Mark Jit
Mark Jit
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Chair and Professor of the Department of Global and Environmental Health
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Professional overview
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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.
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Education
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BSc, Mathematics, University College LondonPhD, Mathematics, University College LondonMPH, Public Health, King's College London
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Honors and awards
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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)
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Publications
Publications
Comparing bivalent and quadrivalent human papillomavirus vaccines: Economic evaluation based on transmission model
AbstractJit, M., Chapman, R., Hughes, O., & Choi, Y. H. (n.d.).Publication year
2011Journal title
BMJ (Online)Volume
343Issue
7825AbstractObjectives: To compare the effect and cost effectiveness of bivalent and quadrivalent human papillomavirus (HPV) vaccination, taking into account differences in licensure indications, protection against non-vaccine type disease, protection against disease related to HPV types 6 and 11, and reported long term immunogenicity. Design: A model of HPV transmission and disease previously used to inform UK vaccination policy, updated with recent evidence and expanded to include scenarios where the two vaccines differ in duration of protection, cross protection, and end points prevented. Setting: United Kingdom. Population: Males and females aged 12-75 years. Main outcome measure: Incremental cost effectiveness ratios for both vaccines and additional cost per dose for the quadrivalent vaccine to be equally cost effective as the bivalent vaccine. Results: The bivalent vaccine needs to be cheaper than the quadrivalent vaccine to be equally cost effective, mainly because of its lack of protection against anogenital warts. The price difference per dose ranges from a median of £19 (interquartile range £12-£27) to £35 (£27-£44) across scenarios about vaccine duration, cross protection, and end points prevented (assuming one quality adjusted life year (QALY) is valued at £30 000 and both vaccines can prevent all types of HPV related cancers). Conclusions: The quadrivalent vaccine may have an advantage over the bivalent vaccine in reducing healthcare costs and QALYs lost. The bivalent vaccine may have an advantage in preventing death due to cancer. However, considerable uncertainty remains about the differential benefit of the two vaccines.Cost-effectiveness of universal rotavirus vaccination in reducing rotavirus gastroenteritis in Ireland
AbstractTilson, L., Jit, M., Schmitz, S., Walsh, C., Garvey, P., McKeown, P., & Barry, M. (n.d.).Publication year
2011Journal title
VaccineVolume
29Issue
43Page(s)
7463-7473AbstractWe evaluated the cost-effectiveness of universal infant rotavirus (RV) vaccination compared to current standard of care of "no vaccination". Two RV vaccines are currently licensed in Ireland: Rotarix™ and RotaTeq™. A cohort model used in several European countries was adapted using Irish epidemiological, resource utilisation and cost data. The base case model considers the impact of Rotarix vaccination on health-related quality of life of children under five years old from a healthcare payer perspective. Other scenarios explored the use of RotaTeq, impact on one caregiver, on societal costs and on cases that do not seek medical attention. Cost was varied between the vaccine list price (€100/course) in the base case and an assumed tender price (€70/course). One-way and probabilistic sensitivity analyses were conducted. Implementing universal RV vaccination may prevent around 1970 GP visits, 3280 A&E attendances and 2490 hospitalisations. A vaccination programme was estimated to cost approximately €6.54 million per year but €4.65 million of this would be offset by reducing healthcare resource use. The baseline ICER was €112,048/QALY and €72,736/QALY from the healthcare payer and societal perspective, respectively, falling to €68,896 and €43,916/QALY, respectively, if the impact on one caregiver was considered. If the price fell to €70 per course, universal RV vaccination would be cost saving under all scenarios. Results were sensitive to vaccination costs, incidence of RV infection and direct medical costs. Universal RV vaccination would not be cost-effective under base case assumptions. However, it could be cost-effective at a lower vaccine price or from a wider societal perspective.Dedicated outreach service for hard to reach patients with tuberculosis in London: Observational study and economic evaluation
