Mark Jit

Chair and Professor of the Department of Global and Environmental Health

Professional overview

Mark Jit is the inaugural chair and a professor in the Department of Global and Environmental Health. He was formerly head of the Department of Infectious Disease Epidemiology & Dynamics and co-director of the Global Health Economics Centre (GHECO) at the London School of Hygiene & Tropical Medicine (LSHTM). He holds honorary appointments at LSHTM as well as the University of Hong Kong (HKU) and the National University of Singapore (NUS).

Dr. Jit’s research focuses on epidemiological and economic modeling of vaccines to support evidence-based public health decision making. He has published papers covering a range of vaccine-preventable or potentially vaccine-preventable diseases including COVID-19, measles, HPV, pneumococcus, rotavirus, influenza, Group B Streptococcus, dengue, EV71 and RSV as well as methodological papers advancing the ways vaccines are evaluated. This work has influenced many of the major changes to immunization policy in countries around the world. Dr. Jit has served on a number of expert advisory committees in the UK as well as for international organizations such as the World Health Organization. He also organises or contributes to academic and professional courses on vaccine modeling, economics and decision science around the world.

Dr. Jit received his BSc and PhD in Mathematics from University College London, specializing in mathematical biology, and a Master of Public Health degree from King’s College London.

Visit Dr. Jit's Google Scholar's page to learn more about his research portfolio.

Education

BSc, Mathematics, University College London

PhD, Mathematics, University College London

MPH, Public Health, King's College London

Honors and awards

Clarivate Highly Cited Researcher (20222023)

Fellow of the Academy of Medical Sciences (2023)

Training Fund Award, Health Protection Agency (2007)

Andrew Rosen Prize, University College London (1999)

Institute of Mathematics and its Applications Award (1998)

Departmental Research Studentship, University College London (1998)

Student Union Commendation, University College London (1997)

Fillon Prize, University College London (1996)

Pathfinder Award, University College London (1995)

Publications

Publications

Economic costs and health-related quality of life for hand, foot and mouth disease (HFMD) patients in China

Zheng, Y., Jit, M., Wu, J. T., Yang, J., Leung, K., Liao, Q., & Yu, H. (n.d.).

Publication year

2017

Journal title

PloS one

Volume

12

Issue

9

10.1371/journal.pone.0184266

Abstract

Abstract

Background: Hand, foot and mouth disease (HFMD) is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China. Method: A telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012–2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication), direct non-medical costs (transportation, nutrition, accommodation and nursery), and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS) were used to calculate associated loss in quality adjusted life years (QALYs). Results: The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215), $1072 (95%CI $999, $1144), $3051 (95%CI $2905, $3197) and $2819 (95%CI $2068, $3571) respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9), 6.9 (95%CI 6.4, 7.4) and 13.7 (95%CI 12.9, 14.5) per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss. Conclusion: HFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.

Impact and cost-effectiveness of selective human papillomavirus vaccination of men who have sex with men

Lin, A., Ong, K. J., Hobbelen, P., King, E., Mesher, D., Edmunds, W. J., Sonnenberg, P., Gilson, R., Bains, I., Choi, Y. H., Tanton, C., Soldan, K., & Jit, M. (n.d.).

Publication year

2017

Journal title

Clinical Infectious Diseases

Volume

64

Issue

5

Page(s)

580-588

10.1093/cid/ciw845

Abstract

Abstract

Background. Men who have sex with men (MSM) have a high lifetime risk of anogenital warts and cancers related to infection with human papillomavirus (HPV). They also benefit less from herd protection than heterosexual males in settings with female-only HPV vaccination. Methods. We evaluated the potential health impact and cost-effectiveness of offering vaccination to MSM who visit genitourinary medicine (GUM) clinics. We used a mathematical model of HPV 6/11/16/18 sexual transmission within an MSM population in England, parameterized with sexual behaviour, GUM attendance, HPV prevalence, HIV prevalence, warts, and cancer incidence data. Interventions considered were offering HPV vaccination to either HIV-positive MSM or MSM regardless of HIV status, for age bands 16-25, 16-30, 16-35, and 16-40 years. Results. Substantial declines in anogenital warts and male HPV-related cancer incidence are projected to occur following an offer of vaccination to MSM. MSM not attending GUM clinics will partially benefit from herd protection. Offering vaccination to HIV-positive MSM up to age 40 is likely to be cost-effective if vaccine procurement and administration costs are below £96.50 a dose. At £48 a dose, offering vaccination to all MSM up to age 40 is likely to be cost-effective. Conclusions. Quadrivalent HPV vaccination of MSM via GUM clinics is likely to be an effective and cost-effective way of reducing the burden of HPV-related disease in MSM.

Mini-review : Can non-human leucocyte antigen genes determine susceptibility to severe dengue syndromes?

Ng, D., Ghosh, A., Jit, M., & Seneviratne, S. L. (n.d.).

Publication year

2017

Journal title

Transactions of the Royal Society of Tropical Medicine and Hygiene

Volume

111

Issue

9

Page(s)

384-392

10.1093/trstmh/trx075

Abstract

Abstract

Dengue viral infections are endemic or epidemic in virtually all tropical countries. Among individuals infected with the dengue virus, severe dengue syndromes (i.e., dengue haemorrhagic fever and dengue shock syndromes) tend to affect only some and this may be due to a combination of host genetic susceptibility and viral factors. In this review article we analyse and discuss the present knowledge of non-human leucocyte antigen host genetic susceptibility to severe dengue syndromes. The relevance of genetic polymorphisms in the pathways of antigen recognition, uptake, processing and presentation, activation of interferon α responses, mast cell and complement activation and T cell activation and dengue disease severity has been reviewed and analysed.

