This website has not been actively maintained since April 2019, as the ebph research group’s project funding has expired. Since some of the group’s projects are still being finalised, this page remains online to document the group’s work (including publications). If you would like to contact former researchers about completed or ongoing ebph research projects, please find below a list of former members and links to their current institutions (last update: 10/2019):
Johanna-Katharina Schönbach and Stefan K Lhachimi of EBPH recently published an article about potential population health effects following a tax on processed meat. They collaborated with Silke Thiele from the ife Institute of Food Economics, Germany.
The research was motivated by a report, in which the International Agency for Research on Cancer (IARC) classified processed meat as being carcinogenic to humans (Bouvard et al., 2015; IARC Working Group on the Evaluation of Carcinogenic Risk to Humans, 2018). At the same time, the World Health Organization (WHO) found fiscal policies to have considerable potential for promoting healthier diets, whereby evidence was strongest for taxes on sugar-sweetened beverages as well as subsidies for fresh fruits and vegetables (World Health Organization, 2015, 2016). In contrast, there was no evidence for expected health impacts of fiscal policies on processed meat, except for a study which modelled potential effects on cardiometabolic disease deaths following a 10% and 30% price increase for processed meat in the U.S. (Penalvo et al., 2017).
Against this background, Johanna-Katharina Schönbach, Silke Thiele and Stefan K Lhachimi conducted an health impact assessment in order to model to what extent different tax rates on processed meat can potentially improve population health (with regard to prevalent cases of IHD, diabetes, colorectal cancer and deaths) for the European context, using the example of Germany. They found that in projection year 10, an extra 9,300 males and 4,500 females would be alive under the lowest tax scenario (4% tax), compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases in males would be 8,400, 9,500 and 500 lower, respectively, and there would be 4,600, 7,800 and 300 fewer cases in females. Under the highest tax scenario (33.3% tax), an extra 76,700 males and 37,100 females would be alive, compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases would be 70,800, 77,900 and 4,900 lower in males and 29,900, 48,900 and 2,300 lower in females.
Rapid reviews have become a pragmatic alternative to traditional Systematic Reviews by streamlining methodological processes such as literature searches, aiming for faster provision of decision-relevant information to stakeholders within the healthcare sector and health decision making in general. The concordance of treatment effect estimates obtained from abbreviated (as conducted in rapid reviews with searches limited to major bibliographic databases, e.g. MEDLINE) and comprehensive literature searches (as performed in Cochrane systematic reviews and widely considered to be the benchmark) is unknown. Under the lead of Barbara Nußbaumer-Streit (co-director of Cochrane Austria), Thomas L Heise and Stefan K Lhachimi from the ebph-research group as well as other members of Cochrane Rapid Reviews and Cochrane Public Health Europe investigated this methodological research question by including 60 randomly selected Cochrane reviews and applying 14 different abbreviated search strategies (overall sample n = 840) to determine changes in conclusions of main results. To be more precise, the non-inferiority of abbreviated searches compared to original searches of Cochrane reviews was assessed. The main study findings got recently published in the Journal of Clinical Epidemiology. When falsely an opposite conclusion was of concern, combining one database with another (e.g. MEDLINE and CENTRAL) or with searches of reference lists was non-inferior to comprehensive searches as performed in the original Cochrane reviews. However, none of the abbreviated search approaches led to the overall quality of the original comprehensive search approaches, resulting in deviation of the main conclusions that were based on effect estimates of re-calculated meta-analyses. Decisions demanding high certainty should still require comprehensive searches. Nevertheless, some abbreviated searches represent viable options for rapid evidence synthesis.
In April 2018 Prof Stefan K Lhachimi was announced as one of the new Academic Editors for PLOS ONE – the world’s first multidisciplinary Open Access journal. Amongst other research topics, the scientific journal focuses on publishing medical and social sciences research featuring a rigorous peer-review evaluation process. PLOS ONE is an online-only journal published by the Public Library of Science since 2006. According to the InCites Journal Citation Reports articles of PLOS ONE are cited annually more than half a million times. Prof Stefan K. Lhachimi is currently the head of the ebph-Research Group for Evidence-based Public Health, a joint collaboration project between the Leibniz Institute for Epidemiology and Prevention Research (BIPS) and the Institute for Public Health and Nursing Research (IPP) of the University of Bremen. He is engaged in policy-focused research of life-style related risk-factors, population health modelling, and health economics.
General journal information about PLOS ONE: Link
Two principles can generally be distinguished to fight poverty: unconditional or conditional programmes. Among those approaches, unconditional cash transfers (UCTs) are cash payments provided to financially disadvantaged people that do not require them to do anything in return. Governments in low and middle-income countries increasingly use these cash transfers to reduce poverty or other vulnerabilities. In 2011, somewhere between 800 million and 1 billion people in these countries received some form of cash transfer. Policy makers have noted that these income-boosting interventions might be used to improve the health of disadvantaged populations, if they were found to be effective for this purpose. Former Secretary-General of the United Nations Ban Ki-moon put emphasis on this topic during the World Humanitarian Summit in Istanbul in 2016. Within so-called „cash transfer programmes“ cash is either indirectly (e.g. vouchers) or directly provided to recipients.
Unconditional cash transfers can be used quite flexible by recipients, this ranges from buying food, clothes, or construction material to paying school fees or transport costs.
An international research team with researchers from New Zealand, the US, and Germany compared outcomes among people who received cash transfers versus those who did not receive them. They found twenty-one studies that had included a total of more than one million participants living in Africa, the Americas, and Southeast Asia. The studies covered 17 different cash transfer programs, and almost all were large cluster randomized trials. Unfortunately, though, most of the studies had a high risk of bias.
Eleven studies were combined in a quantitative meta-analyses. This body of evidence suggests that unconditional cash transfers probably do not impact on a summary measure of health service use. However, they might improve some health outcomes. For example, an unconditional cash transfer probably reduces the odds of having had any illness in the last two to twelve weeks by an estimated 27%. Professor Dr Stefan K. Lhachimi, head of the Research Group for Evidence-Based Public Health at the University of Bremen and BIPS and one of the review authors, was quoted by The Guardian recently: “This is a large and clinically meaningful reduction”.
There is some evidence, although low quality, that suggests unconditional cash transfers might also improve food security and dietary diversity. The review team also found that they probably improved one social determinant of health, namely increased school attendance; and increased the amount of money recipients spent to purchase healthcare. In conclusion, while unconditional cash transfers probably did not impact the use of health services, they probably improved some health outcomes, school attendance, and health care expenditures.
See the full Review on the Cochrane Library: Link
News item from the official Cochrane website including a Podcast: Link
A German translation of the “Plain Language Summary” via Cochrane Kompakt: Link
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.
Obinna 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 . 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 . 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 . 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 .
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.
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.
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.
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.