AbstractJit, M., Stagg, H. R., Aldridge, R. W., White, P. J., & Abubakar, I. (n.d.).Publication year
2011Journal title
BMJ (Online)Volume
343Issue
7826AbstractObjective: To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Design: Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. Setting: London, United Kingdom. Population: Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system. Main outcome measures Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. Results The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10 000/QALY gained (about €7300-€11 000 or $10 000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18 000-£26 000/QALY gained; case management support team, £4100-£6800/QALY gained).Human papillomavirus vaccine introduction in low-income and middle-income countries: Guidance on the use of cost-effectiveness models
AbstractJit, M., Demarteau, N., Elbasha, E., Ginsberg, G., Kim, J., Praditsitthikorn, N., Sinanovic, E., & Hutubessy, R. (n.d.).Publication year
2011Journal title
BMC MedicineVolume
9AbstractBackground: The World Health Organization (WHO) recommends that the cost effectiveness of introducing human papillomavirus (HPV) vaccination is considered before such a strategy is implemented. However, developing countries often lack the technical capacity to perform and interpret results of economic appraisals of vaccines. To provide information about the feasibility of using such models in a developing country setting, we evaluated models of HPV vaccination in terms of their capacity, requirements, limitations and comparability.Methods: A literature review identified six HPV vaccination models suitable for low-income and middle-income country use and representative of the literature in terms of provenance and model structure. Each model was adapted by its developers using standardised data sets representative of two hypothetical developing countries (a low-income country with no screening and a middle-income country with limited screening). Model predictions before and after vaccination of adolescent girls were compared in terms of HPV prevalence and cervical cancer incidence, as was the incremental cost-effectiveness ratio of vaccination under different scenarios.Results: None of the models perfectly reproduced the standardised data set provided to the model developers. However, they agreed that large decreases in type 16/18 HPV prevalence and cervical cancer incidence are likely to occur following vaccination. Apart from the Thai model (in which vaccine and non-vaccine HPV types were combined), vaccine-type HPV prevalence dropped by 75% to 100%, and vaccine-type cervical cancer incidence dropped by 80% to 100% across the models (averaging over age groups). The most influential factors affecting cost effectiveness were the discount rate, duration of vaccine protection, vaccine price and HPV prevalence. Demographic change, access to treatment and data resolution were found to be key issues to consider for models in developing countries.Conclusions: The results indicated the usefulness of considering results from several models and sets of modelling assumptions in decision making. Modelling groups were prepared to share their models and expertise to work with stakeholders in developing countries.Please see related article: http://www.biomedcentral.com/1741-7007/9/55.Modelling borderline and mild dysplasia associated with HPV 6 and 11 infection
AbstractChapman, R., Soldan, K., & Jit, M. (n.d.).Publication year
2011Journal title
VaccineVolume
29Issue
16Page(s)
2881-2886AbstractIntroduction: Low risk HPV types 6/11 are responsible for some low-grade cytological abnormalities. Most economic analyses of HPV vaccination have estimated the additional benefit of HPV 6/11 protection by the quadrivalent vaccine, over the bivalent, based on reduction of genital warts but have not included reduction in repeat smears and colposcopies due to low-grade abnormalities. We investigate the contribution of HPV types 6/11 to abnormal smears and associated costs in England. Methods: The risk of borderline or mild dysplasia due to HPV 6/11 infection was estimated from a study of type-specific HPV DNA in cervical screening specimens collected throughout England. A Markov model representing 10 million women with HPV 6/11 or with no HPV infection from 24 to 64 years was developed to estimate the number of abnormal smears, subsequent repeat smears and colposcopies due to HPV 6/11 associated with borderline or mild dysplasia. Fitting was achieved by varying the force of infection, probability of borderline or mild dysplasia if