Modelling multi-site transmission of the human papillomavirus and its impact on vaccination effectiveness

Lemieux-Mellouki, P., Drolet, M., Jit, M., Gingras, G., Brisson, M., & Jit, M. (n.d.).

Publication year

2017

Journal title

Epidemics

Volume

21

Page(s)

80-87

10.1016/j.epidem.2017.08.001

Abstract

Abstract

Objective: Previous HPV models have only included genital transmission, when evidence suggests that transmission between several anatomical sites occurs. We compared model predictions of population-level HPV vaccination effectiveness against genital HPV16 infection in women, using a 1) uni-site (genital site), and a 2) multi-site model (genital and one extragenital site). Methods: We developed a uni-site and a multi-site deterministic HPV transmission model, assuming natural immunity was either site-specific or systemic. Both models were calibrated to genital HPV16 prevalence (5%–7.5%), whilst the multi-site model was calibrated to HPV16 prevalence representative of oral (0%–1%) and anal (1%–7.5%) sites. For each model, we identified 2500 parameter sets that fit endemic genital and extragenital prevalences within pre-specified target ranges. In the Base-case analysis, vaccination was girls-only with 40% coverage. Vaccine efficacy was 100% for all sites with lifetime protection. The outcome was the relative reduction in genital HPV16 prevalence among women at post-vaccination equilibrium (RRprev). RRprev was stratified by extragenital prevalence pre-vaccination. Results: Under assumptions of site-specific immunity, RRprev with the multi-site model was generally greater than with the uni-site model. Differences between the uni-site and multi-site models were greater when transmission from the extragenital site to the genital site was high. Under assumptions of systemic immunity, the multi-site and uni-site models yielded similar RRprev in the scenario without immunity after extragenital infection. In the scenario with systemic immunity after extragenital infection, the multi-site model yielded lower predictions of RRprev than the uni-site model. Conclusions: Modelling genital-site only transmission may overestimate vaccination impact if extragenital infections contribute to systemic natural immunity or underestimate vaccination impact if a high proportion of genital infections originate from extragenital infections. Under current understanding of heterosexual HPV transmission and immunity, a substantial bias from using uni-site models in predicting vaccination effectiveness against genital HPV infection is unlikely to occur.

Projecting social contact matrices in 152 countries using contact surveys and demographic data

Prem, K., Cook, A. R., & Jit, M. (n.d.).

Publication year

2017

Journal title

PLoS computational biology

Volume

13

Issue

9

10.1371/journal.pcbi.1005697

Abstract

Abstract

Heterogeneities in contact networks have a major effect in determining whether a pathogen can become epidemic or persist at endemic levels. Epidemic models that determine which interventions can successfully prevent an outbreak need to account for social structure and mixing patterns. Contact patterns vary across age and locations (e.g. home, work, and school), and including them as predictors in transmission dynamic models of pathogens that spread socially will improve the models’ realism. Data from population-based contact diaries in eight European countries from the POLYMOD study were projected to 144 other countries using a Bayesian hierarchical model that estimated the proclivity of age-and-location-specific contact patterns for the countries, using Markov chain Monte Carlo simulation. Household level data from the Demographic and Health Surveys for nine lower-income countries and socio-demographic factors from several on-line databases for 152 countries were used to quantify similarity of countries to estimate contact patterns in the home, work, school and other locations for countries for which no contact data are available, accounting for demographic structure, household structure where known, and a variety of metrics including workforce participation and school enrolment. Contacts are highly assortative with age across all countries considered, but pronounced regional differences in the age-specific contacts at home were noticeable, with more inter-generational contacts in Asian countries than in other settings. Moreover, there were variations in contact patterns by location, with work-place contacts being least assortative. These variations led to differences in the effect of social distancing measures in an age structured epidemic model. Contacts have an important role in transmission dynamic models that use contact rates to characterize the spread of contact-transmissible diseases. This study provides estimates of mixing patterns for societies for which contact data such as POLYMOD are not yet available.

Seropositivity to non-vaccine incorporated genotypes induced by the bivalent and quadrivalent HPV vaccines : A systematic review and meta-analysis

Bissett, S. L., Godi, A., Jit, M., & Beddows, S. (n.d.).

