Till Seuring awarded at iHEA congress 2017

Dr. Till Seuring, of ebph, recently received the iHEA Student Prize for second place in this year’s competition. The award was established by the International Health Economics Association and has been awarded bi-annually to recognize excellence by students in the field of health economics. The award was conferred for the paper “The relationship between diabetes, employment status and behavioural risk factors: An application of marginal structural models and fixed effects to Chinese panel data”, which looks at the effects of a diabetes diagnosis on employment status as well as health behaviours important to prevent diabetes related complications. The study focused on China, a country facing a large diabetes problem due to an unprecedented increase in diabetes prevalence over the last couple of decades. Findings suggest important differences between men and women, with positive behaviour changes in men and no reduction in their employment chances post diagnosis, while the picture is opposite for women with much more modest behaviour changes and important reductions in their employment chances of about 16%. The paper is not yet published but an earlier version can be accessed as part of Dr. Seurings PhD thesis.


The paper was presented at the bi-annual International Health Economics Association World Congress, held at Boston University, from the 7th to the 11th of July, 2017. It will be available shortly in the form of a video and a link will be posted here.

Dr. Seuring also presented the results of another paper on the labour market impact of diabetes in Mexico, of which an earlier version can be found here. The congress gathers health economists from all over the world presenting cutting-edge research form all areas of health economics.

Challenges in cost-effectiveness analysis modelling of HPV vaccines in LMIC: beyond the Abstract

obinna_e_bips_2Obinna I Ekwunife and Stefan K Lhachimi of EBPH in collaboration with other international researchers – James F. O’Mahony (Ireland), Andreas Gerber Grote (Switzerland), Christoph Mosch (Germany), Tatjana Paeck (Germany) – recently published a systematic review in PharmacoEconomics. The next paragraphs summarize the necessity for the systematic review, the key findings and the recommendations of the authors.

World Health Organization recommended routine HPV vaccination for girls on the condition that vaccination was found to be cost-effective when assessed in the country or region in question [1]. Numerous studies assessing the cost-effectiveness of HPV vaccination have been published for high, middle and low income countries. These studies typically employ decision analytic models as many of the relevant outcomes will occur over periods too long to practically assess within trials. Cost-effectiveness analysis of HPV vaccination for low and middle income countries (LMICs) often use and adapt decision analytic models employed by studies conducted in high income countries.

However, challenges encountered by LMICs in implementing and maintaining a comprehensive cervical cancer prevention strategy make it difficult to anticipate what programme coverage rates and cost of vaccination might be realised. Both are crucial parameters in most decision analytic models of HPV vaccination as they can determine whether vaccination is cost-effective or not. Accordingly, decision analytic models assessing cost-effectiveness of HPV vaccination in LMICs need to account for the distinct challenges that do not apply to high income countries to such an extent if the appropriate policy advice is to be given.

Therefore, the authors conducted a systematic review to assess how context-specific challenges in implementing and maintaining cervical cancer prevention and control strategies in LMICs were accounted for in cost-effectiveness analysis models of human papillomavirus (HPV) vaccination. The review specifically examined the following questions: (1) Does the existing HPV vaccination cost-effectiveness literature acknowledge the particular challenges of LMICs? (2) How were the LMIC-particular challenges accommodated in the models? (3) Is the uncertainty among the parameters that are particularly sensitive to the implementation challenges in LMICs so large that the policy recommendations are affected?

The key findings of the systematic review were that cost per vaccinated girl, vaccine coverage and screening coverage are highly uncertain parameters in model-based cost-effectiveness analysis (CEA) of human papillomavirus (HPV) vaccines in low and middle income countries. These uncertain parameters matter as they can reverse the conclusions regarding cost-effectiveness made by a CEA, thereby altering the resulting policy choice.

The authors’ proposal for refining cost per vaccinated girl estimates for cost-effectiveness analysis model of HPV vaccination in LMICs involves adaptation of HPV vaccine delivery cost from other countries where vaccination has been implemented to the country of study. With regards to vaccination coverage rate, they believe that it will be most appropriate to use previous country-specific vaccine coverage performance as a base case assumption. They propose the use of coverage rates of adolescent catch-up or booster vaccination programme in countries or regions where such programme is in place, such as in the Middle East and North African region [2]. However, in the absence of adolescent vaccination programme, coverage of Diphtheria-Tetanus-Pertusis (DTP3) could serve as a good proxy especially as vaccination coverage with the third dose of DTP vaccines among infants is the main indicator of immunization programmes’ performance and is used as a benchmark to qualify for Vaccine Alliance (Gavi) support [2].   For screening coverage, they recommend the use of cervical cancer screening coverage rate of countries in the same geographical region for analysis assuming an organized national screening or increased future predicted screening. For instance, in the absence of local data African countries could employ the South African screening coverage rate about 20% as the base-case rather than assuming 70% coverage [3].