HPV-uninfected or infected with HPV 6/11 and the duration of infection. Results: The relative risks of borderline or mild dysplasia when infected with HPV 6/11 compared to not being HPV infected were 6.32 (95% credible interval 1.56-25.6) and 17.5 (1.02-300) respectively. Using best fitting parameters we find the costs incurred are between £170 and £195 per abnormal smear due to infection with HPV 6/11. Conclusions: In England, the impact of cytological abnormalities due to HPV 6/11 is relatively small, but not negligible. A vaccine that protects against HPV 6/11 infections could reduce costs associated with borderline and mild dysplasia, and associated colposcopies. These benefits should be considered when formulating immunisation policy, if possible. Smears and colposcopies in those uninfected with HPV far outnumber those in women infected with HPV 6/11.Modelling the epidemiology of infectious diseases for decision analysis: A primer
AbstractJit, M., & Brisson, M. (n.d.).Publication year
2011Journal title
PharmacoEconomicsVolume
29Issue
5Page(s)
371-386AbstractThe number of economic evaluations related to infectious disease topics has increased over the last 2 decades. However, many such evaluations rely on models that do not take into account unique features of infectious diseases that can affect the estimated value of interventions against them. These include their transmissibility from infected to susceptible individuals, the possibility of acquiring natural immunity following recovery from infection and the uncertainties that arise as a result of their complex natural history and epidemiology. Modellers conducting economic evaluations of infectious disease interventions need to know the main features of different types of infectious disease models, the situations in which they should be applied and the effects of model choices on the cost effectiveness of interventions.Prevalence of human papillomavirus antibodies in males and females in England
AbstractDesai, S., Chapman, R., Jit, M., Nichols, T., Borrow, R., Wilding, M., Linford, C., Lowndes, C. M., Nardone, A., Pebody, R., & Soldan, K. (n.d.).Publication year
2011Journal title
Sexually Transmitted DiseasesVolume
38Issue
7Page(s)
622-629AbstractBackground: Most studies of human papillomavirus (HPV) epidemiology have employed DNA testing, which measures current infections. Serum antibodies offer a longer-term marker of infection in individuals who seroconvert and can therefore provide additional information about the exposure of populations to HPV. Methods: Sera from a population-based sample of males and females aged 10 to 49 years, in England, were tested for type-specific HPV antibodies using a multiplexed competitive Luminex assay and previously defined cutoffs of 20, 16, 20, and 24 mMU mL -1 for HPV 6, 11, 16, and 18, respectively. Seropositivity and geometric mean titers of seropositives were analyzed by HPV type, gender, and age. Catalytic models were developed to explore potential effects of antibody waning over time and changing risk of infection by age-cohort. Results: Seroprevalence for HPV 6, 11, 16, and 18 was 16.4%, 5.7%, 14.7%, and 6.3%, respectively, among females and 7.6%, 2.2%, 5.0%, and 2.0%, respectively, among males. Seroprevalence in females was significantly higher than males (P < 0.001 for all types) and showed a decline in older ages that was not seen in males. There was no evidence of declining antibody titers with increasing age. Model results suggest that cohort effects mediated through changes in sexual behavior better explain the observed trend in seroprevalence than waning antibodies over time. Conclusions: Preimmunization HPV seroprevalence in England shows similar trends to reports from other developed countries. We find the lower seroprevalence in older females probably reflects changes in sexual behavior over the last few decades. This study provides baseline data to monitor the impact of the immunization programme.Response to comment on article by Jit et al. "The cost effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe"
Jit, M., Bilcke, J., Mangen, M. J. J., Salo, H., Melliez, H., Edmunds, W. J., Yazdanpanah, Y., & Beutels, P. (n.d.). In Vaccine (1–).Publication year
2011Volume
29Issue
21Page(s)
3732-3733The cost-effectiveness of rotavirus vaccination in Armenia
AbstractJit, M., Yuzbashyan, R., Sahakyan, G., Avagyan, T., & Mosina, L. (n.d.).Publication year
2011Journal title
VaccineVolume
29Issue
48Page(s)
9104-9111AbstractThe cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as " very cost-effective" from a WHO standpoint. Vaccination may still be " very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted.The impact of genital warts: Loss of quality of life and cost of treatment in eight sexual health clinics in the UK