Publication year

2017

Journal title

Vaccine

Volume

35

Issue

32

Page(s)

3922-3929

10.1016/j.vaccine.2017.06.028

Abstract

Abstract

Background Human papillomavirus vaccines have demonstrated remarkable efficacy against persistent infection and disease associated with vaccine-incorporated genotypes and a degree of efficacy against some genetically related, non-vaccine-incorporated genotypes. The vaccines differ in the extent of cross-protection against these non-vaccine genotypes. Data supporting the role for neutralizing antibodies as a correlate or surrogate of cross-protection are lacking, as is a robust assessment of the seroconversion rates against these non-vaccine genotypes. Methods We performed a systematic review and meta-analysis of available data on vaccine-induced neutralizing antibody seropositivity to non-vaccine incorporated HPV genotypes. Results Of 304 articles screened, 9 were included in the analysis representing ca. 700 individuals. The pooled estimate for seropositivity against HPV31 for the bivalent vaccine (86%; 95%CI 78–91%) was higher than that for the quadrivalent vaccine (61%; 39–79%; p = 0.011). The pooled estimate for seropositivity against HPV45 for the bivalent vaccine (50%; 37–64%) was also higher than that for the quadrivalent vaccine (16%; 6–36%; p = 0.007). Seropositivity against HPV33, HPV52 and HPV58 were similar between the vaccines. Mean seropositivity rates across non-vaccine genotypes were positively associated with the corresponding vaccine efficacy data reported from vaccine trials. Conclusions These data improve our understanding of vaccine-induced functional antibody specificity against non-vaccine incorporated genotypes and may help to parameterize vaccine-impact models and improve patient management in a post-vaccine setting.

Social contact patterns relevant to the spread of respiratory infectious diseases in Hong Kong

Leung, K., Jit, M., Lau, E. H., & Wu, J. T. (n.d.).

Publication year

2017

Journal title

Scientific reports

Volume

7

10.1038/s41598-017-08241-1

Abstract

Abstract

The spread of many respiratory infections is determined by contact patterns between infectious and susceptible individuals in the population. There are no published data for quantifying social contact patterns relevant to the spread of respiratory infectious diseases in Hong Kong which is a hotspot for emerging infectious diseases due to its high population density and connectivity in the air transportation network. We adopted a commonly used diary-based design to conduct a social contact survey in Hong Kong in 2015/16 using both paper and online questionnaires. Participants using paper questionnaires reported more contacts and longer contact duration than those using online questionnaires. Participants reported 13 person-hours of contact and 8 contacts per day on average, which decreased over age but increased with household size, years of education and income level. Prolonged and frequent contacts, and contacts at home, school and work were more likely to involve physical contacts. Strong age-assortativity was observed in all age groups. We evaluated the characteristics of social contact patterns relevant to the spread of respiratory infectious diseases in Hong Kong. Our findings could help to improve the design of future social contact surveys, parameterize transmission models of respiratory infectious diseases, and inform intervention strategies based on model outputs.

The impact of influenza on the health related quality of life in China : An EQ-5D survey

Yang, J., Jit, M., Zheng, Y., Feng, L., Liu, X., Wu, J. T., & Yu, H. (n.d.).

Publication year

2017

Journal title

BMC Infectious Diseases

Volume

17

Issue

1

10.1186/s12879-017-2801-2

Abstract

Abstract

Background: Influenza causes considerable morbidity and mortality in China, but its impact on the health-related quality of life (HRQoL) has not been previously measured. Methods: We conducted a retrospective telephone survey to assess the impact of influenza on the HRQoL among outpatients and inpatients using the EuroQoL EQ-5D-3 L instrument. Participants were individuals with laboratory-confirmed influenza infection registered by the National Influenza-like-illness Surveillance Network in 2013. Results: We interviewed 839 of 11,098 eligible influenza patients. After excluding those who were unable to complete the HRQoL for the registered influenza episode, 778 patients were included in the analysis. Both outpatients (n = 529) and inpatients (n = 249) most commonly reported problems with pain/discomfort (71.8% of outpatients and 71.9% of inpatients) and anxiety/depression (62.0% of outpatients and 75.1% of inpatients). For individual influenza outpatients, the mean health utility was 0.6142 (SD 0.2006), and the average quality adjusted life days (QALD) loss was 1.62 (SD 1.84) days. The HRQoL of influenza inpatients was worse (mean health utility 0.5851, SD 0.2197; mean QALD loss 3.51 days, SD 4.25) than that of outpatients (p < 0.05). The presence of underlying medical conditions lowered the HRQoL for both outpatients and inpatients (p < 0.05). Conclusions: Influenza illness had a substantial impact on HRQoL. QALD loss due to an acute influenza episode in younger children was comparable to that due to enterovirus A71-associated hand, foot and mouth disease. Our findings are key inputs into disease burden estimates and cost-effectiveness evaluations of influenza-related interventions in China.

Adding interventions to mass measles vaccinations in India

Johri, M., Verguet, S., Morris, S. K., Sharma, J. K., Ram, U., Gauvreau, C., Jones, E., Jha, P., & Jit, M. (n.d.).

Publication year

2016

Journal title

Bulletin of the World Health Organization

Volume

94

Issue

10

Page(s)

718-727

10.2471/BLT.15.160044

Abstract

Abstract

Objective To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India’s 2010-2013 measles supplementary immunization activity. Methods We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India’s Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets). Findings The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200-79 300), preventing 73 700 child deaths (range: 70 000-79 000) and 300 maternal deaths (range: 200-400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including addon interventions. Conclusion In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality.

Assessing dengue vaccination impact : Model challenges and future directions

Recker, M., Vannice, K., Hombach, J., Jit, M., & Simmons, C. P. (n.d.).

