Cost-effectiveness of controlling infectious diseases from a public health perspective

PhD ceremony: Ms. A.K. Krabbe Lugnér, 14.45 uur, Academiegebouw, Broerstraat 5, Groningen

Title: Cost-effectiveness of controlling infectious diseases from a public health perspective

Promoter(s): prof. M.J. Postma

Faculty: Mathematics and Natural Sciences

In her thesis Anna Krabbe Lugnér investigated the cost-effectiveness of public health interventions in the Netherlands against three specific infectious diseases: pandemic influenza, rubella and pertussis. She developed a dynamic transmission model for the pandemic influenza preparedness planning and applied to possible interventions during a pandemic that could cause a high number of infections and deaths. Her results showed that both vaccination and treatment with antiviral drugs were cost-effective when targeted at reducing the transmission and the complications of illness. The cost-effectiveness of stockpiling antiviral drugs to use during a pandemic depended heavily on the probability of a pandemic outbreak. In comparing the cost-effectiveness of different vaccination strategies, it was shown by Krabbe Lugnér that already existing immunity among elderly affects the cost-effectiveness and changes the preferred strategy, partly due to the reduced transmission. The importance of external effects of vaccination was shown, entailing protection of non-vaccinated individuals due to less circulation and transmission of an infection. In regions with a low-vaccination-rate, outbreaks of vaccine-preventable infectious diseases, such as rubella, can cause considerable illness. Krabbe Lugnér has also investigated the cost-effectiveness of a screening and vaccination program against rubella. In low-vaccination-rate regions, this program could be a cost-effective means to prevent complications in unborn babies. The final example was an economic evaluation of a pertussis-booster vaccination in four-year-olds. This vaccination strategy was not evidently cost-effective, although it has reduced the number of pertussis infections overall. Krabbe Lugnér concludes that to validly underpin improvements of public-resource allocations, the external effects of vaccination need to be included in economic evaluations.