AbstractWoodhall, S. C., Jit, M., Soldan, K., Kinghorn, G., Gilson, R., Nathan, M., Ross, J. D., & Lacey, C. J. (n.d.).Publication year
2011Journal title
Sexually transmitted infectionsVolume
87Issue
6Page(s)
458-463AbstractObjectives: To estimate the loss of quality of life and cost of treatment associated with genital warts seen in sexual health clinics. Methods: A cross-sectional questionnaire study and case note review of individuals with genital warts, carried out in eight sexual health clinics in England and Northern Ireland. Individuals with genital warts attending the participating clinics were invited to take part in the questionnaire study. 895 participants were recruited. A separate sample of 370 participants who had attended a participating clinic with a first visit for a first or recurrent episode of genital warts between April and June 2007 was included in the case note review. Quality of life was measured using the EQ-5D questionnaire and the cost of an episode of care was derived from the case note review. Results: The weighted mean EQ-5D index score was 0.87 (95% CI 0.85 to 0.89). The weighted mean disutility was 0.056 (95% CI 0.038 to 0.074). The estimated mean loss of quality-adjusted life-years associated with an episode of genital warts was 0.018 (95% CI 0.0079 to 0.031), equivalent to 6.6 days of healthy life lost per episode. The weighted mean cost per episode of care was £94 (95% CI £84 to £104), not including the cost of a sexually transmitted infection screen. Conclusions: Genital warts have a substantial impact on the health service and the individual. This information can be utilised for economic evaluation of human papillomavirus vaccination.The impact of pandemic influenza H1N1 on health-related quality of life: A prospective population-based study
AbstractVan Hoek, A. J., Underwood, A., Jit, M., Miller, E., & Edmunds, W. J. (n.d.).Publication year
2011Journal title
PloS oneVolume
6Issue
3AbstractBackground: While the H1N1v influenza pandemic in 2009 was clinically mild, with a low case-fatality rate, the overall disease burden measured in quality-adjusted life years (QALY) lost has not been estimated. Such a measure would allow comparison with other diseases and assessment of the cost-effectiveness of pandemic control measures. Methods and Findings: Cases of H1N1v confirmed by polymerase chain reaction (PCR) and PCR negative cases with similar influenza-like illness (ILI controls) in 7 regions of England were sent two questionnaires, one within a week of symptom onset and one two weeks later, requesting information on duration of illness, work loss and antiviral use together with EQ-5D questionnaires. Results were compared with those for seasonal influenza from a systematic literature review. A total QALY loss for the 2009 pandemic in England was calculated based on the estimated total clinical cases and reported deaths. A total of 655 questionnaires were sent and 296 (45%) returned. Symptoms and average illness duration were similar between confirmed cases and ILI controls (8.8 days and 8.7 days respectively). Days off work were greater for cases than ILI controls (7.3 and 4.9 days respectively, p = 0.003). The quality-adjusted life days lost was 2.92 for confirmed cases and 2.74 for ILI controls, with a reduction in QALY loss after prompt use of antivirals in confirmed cases. The overall QALY loss in the pandemic was estimated at 28,126 QALYs (22,267 discounted) of which 40% was due to deaths (24% with discounting). Conclusion: Given the global public health significance of influenza, it is remarkable that no previous prospective study of the QALY loss of influenza using standardised and well validated methods has been performed. Although the QALY loss was minor for individual patients, the estimated total burden of influenza over the pandemic was substantial when compared to other infectious diseases.What types of contacts are important for the spread of infections? Using contact survey data to explore European mixing patterns
AbstractMelegaro, A., Jit, M., Gay, N., Zagheni, E., & Edmunds, W. J. (n.d.).Publication year
2011Journal title
EpidemicsVolume
3Issue
3Page(s)
143-151AbstractKnowledge of the determinants of infectious disease transmission is a public health priority as it allows the design of optimal control strategies for endemic or emerging infections. We analyse a detailed dataset on contact patterns across five European countries and use available serological profiles for varicella and parvovirus B19 infections to identify the types of contact that may be most relevant for transmission. We show that models informed by contact data fit well the observed serological profiles of both infections. We find that intimate types of contacts explain the pattern of acquisition of serological markers by age better than other types of social contacts. We observe similar patterns in each of the countries analysed, suggesting that there are consistent biological mechanisms at work.A brief history of economic evaluation for human papillomavirus vaccination policy