Publication year

2016

Journal title

Vaccine

Volume

34

Issue

38

Page(s)

4461-4465

10.1016/j.vaccine.2016.06.082

Abstract

Abstract

In response to the sharp rise in the global burden caused by dengue virus (DENV) over the last few decades, the WHO has set out three specific key objectives in its disease control strategy: (i) to estimate the true burden of dengue by 2015; (ii) a reduction in dengue mortality by at least 50% by 2020 (used as a baseline); and (iii) a reduction in dengue morbidity by at least 25% by 2020. Although various elements will all play crucial parts in achieving this goal, from diagnosis and case management to integrated surveillance and outbreak response, sustainable vector control, vaccine implementation and finally operational and implementation research, it seems clear that new tools (e.g. a safe and effective vaccine and/or effective vector control) are key to success. The first dengue vaccine was licensed in December 2015, Dengvaxia® (CYD-TDV) developed by Sanofi Pasteur. The WHO has provided guidance on the use of CYD-TDV in endemic countries, for which there are a variety of considerations beyond the risk–benefit evaluation done by regulatory authorities, including public health impact and cost-effectiveness. Population-level vaccine impact and economic and financial aspects are two issues that can potentially be considered by means of mathematical modelling, especially for new products for which empirical data are still lacking. In December 2014 a meeting was convened by the WHO in order to revisit the current status of dengue transmission models and their utility for public health decision-making. Here, we report on the main points of discussion and the conclusions of this meeting, as well as next steps for maximising the use of mathematical models for vaccine decision-making.

Clustering of contacts relevant to the spread of infectious disease

Xiao, X., van Hoek, A. J., Kenward, M. G., Melegaro, A., & Jit, M. (n.d.).

Publication year

2016

Journal title

Epidemics

Volume

17

Page(s)

1-9

10.1016/j.epidem.2016.08.001

Abstract

Abstract

Objective Infectious disease spread depends on contact rates between infectious and susceptible individuals. Transmission models are commonly informed using empirically collected contact data, but the relevance of different contact types to transmission is still not well understood. Some studies select contacts based on a single characteristic such as proximity (physical/non-physical), location, duration or frequency. This study aimed to explore whether clusters of contacts similar to each other across multiple characteristics could better explain disease transmission. Methods Individual contact data from the POLYMOD survey in Poland, Great Britain, Belgium, Finland and Italy were grouped into clusters by the k medoids clustering algorithm with a Manhattan distance metric to stratify contacts using all four characteristics. Contact clusters were then used to fit a transmission model to sero-epidemiological data for varicella-zoster virus (VZV) in each country. Results and discussion Across the five countries, 9–15 clusters were found to optimise both quality of clustering (measured using average silhouette width) and quality of fit (measured using several information criteria). Of these, 2–3 clusters were most relevant to VZV transmission, characterised by (i) 1–2 clusters of age-assortative contacts in schools, (ii) a cluster of less age-assortative contacts in non-school settings. Quality of fit was similar to using contacts stratified by a single characteristic, providing validation that single stratifications are appropriate. However, using clustering to stratify contacts using multiple characteristics provided insight into the structures underlying infection transmission, particularly the role of age-assortative contacts, involving school age children, for VZV transmission between households.

Correction : Routine pediatric Enterovirus 71 vaccination in China: A cost-effectiveness analysis (PLoS Med, (2016), 13, 3, e1001975, 10.1371/journal.pmed.1001975)

Wu, J. T., Jit, M., Zheng, Y., Leung, K., Xing, W., Yang, J., Liao, Q., Cowling, B. J., Yang, B., Lau, E. H., Takahashi, S., Farrar, J. J., Grenfell, B. T., Leung, G. M., Yu, H., & Jit, M. (n.d.).

Publication year

2016

Journal title

PLoS Medicine

Volume

13

Issue

4

10.1371/JOURNAL.PMED.1002013

Abstract

Abstract

The following information is missing from the Funding section: YZ, WX, JY, QL and HY were supported by the TOTAL foundation (no. 2015–099).

Current global pricing for human papillomavirus vaccines brings the greatest economic benefits to rich countries

Herlihy, N., Hutubessy, R., & Jit, M. (n.d.).

Publication year

2016

Journal title

Health Affairs

Volume

35

Issue

2

Page(s)

227-234

10.1377/hlthaff.2015.1411

Abstract

Abstract

Vaccinating females against human papillomavirus (HPV) prior to the debut of sexual activity is an effective way to prevent cervical cancer, yet vaccine uptake in low- and middle-income countries has been hindered by high vaccine prices. We created an economic model to estimate the distribution of the economic surplus-the sum of all health and economic benefits of a vaccine, minus the costs of development, production, and distribution-among different country income groups and manufacturers for a cohort of twelve-year-old females in 2012. We found that manufacturers may have received economic returns worth five times their original investment in HPV vaccine development. Highincome countries gained the greatest economic surplus of any income category, realizing over five times more economic value per vaccinated female than low-income countries did. Subsidizing vaccine prices in lowand middle-income countries could both reduce financial barriers to vaccine adoption and still allow high-income countries to retain their economic surpluses and manufacturers to retain their profits.

Eurogin Roadmap 2015 : How has HPV knowledge changed our practice: Vaccines

Brotherton, J. M., Jit, M., Gravitt, P. E., Brisson, M., Kreimer, A. R., Pai, S. I., Fakhry, C., Monsonego, J., & Franceschi, S. (n.d.).