Futher information

Download the full-text at PharmacoEconomics: Link


1. WHO. Human papillomavirus vaccines. WHO position paper. Weekly Epidemiological Record 2009.

2. Jumaan AO, Ghanem S, Taher J, Braikat M, Al Awaidy S, Dbaibo GS. Prospects and challenges in the introduction of human papillomavirus vaccines in the extended Middle East and North Africa region. Vaccine. 2013;31 Suppl 6:G58-64. doi:10.1016/j.vaccine.2012.06.097.

3. Bruni L B-RL, Albero G, Aldea M, Serrano B, Valence S, Brotons M, Mena M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and Cancer (HPVInformation Centre). Human Papillomavirus and Related Diseases Report: South Africa2015. Report No.: 2015-03-20.

Cochrane review on SSB taxation receives funding from CRSP

Based on 23 review title applications from various Cochrane review groups, the upcoming Cochrane review on SSB taxation led by the ebph – research group was successfully selected in the second round of the Cochrane Review Support Programme (CRSP). The CRSP was established to support upcoming Cochrane reviews with high priority. In the second round of the CRSP, ten review titles were considered in total. The selection was made by an international assessment panel comprising nine Cochrane contributors and users of Cochrane reviews. Contributors of the review are grateful for the upcoming financial support.

Update of ‘Cochrane Priority Review list’ includes Reviews with lead authors from the ebph research group

Two Cochrane Reviews – currently at protocol stage – on the effects of taxation of sugar or sugar added foods and food products high in saturated fat were recently added to the Cochrane Priority Review list, released in May 2016. Prioritisation of Review titles is part of Cochrane’s Strategy to 2020 and identifies either new titles or reviews requiring updates that best meet the needs of healthcare and health policy decision makers. Lead authors from ebph and our international author team welcomes this decision made by Cochrane review groups and other relevant stakeholders involved in this process.

Cochrane Review about Unconditional Cash Transfers published

An international research team—Frank Pega (New Zealand), Sze Yan Liu (USA) Stefan Walter (USA), Prof. Stefan K Lhachimi (Germany)—recently published a Cochrane Review in the research field of Cochrane Public Health about the effects of Unconditional Cash Transfers (UCT).

Unconditional cash transfers (UCTs) for humanitarian assistance during disasters may improve health in low- and middle-income countries (LMICs) by giving recipients additional income.

This review sought to assess the effect of UCTs on health services use, health outcomes, social determinants of health, health care expenditure, and local markets and infrastructure in LMICs. The authors also assessed the effects of UCTs paid in-hand compared with grants of other goods (e.g., food) and types of cash transfers.

The authors sought expert advice, looked for different study types that investigated how UCTs affected the use of health services or health outcomes, and searched academic databases, organisational websites, bibliographies of included studies, and academic journals.

The review included three studies on a total of 13,885 participants (9640 children and 4245 adults) and 1200 households in Nicaragua and Niger. They examined five programmes by governmental, non-governmental or research organisations that gave recipients cash handouts worth USD 145 to USD 250 (or more, depending on household characteristics) as part of a disaster response (in these cases, to droughts). The studies had some serious methodological limitations, so the authors considered the evidence to be of very low quality and very uncertain.

UCTs appeared to contribute to a very small increase in the proportion of children who received vitamin or iron supplements and a beneficial effect on children’s home environment. They may have resulted in a very large reduction in the chance of dying, a moderate reduction in the number of days spent sick in bed, and a large reduction in children’s risk of acute malnutrition. UCTs had no clear effect on the proportion of children who received deworming drugs, children’s height for age, adults’ level of depression, or the quality of parenting behaviour. No adverse effects were identified.The included studies did not examine several important outcomes, including food security and equity impacts.

Compared with grants of food, there was no evidence that a UCT influenced the chance of child death or severe acute malnutrition. Compared with the same UCT paid via mobile phone, a UCT paid in-hand led to a moderate increase in household dietary diversity, but there was no evidence for any effect on social determinants of health, health service expenditure, or local markets and infrastructure.

Additional research is required to reach clear conclusions regarding the effectiveness and relative effectiveness of UCTs in improving health services use and health outcomes in humanitarian disasters in LMICs.

Conclusion: Additional high-quality evidence (especially RCTs of humanitarian disaster contexts other than droughts) is required to reach clear conclusions regarding the regarding the effectiveness and relative effectiveness of UCTs for improving health services use and health outcomes in humanitarian disasters in LMICs.

Futher information

See the full Review on the Cochrane Library: Link
News item from the official Cochrane website: Link

Cochrane Public Health reaches out to Europe

Five institutions from Germany, Austria and Switzerland join forces to establish a European satellite of Cochrane Public Health with the goal of supporting and disseminating the work of Cochrane Public Health in Europe and beyond, and to strengthen European collaboration in public health research.

How should society and politics deal with the rapid increase in overweight and obesity among the general population? Can we justify mandatory vaccination against certain diseases? What regulations are required to address particulate matter air pollution? To find answers to these questions there is a need for specific research in the field of public health as well as transparent and responsible use of the resulting evidence and insights gained.