AbstractBeutels, P., & Jit, M. (n.d.).Publication year
2010Journal title
Sexual HealthVolume
7Issue
3Page(s)
352-358AbstractBackground: This commentary discusses key issues for health economic evaluation and modelling, applied to human papillomavirus (HPV) vaccine programs. Methods: We outline some of the specific features of HPV disease and vaccination, and associated policy questions in light of a literature search for economic evaluations on HPV vaccination. Results: We observe that some policy questions could not be reliably addressed by many of the 43 published economic evaluations we found. Despite this, policy making on universal HPV vaccination followed shortly after vaccine licensure in many developed countries, so the role economic evaluation played in informing these decisions (pre-dating 2008) seems to have been fairly limited. For more recent decisions, however, economic evaluation is likely to have been used more widely and more intensively. Conclusions: We expect future cost-effectiveness analyses to be more instrumental in policy making regarding vaccines covering more HPV types, therapeutic HPV vaccines, and novel diagnostic tests for biomarkers of HPV infection and disease integrated with cervical screening programs.An update to " The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe"
AbstractJit, M., Mangen, M. J. J., Melliez, H., Yazdanpanah, Y., Bilcke, J., Salo, H., Edmunds, W. J., & Beutels, P. (n.d.). In Vaccine (1–).Publication year
2010Volume
28Issue
47Page(s)
7457-7459AbstractA cost-effectiveness analysis of rotavirus vaccination in Belgium, England and Wales, Finland, France and the Netherlands published in 2009 was updated based on recent studies on rotavirus burden of disease and vaccine efficacy. All the qualitative conclusions in the previous study were found to remain valid. Vaccination remains cost-effective in Finland only when using plausible tender prices.Estimating progression rates for human papillomavirus infection from epidemiological data
AbstractJit, M., Gay, N., Soldan, K., Hong Choi, Y., & Edmunds, W. J. (n.d.).Publication year
2010Journal title
Medical Decision MakingVolume
30Issue
1Page(s)
84-98AbstractA Markov model was constructed in order to estimate typespecific rates of cervical lesion progression and regression in women with high-risk human papillomavirus (HPV). The model was fitted to age- and type-specific data regarding the HPV DNA and cytological status of women undergoing cervical screening in a recent screening trial, as well as cervical cancer incidence. It incorporates different assumptions about the way lesions regress, the accuracy of cytological screening, the specificity of HPV DNA testing, and the age-specific prevalence of HPV infection. Combinations of assumptions generate 162 scenarios for squamous cell carcinomas and 54 scenarios for adenocarcinomas. Simulating an unscreened cohort of women infected with high-risk HPV indicates that the probability of an infection continuing to persist and to develop into invasive cancer depends on the length of time it has already persisted. The scenarios and parameter sets that produce the best fit to available epidemiological data provide a basis for modeling the natural history of HPV infection and disease.Predicting the life-time benefit of school-based smoking prevention programmes
AbstractJit, M., Aveyard, P., Barton, P., & Meads, C. A. (n.d.).Publication year
2010Journal title
AddictionVolume
105Issue
6Page(s)
1109-1116AbstractAim School-based smoking prevention programmes may delay the age of smoking initiation, but do not appear to achieve lasting reductions in smoking prevalence beyond school-leaving age. We explored whether delaying the age at which someone initiates smoking may have life-time benefits by increasing the likelihood of quitting in later life. Design and setting Data from the General Household Survey of Great Britain were used in a logistic regression model to examine the association between age at which someone initiates regular smoking and the probability that the person will quit smoking later in life. The effect of confounding variables (sex, ethnicity, socio-economic class, education and geographical location) was taken into account. The predicted relationship was used in a cohort model to