Publication year

2016

Journal title

International Journal of Cancer

Volume

139

Issue

3

Page(s)

510-517

10.1002/ijc.30063

Abstract

Abstract

This review is one of two complementary reviews that have been prepared in the framework of the Eurogin Roadmap 2015 to evaluate how knowledge about HPV is changing practices in HPV infection and disease control through vaccination and screening. In this review of HPV vaccine knowledge, we present the most significant findings of the past year which have contributed to our knowledge of the two HPV prophylactic vaccines currently in widespread use and about the recently licensed nonavalent HPV vaccine. Whereas anal cancer is dealt with in the companion mini-review on screening, we also review here the rapidly evolving evidence regarding HPV-associated head and neck cancer and priority research areas.

Methodological Challenges to Economic Evaluations of Vaccines : Is a Common Approach Still Possible?

Jit, M., & Hutubessy, R. (n.d.).

Publication year

2016

Journal title

Applied Health Economics and Health Policy

Volume

14

Issue

3

Page(s)

245-252

10.1007/s40258-016-0224-7

Abstract

Abstract

Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker’s stated aims for that spending to achieve.

Methods for Health Economic Evaluation of Vaccines and Immunization Decision Frameworks : A Consensus Framework from a European Vaccine Economics Community

Ultsch, B., Damm, O., Beutels, P., Bilcke, J., Brüggenjürgen, B., Gerber-Grote, A., Greiner, W., Hanquet, G., Hutubessy, R., Jit, M., Knol, M., von Kries, R., Kuhlmann, A., Levy-Bruhl, D., Perleth, M., Postma, M., Salo, H., Siebert, U., Wasem, J., & Wichmann, O. (n.d.).

Publication year

2016

Journal title

PharmacoEconomics

Volume

34

Issue

3

Page(s)

227-244

10.1007/s40273-015-0335-2

Abstract

Abstract

Background: Incremental cost-effectiveness and cost-utility analyses [health economic evaluations (HEEs)] of vaccines are routinely considered in decision making on immunization in various industrialized countries. While guidelines advocating more standardization of such HEEs (mainly for curative drugs) exist, several immunization-specific aspects (e.g. indirect effects or discounting approach) are still a subject of debate within the scientific community. Objective: The objective of this study was to develop a consensus framework for HEEs of vaccines to support the development of national guidelines in Europe. Methods: A systematic literature review was conducted to identify prevailing issues related to HEEs of vaccines. Furthermore, European experts in the field of health economics and immunization decision making were nominated and asked to select relevant aspects for discussion. Based on this, a workshop was held with these experts. Aspects on ‘mathematical modelling’, ‘health economics’ and ‘decision making’ were debated in group-work sessions (GWS) to formulate recommendations and/or—if applicable—to state ‘pros’ and ‘contras’. Results: A total of 13 different aspects were identified for modelling and HEE: model selection, time horizon of models, natural disease history, measures of vaccine-induced protection, duration of vaccine-induced protection, indirect effects apart from herd protection, target population, model calibration and validation, handling uncertainty, discounting, health-related quality of life, cost components, and perspectives. For decision making, there were four aspects regarding the purpose and the integration of HEEs of vaccines in decision making as well as the variation of parameters within uncertainty analyses and the reporting of results from HEEs. For each aspect, background information and an expert consensus were formulated. Conclusions: There was consensus that when HEEs are used to prioritize healthcare funding, this should be done in a consistent way across all interventions, including vaccines. However, proper evaluation of vaccines implies using tools that are not commonly used for therapeutic drugs. Due to the complexity of and uncertainties around vaccination, transparency in the documentation of HEEs and during subsequent decision making is essential.

Modeling the impact of rubella vaccination in Vietnam

Vynnycky, E., Yoshida, L. M., Thanh Huyen, D. T., Trung, N. D., Toda, K., Van Cuong, N., Hong, D. T., Ariyoshi, K., Miyakawa, M., Moriuchi, H., Tho, L. H., Nguyen, H. A., Anh, D. D., Jit, M., & Hien, N. T. (n.d.).

Publication year

2016

Journal title

Human Vaccines and Immunotherapeutics

Volume

12

Issue

1

Page(s)

150-158

10.1080/21645515.2015.1060380

Abstract

Abstract

Supported by GAVI Alliance, measles-rubella vaccination was introduced in Vietnam in 2014, involving a mass campaign among 1–14 year olds and routine immunization of children aged 9 months. We explore the impact on the incidence of Congenital Rubella Syndrome (CRS) during 2013–2050 of this strategy and variants involving women aged 15–35 years. We use an age and sex-structured dynamic transmission model, set up using recently-collected seroprevalence data from Central Vietnam, and also consider different levels of transmission and contact patterns. If the serological profile resembles that in Central Vietnam, the planned vaccination strategy could potentially prevent 125,000 CRS cases by 2050 in Vietnam, despite outbreaks predicted in the meantime. Targeting the initial campaign at 15–35 year old women with or without children aged 9 months–14 years led to sustained reductions in incidence, unless levels of ongoing transmission were medium-high before vaccination started. Assumptions about contact greatly influenced predictions if the initial campaign just targeted 15–35 year old women and/or levels of ongoing transmission were medium-high. Given increased interest in rubella vaccination, resulting from GAVI Alliance funding, the findings are relevant for many countries.

Oral human papillomavirus infection in men who have sex with men : A systematic review and meta-analysis

King, E. M., Oomeer, S., Gilson, R., Copas, A., Beddows, S., Soldan, K., Jit, M., Edmunds, W. J., & Sonnenberg, P. (n.d.).