The Ludwig Maximilians University (LMU) Munich, Cochrane Austria, Cochrane Switzerland, the University of Zurich, the University of Bremen, and the Leibniz Institute for Prevention Research and Epidemiology – BIPS teamed up to strengthen and better coordinate European public health research, and thus to give a strong, evidence-based voice to important societal health issues. This initiative is supported by Cochrane Germany.

Cochrane Public Health Europe is a satellite of Cochrane Public Health situated in Melbourne, Australia, which is one of the over 50 topic-specific working groups within the international research network Cochrane. The network’s central aim is to improve the scientific evidence for health system decisions, in particular through the preparation, maintenance and dissemination of systematic reviews.

Professor Dr Gerald Gartlehner, director of Cochrane Austria and head of the Department for Evidence-based Medicine and Clinical Epidemiology at the Danube University in Krems, states: “Obesity and many other public health challenges are international problems and are best tackled through international cooperation. We will implement global knowledge at the local level.”

A first joint project is the web page “Cochrane Kompakt” (www.cochrane.org/de/kompakt), in which plain language summaries of important reviews are translated into German and made accessible online to anyone interested. “Health information must not be left to commercially motivated groups”, emphasises Dr Erik von Elm, senior researcher at the Institute of Social and Preventive Medicine at the University Hospital Lausanne and co-director of Cochrane Switzerland. “Patients, relatives, or parents have the right to obtain independent and objective information about the effectiveness or potential harms of health interventions. This is what we want to achieve through Cochrane Kompakt.”

“Unlike pharmaceutical interventions, public health approaches are often complex: they may involve combinations of technical, regulatory, and educational measures and must be adapted to the local circumstances”, explains Dr Eva Rehfuess, senior researcher at the Institute for Medical Informatics, Biometry and Epidemiology at LMU who currently coordinates Cochrane Public Health Europe. “In order to correctly determine the effectiveness of these interventions we must have a toolkit of innovative methods. We are addressing this need together, in particular in relation to preparing systematic reviews and appraising the resulting evidence.”

To set the future research agenda of Cochrane Public Health, a list of priority research topics in relation to both content and methods will be prepared. Topics will be identified through interviews with policy makers, health authorities, researchers and patient groups in German-speaking countries. The aim is to identify both knowledge gaps that need to be filled, as well as fields with an overload of information that require structuring. Professor Dr Stefan K. Lhachimi, head of the Research Group for Evidence-Based Public Health at the University of Bremen and BIPS, emphasises: “In order to adapt our research activities to the expectations and needs of our target group, we need to perform an ‘inventory’ of the most pressing public health problems: Where do we lack information and need to know more in order to be able to make informed decisions? Where do we have too much information and require structured knowledge instead?”.

For more information please visit the website of CPH Europe or contact cochranepublichealth@ibe.med.uni-muenchen.de

Download this press release as a .pdf: English version, German version.

Further information
Website of “Cochrane Public Health Europe”: http://ph.cochrane.org/cochrane-public-health-europe?
Website of “Cochrane Kompakt”: http://www.cochrane.org/de/evidence
Website of Cochrane international: http://www.cochrane.org/
Institute for Medical Informatics, Biometry and Epidemiology and Pettenkofer School of Public Health, LMU, Munich: http://www.ibe.med.uni-muenchen.de/
“Research Group for Evidence-Based Public Health”, University of Bremen and BIPS: http://www.ebph.uni-bremen.de/

Ludwig-Maximilians-Universität München
PD Dr. Eva Rehfuess
Institute for Medical Informatics, Biometry and Epidemiology and Pettenkofer School of Public Health, LMU, Munic
Mobile: 0163/6859436
E-Mail: rehfuess@ibe.med.uni-muenchen.de

Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS / Universität Bremen
Prof. Dr. Stefan Lhachimi
Tel.: 0421/218-56919
E-Mail: stefan.lhachimi@uni-bremen.de

Prof. Stefan K. Lhachimi has been appointed to the Third EU Health Programme as an external expert

Professor Stefan K. Lhachimi – head of the research group “Evidence-Based Public Health” at the BIPS and the University of Bremen – has been appointed to the Third EU Health Programme as an external expert by the European Commission. With the EU Health Programme and the support of the EU Agency for consumer health and food (Chafea), the European Commission seeks to implement the EU Health Strategy.

The Third EU Health Programme , for the period 2014 to 2020, has four overarching objectives. It seeks to: promote health, prevent diseases and foster supportive environments for healthy lifestyles taking into account the ‘health in all policies’ principle (1), protect Union citizens from serious cross-border health threats (2), contribute to innovative, efficient and sustainable health systems (3), and facilitate access to better and safer healthcare for Union citizens (4).

Obinna Ekwunife receives Georg Forster Research Fellowship

Obinna Ekwunife received the Georg Forster Research Fellowship to research „Cost effectiveness analysis of primary prevention against secondary prevention of cervical cancer in Nigeria”. The fellowship program aims at faciliating research that benefits the scholars’ home country, carried out in cooperation with a german research institute. Obinna Ekwunife is going to support the ebph research group until late 2015 with Stefan K. Lhachimi being his supervisor.