estimate the life-time reduction in smoking prevalence and all-cause mortality of a school-based smoking prevention programme. Results Age of regular smoking initiation was associated strongly with the probability of quitting later in life (coefficient -0.103, P < 0.001). The strength of the association was slightly reduced but still significant when confounding variables were included (coefficient -0.075, P < 0.001). An intervention that delays smoking initiation without decreasing smoking prevalence at age 18 may reduce adult smoking prevalence by 0.13-0.32% (depending on age) and all-cause mortality by 0.09% over the life-time of the sample. Conclusion School-based smoking prevention programmes have potential for a beneficial effect over the life-time of the participants even if they have no apparent effect at school-leaving age.The cost-effectiveness of vaccinating pregnant women against seasonal influenza in England and Wales
AbstractJit, M., Cromer, D., Baguelin, M., Stowe, J., Andrews, N., & Miller, E. (n.d.).Publication year
2010Journal title
VaccineVolume
29Issue
1Page(s)
115-122AbstractWe assessed the cost-effectiveness of vaccinating pregnant women against seasonal influenza in England and Wales, taking into account the timing of vaccination relative to both the influenza season and trimester of pregnancy. Women were assumed to be vaccinated in their second or third trimester. Vaccination between September and December was found to have an incremental cost-effectiveness ratio of £23,000 per quality adjusted life year (QALY) (95% CI £10,000-£140,000) if it is assumed that infants are partially protected through their mothers, and of £28,000 per QALY gained (95% CI £13,000-£200,000) if infants are not protected. If some vaccine protection lasts for a second season, then the ratio is only £15,000 per QALY gained (95% CI £6,000-£93,000). Most of the benefit of vaccination is in preventing symptomatic episodes, regardless of health care resource use. Extending vaccination beyond December is unlikely to be cost-effective unless there is good protection into a second influenza season. Key sources of uncertainty are the cost of vaccine delivery and the quality of life detriment due to a clinically apparent episode of confirmed influenza. The cost of vaccine purchase itself is relatively low.The risk of sequelae due to pneumococcal meningitis in high-income countries: A systematic review and meta-analysis
AbstractJit, M. (n.d.).Publication year
2010Journal title
Journal of InfectionVolume
61Issue
2Page(s)
114-124AbstractObjectives: To determine the risk of various kinds of sequelae in survivors of meningitis due to Streptococcus pneumoniae, as well as the influence of co-factors such as study design, study population and treatment on this risk. Methods: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 September 1991 to 18 June 2009 for original articles on pneumococcal meningitis sequelae. Prevalence of sequelae was pooled using random effects meta-analysis. Studies were appraised for the influence of referral bias, external validity of study populations, testing procedure and publication bias. Results: Data were extracted from 63 studies involving 3408 pneumococcal meningitis survivors. The pooled prevalence of any reported sequelae from 48 studies was 31.7% (95% confidence interval 27.2-36.3%) using a random effects model (Cochran-Q = 277, p < 0.01). Differences in studies due to design, study population and treatment were not significant. The pooled prevalence of hearing loss, seizures, hydrocephalus, spasticity/paresis, cranial nerve palsies and visual impairment was 20.9% (17.1-24.7%), 6.5% (3.3-9.7%), 6.8% (3.3-10.2%), 8.7% (6.4-11.0%), 12.2% (5.3-19.1%) and 2.4% (0-5.7%) respectively. Conclusions: The burden of sequelae due to pneumococcal meningitis remains high in the reviewed studies.Transmission dynamic modelling of the impact of human papillomavirus vaccination in the United Kingdom
AbstractChoi, Y. H., Jit, M., Gay, N., Cox, A., Garnett, G. P., & Edmunds, W. J. (n.d.).Publication year
2010Journal title
VaccineVolume
28Issue
24Page(s)