Publication year

2016

Journal title

PloS one

Volume

11

Issue

7

10.1371/journal.pone.0157976

Abstract

Abstract

Background: The epidemiology of oral human papillomavirus (HPV) infection in men who have sex with men (MSM) differs from anogenital HPV infection. The impact of HPV vaccination has, to date, largely focussed on anogenital outcomes. Vaccination of MSM in the UK has been recommended and, if implemented, baseline estimates of oral HPV prevalence will be useful. Methods: We searched Medline, Embase and psycINFO databases for studies reporting prevalence, incidence, and clearance of oral HPV infection in MSM. We performed a random-effects meta-analysis and meta-regression on prevalence estimates and summarised within-study risk factors for oral HPV DNA detection and incidence/clearance rates. We also performed a meta-analysis of the effect of MSM on oral HPV prevalence compared to heterosexual men. Results: 26 publications were identified. The pooled prevalence of oral HPV16 from twelve estimates was 3.0% (95%CI 0.5-5.5) in HIV-negative and 4.7% (95%CI 2.1-7.3) in HIV-positive MSM. Median age of study participants explained 38% of heterogeneity (p

Population-level impact, herd immunity, and elimination after human papillomavirus vaccination : a systematic review and meta-analysis of predictions from transmission-dynamic models

Brisson, M., Bénard, É., Drolet, M., Bogaards, J. A., Baussano, I., Vänskä, S., Jit, M., Boily, M. C., Smith, M. A., Berkhof, J., Canfell, K., Chesson, H. W., Burger, E. A., Choi, Y. H., De Blasio, B. F., De Vlas, S. J., Guzzetta, G., Hontelez, J. A., Horn, J., … Walsh, C. (n.d.).

Publication year

2016

Journal title

The Lancet Public Health

Volume

1

Issue

1

Page(s)

e8-e17

10.1016/S2468-2667(16)30001-9

Abstract

Abstract

Background Modelling studies have been widely used to inform human papillomavirus (HPV) vaccination policy decisions; however, many models exist and it is not known whether they produce consistent predictions of population-level effectiveness and herd effects. We did a systematic review and meta-analysis of model predictions of the long-term population-level effectiveness of vaccination against HPV 16, 18, 6, and 11 infection in women and men, to examine the variability in predicted herd effects, incremental benefit of vaccinating boys, and potential for HPV-vaccine-type elimination. Methods We searched MEDLINE and Embase for transmission-dynamic modelling studies published between Jan 1, 2009, and April 28, 2015, that predicted the population-level impact of vaccination on HPV 6, 11, 16, and 18 infections in high-income countries. We contacted authors to determine whether they were willing to produce new predictions for standardised scenarios. Strategies investigated were girls-only vaccination and girls and boys vaccination at age 12 years. Base-case vaccine characteristics were 100% efficacy and lifetime protection. We did sensitivity analyses by varying vaccination coverage, vaccine efficacy, and duration of protection. For all scenarios we pooled model predictions of relative reductions in HPV prevalence (RRprev) over time after vaccination and summarised results using the median and 10th and 90th percentiles (80% uncertainty intervals [UI]). Findings 16 of 19 eligible models from ten high-income countries provided predictions. Under base-case assumptions, 40% vaccination coverage and girls-only vaccination, the RRprev of HPV 16 among women and men was 0·53 (80% UI 0·46–0·68) and 0·36 (0·28–0·61), respectively, after 70 years. With 80% girls-only vaccination coverage, the RRprev of HPV 16 among women and men was 0·93 (0·90–1·00) and 0·83 (0·75–1·00), respectively. Vaccinating boys in addition to girls increased the RRprev of HPV 16 among women and men by 0·18 (0·13–0·32) and 0·35 (0·27–0·39) for 40% coverage, and 0·07 (0·00–0·10) and 0·16 (0·01–0·25) for 80% coverage, respectively. The RRprev were greater for HPV 6, 11, and 18 than for HPV 16 for all scenarios investigated. Finally at 80% coverage, most models predicted that girls and boys vaccination would eliminate HPV 6, 11, 16, and 18, with a median RRprev of 1·00 for women and men for all four HPV types. Variability in pooled findings was low, but increased with lower vaccination coverage and shorter vaccine protection (from lifetime to 20 years). Interpretation Although HPV models differ in structure, data used for calibration, and settings, our population-level predictions were generally concordant and suggest that strong herd effects are expected from vaccinating girls only, even with coverage as low as 20%. Elimination of HPV 16, 18, 6, and 11 is possible if 80% coverage in girls and boys is reached and if high vaccine efficacy is maintained over time. Funding Canadian Institutes of Health Research.

Public health impact and cost-effectiveness of the RTS,S/AS01 malaria vaccine : A systematic comparison of predictions from four mathematical models

Penny, M. A., Verity, R., Bever, C. A., Sauboin, C., Galactionova, K., Flasche, S., White, M. T., Wenger, E. A., Van De Velde, N., Pemberton-Ross, P., Griffin, J. T., Smith, T. A., Eckhoff, P. A., Muhib, F., Jit, M., & Ghani, A. C. (n.d.).

