list 1B of the drugs reimbursement system (GVS).
In his thesis ‘Health-economics of interventions aimed at infectious diseases: dynamic modeling inevitable for reliable medical decision-making’, Robin de Vries closely examined various types of models to estimate the cost-effectiveness of medical interventions designed for infectious diseases. This included the introduction of new medication and vaccination campaigns within the framework of national prevention programmes.
De Vries differentiates between static and dynamic models. According to the PhD researcher, the former are eminently suitable for many cost-effectiveness analyses. However, De Vries also proves that these static models for health economics evaluations are not very suitable for evaluating vaccination campaigns against infectious diseases. This is because the illnesses can be transferred from one person to another and that makes a health economics analysis much more complicated. De Vries: ‘With vaccination, so-called herd immunity effects can emerge – vaccination can indirectly ensure that non-vaccinated people are also protected, and thus the illness spreads much less swiftly.’ De Vries emphasizes that dynamic models are then able to chart the cost-effectiveness much more accurately.
When estimating the cost-effectiveness of, for example, vaccination campaigns, static models tend to be what are used. This is also true for the Netherlands. That could have far-reaching consequences for decision-making related to reimbursement or implementation of interventions for infectious diseases, states De Vries. ‘They can sometimes be based on a possibly incorrect estimation of the cost-effectiveness’, he explains. ‘Static models may be attractive due to their black-and-white approach, but sometimes a much more complex dynamic model is unavoidable.’
According to De Vries, the conclusions of his research are important for institutions who are responsible for decision-making in the field of medication reimbursement, such as the Ministry of Health, the Healthcare Insurance Board (CVZ) and the Health Council.
De Vries believes that the national guidelines for pharmacoeconomics research must be adapted. In addition, he has drawn up a step-by-step plan for choosing the right method for every situation. De Vries: ‘Due to the herd immunity effects, infectious diseases need a unique approach. Before you can get reliable results and thus correct policy implementation, it’s crucial to dynamically model these illnesses.’
De Vries comments that no cost-effectiveness analysis was performed in advance of the recent vaccination campaign against the spread of H1N1, or swine flu. ‘The government had to act fast’, he explains. ‘In addition, other factors played a role, including public opinion, the international situation and a sense of better safe than sorry.’ Nevertheless, according to De Vries it is always worth doing a health economics analysis: ‘Money can only be spent once, and so it’s important to achieve as much health benefit as possible.’
Robin de Vries (Zwolle, 1979) studied pharmacy at the University of Groningen. He will be awarded a PhD on 8 January 2010 with a thesis entitled Health-economics of interventions aimed at infectious diseases: dynamic modeling inevitable for reliable medical decision making. De Vries conducted his research at the unit of Pharmacoepidemiology & Pharmacoeconomics of the department of Pharmacy. His supervisors were Prof. M.J. Postma and Prof. L.T.W. de Jong-Van den Berg. De Vries currently works for the same department.
More information: Robin de Vries, tel. 050-3638707, e-mail: firstname.lastname@example.org
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