4091-4102AbstractMany countries are considering vaccination against human papillomavirus (HPV). However, the long-term impact of vaccination is difficult to predict due to uncertainty about the prevalence of HPV infection, pattern of sexual partnerships, progression of cervical neoplasias, accuracy of screening as well as the duration of infectiousness and immunity. Dynamic models of human papillomavirus (HPV) transmission were developed to describe the infection spread and development of cervical neoplasia, cervical cancer (squamous cell and adenocarcinoma) and anogenital warts. Using different combinations of assumptions, 9900 scenarios were created. Each scenario was then fitted to epidemiological data and the best-fitting scenarios used to predict the impact of vaccination. Results suggest that vaccinating 12-year-old girls at 80% coverage will result in a 38-82% reduction in cervical cancer incidence and 44-100% reduction in anogenital warts incidence after 60 years of an ongoing vaccination programme if vaccine protection lasts 20 years on average. The marginal benefit of vaccinating boys depends on the degree of protection achieved by vaccinating girls.Vaccination against pandemic influenza A/H1N1v in England: A real-time economic evaluation
AbstractBaguelin, M., Hoek, A. J. V., Jit, M., Flasche, S., White, P. J., & Edmunds, W. J. (n.d.).Publication year
2010Journal title
VaccineVolume
28Issue
12Page(s)
2370-2384AbstractDecisions on how to mitigate an evolving pandemic are technically challenging. We present a real-time assessment of the effectiveness and cost-effectiveness of alternative influenza A/H1N1v vaccination strategies. A transmission dynamic model was fitted to the estimated number of cases in real-time, and used to generate plausible autumn scenarios under different vaccination options. The proportion of these cases by age and risk group leading to primary care consultations, National Pandemic Flu Service consultations, emergency attendances, hospitalisations, intensive care and death was then estimated using existing data from the pandemic. The real-time model suggests that the epidemic will peak in early November, with the peak height being similar in magnitude to the summer wave. Vaccination of the high-risk groups is estimated to prevent about 45 deaths (80% credibility interval 26-67), and save around 2900 QALYs (80% credibility interval 1600-4500). Such a programme is very likely to be cost-effective if the cost of vaccine purchase itself is treated as a sunk cost. Extending vaccination to low-risk individuals is expected to result in more modest gains in deaths and QALYs averted. Extending vaccination to school-age children would be the most cost-effective extension. The early availability of vaccines is crucial in determining the impact of such extensions. There have been a considerable number of cases of H1N1v in England, and so the benefits of vaccination to mitigate the ongoing autumn wave are limited. However, certain groups appear to be at significantly higher risk of complications and deaths, and so it appears both effective and cost-effective to vaccinate them. The United Kingdom was the first country to have a major epidemic in Europe. In countries where the epidemic is not so far advanced vaccination of children may be cost-effective. Similar, detailed, real-time modelling and economic studies could help to clarify the situation.Cost of treatment and QALYs lost due to genital warts: Data for the economic evaluation of HPV vaccines in the United Kingdom
AbstractWoodhall, S. C., Jit, M., Cai, C., Ramsey, T., Zia, S., Crouch, S., Birks, Y., Newton, R., Edmunds, W. J., & Lacey, C. J. (n.d.).Publication year
2009Journal title
Sexually Transmitted DiseasesVolume
36Issue
8Page(s)
515-521AbstractBACKGROUND: Data on the burden of genital warts in terms of treatment costs and detriment to quality of life (QoL) are required to assess cost-effectiveness of quadrivalent human papillomavirus vaccination. We investigated the cost of treatment and period of time for which QoL is affected to obtain estimates of quality-adjusted life year (QALY) loss associated with an episode of genital warts. METHODS: Adults diagnosed with genital warts attending the York sexually transmitted disease clinic during two 3-month periods in 2006 and 2007 were enrolled (n = 189). Data on cost of treatment and duration of episode of care were collected from a retrospective case note review. QALY loss was calculated by applying estimates of the duration of time for which QoL was affected to the previously reported detriment to QoL associated with genital warts. RESULTS: The average cost per episode of care was $286 (£139, 95% CI: $246-$327). Estimated loss of QALYs ranged from 0.0045 (95% CI: 0.0014-0.0078) to 0.023 (95% CI: 0.0072-0.039). CONCLUSIONS: Genital warts present a significant burden both to individuals and to the health service. Data on the burden of genital warts should be incorporated into economic evaluations of human papillomavirus vaccination strategies.The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe
AbstractJit, M., Bilcke, J., Mangen, M. J. J., Salo, H., Melliez, H., Edmunds, W. J., Yazdan, Y., & Beutels, P. (n.d.).Publication year
2009Journal title
VaccineVolume
27Issue
44Page(s)