Publication year

2016

Journal title

The Lancet

Volume

387

Issue

10016

Page(s)

367-375

10.1016/S0140-6736(15)00725-4

Abstract

Abstract

Summary Background The phase 3 trial of the RTS,S/AS01 malaria vaccine candidate showed modest efficacy of the vaccine against Plasmodium falciparum malaria, but was not powered to assess mortality endpoints. Impact projections and cost-effectiveness estimates for longer timeframes than the trial follow-up and across a range of settings are needed to inform policy recommendations. We aimed to assess the public health impact and cost-effectiveness of routine use of the RTS,S/AS01 vaccine in African settings. Methods We compared four malaria transmission models and their predictions to assess vaccine cost-effectiveness and impact. We used trial data for follow-up of 32 months or longer to parameterise vaccine protection in the group aged 5-17 months. Estimates of cases, deaths, and disability-adjusted life-years (DALYs) averted were calculated over a 15 year time horizon for a range of levels of Plasmodium falciparum parasite prevalence in 2-10 year olds (PfPR2-10; range 3-65%). We considered two vaccine schedules: three doses at ages 6, 7·5, and 9 months (three-dose schedule, 90% coverage) and including a fourth dose at age 27 months (four-dose schedule, 72% coverage). We estimated cost-effectiveness in the presence of existing malaria interventions for vaccine prices of US$2-10 per dose. Findings In regions with a PfPR2-10 of 10-65%, RTS,S/AS01 is predicted to avert a median of 93940 (range 20490-126540) clinical cases and 394 (127-708) deaths for the three-dose schedule, or 116480 (31450-160410) clinical cases and 484 (189-859) deaths for the four-dose schedule, per 100000 fully vaccinated children. A positive impact is also predicted at a PfPR2-10 of 5-10%, but there is little impact at a prevalence of lower than 3%. At $5 per dose and a PfPR2-10 of 10-65%, we estimated a median incremental cost-effectiveness ratio compared with current interventions of $30 (range 18-211) per clinical case averted and $80 (44-279) per DALY averted for the three-dose schedule, and of $25 (16-222) and $87 (48-244), respectively, for the four-dose schedule. Higher ICERs were estimated at low PfPR2-10 levels. Interpretation We predict a significant public health impact and high cost-effectiveness of the RTS,S/AS01 vaccine across a wide range of settings. Decisions about implementation will need to consider levels of malaria burden, the cost-effectiveness and coverage of other malaria interventions, health priorities, financing, and the capacity of the health system to deliver the vaccine. Funding PATH Malaria Vaccine Initiative; Bill & Melinda Gates Foundation; Global Good Fund; Medical Research Council; UK Department for International Development; GAVI, the Vaccine Alliance; WHO.

Rotavirus vaccines contribute towards universal health coverage in a mixed public–private healthcare system

Loganathan, T., Jit, M., Hutubessy, R., Ng, C. W., Lee, W. S., & Verguet, S. (n.d.).

Publication year

2016

Journal title

Tropical Medicine and International Health

Volume

21

Issue

11

Page(s)

1458-1467

10.1111/tmi.12766

Abstract

Abstract

Objectives: To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes. Methods: The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model. Results: We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles. Conclusion: We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency.

Routine Pediatric Enterovirus 71 Vaccination in China : a Cost-Effectiveness Analysis

Wu, J. T., Jit, M., Zheng, Y., Leung, K., Xing, W., Yang, J., Liao, Q., Cowling, B. J., Yang, B., Lau, E. H., Takahashi, S., Farrar, J. J., Grenfell, B. T., Leung, G. M., & Yu, H. (n.d.).

Publication year

2016

Journal title

PLoS Medicine

Volume

13

Issue

3

10.1371/journal.pmed.1001975

Abstract

Abstract

Background: China accounted for 87% (9.8 million/11.3 million) of all hand, foot, and mouth disease (HFMD) cases reported to WHO during 2010–2014. Enterovirus 71 (EV71) is responsible for most of the severe HFMD cases. Three EV71 vaccines recently demonstrated good efficacy in children aged 6–71 mo. Here we assessed the cost-effectiveness of routine pediatric EV71 vaccination in China. Methods and Findings: We characterized the economic and health burden of EV71-associated HFMD (EV71-HFMD) in China using (i) the national surveillance database, (ii) virological surveillance records from all provinces, and (iii) a caregiver survey on the household costs and health utility loss for 1,787 laboratory-confirmed pediatric cases. Using a static model parameterized with these data, we estimated the effective vaccine cost (EVC, defined as cost/efficacy or simply the cost of a 100% efficacious vaccine) below which routine pediatric vaccination would be considered cost-effective. We performed the base-case analysis from the societal perspective with a willingness-to-pay threshold of one times the gross domestic product per capita (GDPpc) and an annual discount rate of 3%. We performed uncertainty analysis by (i) accounting for the uncertainty in the risk of EV71-HFMD due to missing laboratory data in the national database, (ii) excluding productivity loss of parents and caregivers, (iii) increasing the willingness-to-pay threshold to three times GDPpc, (iv) increasing the discount rate to 6%, and (v) accounting for the proportion of EV71-HFMD cases not registered by national surveillance. In each of these scenarios, we performed probabilistic sensitivity analysis to account for parametric uncertainty in our estimates of the risk of EV71-HFMD and the expected costs and health utility loss due to EV71-HFMD. Routine pediatric EV71 vaccination would be cost-saving if the all-inclusive EVC is below US$10.6 (95% CI US$9.7–US$11.5) and would remain cost-effective if EVC is below US$17.9 (95% CI US$16.9–US$18.8) in the base case, but these ceilings could be up to 66% higher if all the test-negative cases with missing laboratory data are EV71-HFMD. The EVC ceiling is (i) 10%–14% lower if productivity loss of parents/caregivers is excluded, (ii) 58%–84% higher if the willingness-to-pay threshold is increased to three times GDPpc, (iii) 14%–19% lower if the discount rate is increased to 6%, and (iv) 36% (95% CI 23%–50%) higher if the proportion of EV71-HFMD registered by national surveillance is the same as that observed in the three EV71 vaccine phase III trials. The validity of our results relies on the following assumptions: (i) self-reported hospital charges are a good proxy for the opportunity cost of care, (ii) the cost and health utility loss estimates based on laboratory-confirmed EV71-HFMD cases are representative of all EV71-HFMD cases, and (iii) the long-term average risk of EV71-HFMD in the future is similar to that registered by national surveillance during 2010–2013. Conclusions: Compared to no vaccination, routine pediatric EV71 vaccination would be very cost-effective in China if the cost of immunization (including all logistical, procurement, and administration costs needed to confer 5 y of vaccine protection) is below US$12.0–US$18.3, depending on the choice of vaccine among the three candidates. Given that the annual number of births in China has been around 16 million in recent years, the annual costs for routine pediatric EV71 vaccination at this cost range should not exceed US$192–US$293 million. Our results can be used to determine the optimal vaccine when the prices of the three vaccines are known.