6121-6128AbstractCost-effectiveness analyses are usually not directly comparable between countries because of differences in analytical and modelling assumptions. We investigated the cost-effectiveness of rotavirus vaccination in five European Union countries (Belgium, England and Wales, Finland, France and the Netherlands) using a single model, burden of disease estimates supplied by national public health agencies and a subset of common assumptions. Under base case assumptions (vaccination with Rotarix®, 3% discount rate, health care provider perspective, no herd immunity and quality of life of one caregiver affected by a rotavirus episode) and a cost-effectiveness threshold of €30,000, vaccination is likely to be cost effective in Finland only. However, single changes to assumptions may make it cost effective in Belgium and the Netherlands. The estimated threshold price per dose for Rotarix® (excluding administration costs) to be cost effective was €41 in Belgium, €28 in England and Wales, €51 in Finland, €36 in France and €46 in the Netherlands.Economic evaluation of human papillomavirus vaccination in the United Kingdom
AbstractJit, M., Yoon, H. C., & Edmunds, W. J. (n.d.).Publication year
2008Journal title
BMJVolume
337Issue
7665Page(s)
331-335AbstractObjective: To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom. Design: Economic evaluation. Setting UK. Population: Schoolgirls aged 12 or older. Main outcome measures: Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios fora range of vaccination options. Results: Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of £30 000 (€37 700; $59 163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing £13-£21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective in terms of health benefits. Conclusions: Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.Estimation of the impact of genital warts on health-related quality of life
AbstractWoodhall, S., Ramsey, T., Cai, C., Crouch, S., Jit, M., Birks, Y., Edmunds, W. J., Newton, R., & Lacey, C. J. (n.d.).Publication year
2008Journal title
Sexually transmitted infectionsVolume
84Issue
3Page(s)
161-166AbstractObjectives: One of the two new human papillomavirus (HPV) vaccines protects against HPV types 6 and 11, which cause over 95% of genital warts, in addition to protecting against HPV types 16 and 18. In anticipation of HPV vaccine implementation, the impact of genital warts on health-related quality of life (HRQoL) was measured to assess the potential benefits of the quadrivalent over the bivalent vaccine. Methods: Genitourinary medicine clinic patients aged 18 years and older with a current diagnosis of genital warts were eligible; 81 consented and were interviewed by a member of the research team. A generic HRQoL questionnaire, the EQ-5D (comprising EQ-5D index and EQ visual analogue scale (VAS) scores) and a disease-specific HRQoL instrument, the CECA10, were administered. Previously established UK population norms were used as a control group for EQ-5D comparisons. Results: Cases (with genital warts) had lower EQ VAS and EQ-5D index scores than controls. After adjusting for age a mean difference between cases and controls 30 years of age and under (n = 70) of 13.9 points (95% CI 9.9 to 17.6, p<0.001 ) for the EQ VAS and 0.039 points (95% CI 0.005 to 0.068, p = 0.02) on the EQ-5D index (also adjusted for sex) was observed. The difference between cases and controls for the EQ VAS was especially notable in young women. Conclusions: Genital warts are associated with a significant detriment to HRQoL. The potential added benefit of preventing most cases of genital warts by HPV vaccination should be considered in decisions about which HPV vaccine to implement in the United Kingdom.Restructuring routine elective services to reduce overall capacity requirements within a local health economy
AbstractUtley, M., Jit, M., & Gallivan, S. (n.d.).Publication year
2008Journal title
Health Care Management ScienceVolume
11Issue
3Page(s)
240-247AbstractThe UK Government has introduced a new class of health service providers called Treatment Centres that provide routine elective services but that do not deal with emergency cases or non-routine elective patients. The introduction of these centres provides a possible mechanism for improving the efficiency of service delivery in terms of overall capacity requirements. In this paper we discuss a mathematical modelling approach that has been used to examine circumstances under which such benefits might be realised. As an illustration of the analysis, we present results obtained using data concerning urological services, for which there would seem to be benefits associated with the introduction of a TC in only a limited range of circumstances.