Seasonal influenza vaccination delivery through community pharmacists in England : Evaluation of the London pilot

Atkins, K., Van Hoek, A. J., Watson, C., Baguelin, M., Choga, L., Patel, A., Raj, T., Jit, M., & Griffiths, U. (n.d.).

Publication year

2016

Journal title

BMJ open

Volume

6

Issue

2

10.1136/bmjopen-2015-009739

Abstract

Abstract

Objective: To evaluate the effectiveness and cost of the pan-London pharmacy initiative, a programme that allows administration of seasonal influenza vaccination to eligible patients at pharmacies. Design: We analysed 2013-2015 data on vaccination uptake in pharmacies via the Sonar reporting system, and the total vaccination uptake via 2011-2015 ImmForm general practitioner (GP) reporting system data. We conducted an online survey of London pharmacists who participate in the programme to assess time use data, vaccine choice, investment costs and opinions about the programme. We conducted an online survey of London GPs to assess vaccine choice of vaccine and opinions about the pharmacy vaccine delivery programme. Setting: All London boroughs. Participants: London-based GPs, and pharmacies that currently offer seasonal flu vaccination. Interventions: Not applicable. Main outcome measures: Comparison of annual vaccine uptake in London across risk groups from years before pharmacy vaccination introduction to after pharmacy vaccination introduction. Completeness of vaccine uptake reporting data. Cost to the National Health Service (NHS) of flu vaccine delivery at pharmacies with that at GPs. Cost to pharmacists of flu delivery. Opinions of pharmacists and GPs regarding the flu vaccine pharmacy initiative. Results: No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data. Conclusions: Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients. However, there is no evidence that vaccination uptake increases and the use of 2 separate recording systems leads to time-consuming data entry and missing vaccine record data.

The economic burden of dengue : no longer invisible or unavoidable

Jit, M. (n.d.).

Publication year

2016

Journal title

The Lancet Infectious Diseases

Volume

16

Issue

8

Page(s)

873-874

10.1016/S1473-3099(16)30001-9

Abstract

Abstract

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The hidden health and economic burden of rotavirus gastroenteritis in Malaysia an estimation using multiple data sources

Loganathan, T., Ng, C. W., Lee, W. S., & Jit, M. (n.d.).

Publication year

2016

Journal title

Pediatric Infectious Disease Journal

Volume

35

Issue

6

Page(s)

601-606

10.1097/INF.0000000000001129

Abstract

Abstract

Background: Rotavirus gastroenteritis (RVGE) results in substantial mortality and morbidity worldwide. However, an accurate estimation of the health and economic burden of RVGE in Malaysia covering public, private and home treatment is lacking. Methods: Data from multiple sources were used to estimate diarrheal mortality and morbidity according to health service utilization. The proportion of this burden attributable to rotavirus was estimated from a communitybased study and a meta-analysis we conducted of primary hospital-based studies. Rotavirus incidence was determined by multiplying acute gastroenteritis incidence with estimates of the proportion of gastroenteritis attributable to rotavirus. The economic burden of rotavirus disease was estimated from the health systems and societal perspective. Results: Annually, rotavirus results in 27 deaths, 31,000 hospitalizations, 41,000 outpatient visits and 145,000 episodes of home-treated gastroenteritis in Malaysia. We estimate an annual rotavirus incidence of 1 death per 100,000 children and 12 hospitalizations, 16 outpatient clinic visits and 57 home-treated episodes per 1000 children under-5 years. Annually, RVGE is estimated to cost US$ 34 million to the healthcare provider and US$ 50 million to society. Productivity loss contributes almost a third of costs to society. Publicly, privately and home-treated episodes consist of 52%, 27% and 21%, respectively, of the total societal costs. Conclusions: RVGE represents a considerable health and economic burden in Malaysia. Much of the burden lies in privately or home-treated episodes and is poorly captured in previous studies. This study provides vital information for future evaluation of cost-effectiveness, which are necessary for policy-making regarding universal vaccination.