Yesim Tozan
Yesim Tozan
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Assistant Professor of Global and Environmental Health
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Professional overview
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Dr. Yesim Tozan’s research centers on health decision science and priority setting, and explores the costs and cost-effectiveness of health care interventions using decision analytic models and the issues of health care resource allocation in low- and middle-income countries. Her main focus has been infectious disease prevention and control with an emphasis on dengue and malaria. Dr. Tozan is currently leading a health economics work package in a European Union-funded research project on dengue surveillance and control with field sites in Sri Lanka and Thailand. She is also leading a prospective multi-center study on the cost of dengue illness in international travelers utilizing a network of travel clinics in Europe, the US, the Middle East and Australia. Most recently, she has been working on economic evaluation of artemisinin-based combination therapies for the treatment of uncomplicated childhood malaria using data from multi-site randomized clinical trials in Africa and Asia. Dr. Tozan was a task force associate for the UN Millennium Project’s Task Force on HIV/AIDS, Malaria, Tuberculosis and Access to Essential Medicines and was lead author of the malaria task force report entitled “Coming to grips with malaria in the new millennium.”
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Education
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BS, Environmental Engineering, Istanbul Technical University, TurkeyMS, Environmental Technology, Bogazici University, TurkeyMA, Public Affairs, Princeton University, Princeton, NJPhD, Public Affairs, Princeton University, Princeton, NJ
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Areas of research and study
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Cost EffectivenessCost-effective Health Programs and PoliciesEconomic EvaluationHealth EconomicsInfectious DiseasesPrevention Interventions
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Publications
Publications
The impact of insecticide-treated school uniforms on dengue infections in school-aged children: Study protocol for a randomised controlled trial in Thailand
AbstractWilder-Smith, A., Byass, P., Olanratmanee, P., Maskhao, P., Sringernyuang, L., Logan, J. G., Lindsay, S. W., Banks, S., Gubler, D., Louis, V. R., Tozan, Y., & Kittayapong, P. (n.d.).Publication year
2012Journal title
TrialsVolume
13AbstractBackground: There is an urgent need to protect children against dengue since this age group is particularly sensitive to the disease. Since dengue vectors are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesise that insecticide-treated school uniforms will reduce the incidence of dengue infection in school-aged children. Our objective is to determine the impact of impregnated school uniforms on dengue incidence.Methods: A randomised controlled trial will be conducted in eastern Thailand in a group of schools with approximately 2,000 students aged 7-18 years. Pre-fabricated school uniforms will be commercially treated to ensure consistent, high-quality insecticide impregnation with permethrin. A double-blind, randomised, crossover trial at the school level will cover two dengue transmission seasons.Discussion: Practical issues and plans concerning intervention implementation, evaluation, analysing and interpreting the data, and possible policy implications arising from the trial are discussed.Trial registration: clinicaltrial.gov. Registration number: NCT01563640.Social determinants approaches to public health
Failed generating bibliography.Publication year
2011Prereferral rectal artesunate for treatment of severe childhood malaria: A cost-effectiveness analysis
AbstractTozan, Y., Klein, E. Y., Darley, S., Panicker, R., Laxminarayan, R., & Breman, J. G. (n.d.).Publication year
2010Journal title
The LancetVolume
376Issue
9756Page(s)
1910-1915AbstractSeverely ill patients with malaria with vomiting, prostration, and altered consciousness cannot be treated orally and need injections. In rural areas, access to health facilities that provide parenteral antimalarial treatment is poor. Safe and effective treatment of most severe malaria cases is delayed or not achieved. Rectal artesunate interrupts disease progression by rapidly reducing parasite density, but should be followed by further antimalarial treatment. We estimated the cost-effectiveness of community-based prereferral artesunate treatment of children suspected to have severe malaria in areas with poor access to formal health care. We assessed the cost-effectiveness (in international dollars) of the intervention from the provider perspective. We studied a cohort of 1000 newborn babies until 5 years of age. The analysis assessed how the cost-effectiveness results changed with low (25), moderate (50), high (75), and full (100) referral compliance and intervention uptake. At low intervention uptake and referral compliance (25), the intervention was estimated to avert 19 disability-adjusted life-years (DALYs; 95 CI 16-21) and to cost I$1173 (95 CI 1050-1297) per DALY averted. Under the full uptake and compliance scenario (100), the intervention could avert 967 DALYs (884-1050) at a cost of I$77 (73-81) per DALY averted. Prereferral artesunate treatment is a cost-effective, life-saving intervention, which can substantially improve the management of severe childhood malaria in rural African settings in which programmes for community health workers are in place. The Disease Control Priorities Project; Fogarty International Center; US National Institutes of Health; and the Peter Paul Career Development Professorship, Boston University.Prereferral rectal artesunate for treatment of severe childhood malaria: a cost-effectiveness analysis
Klein, E. Y., Darley, S., Panicker, R., Laxminarayan, R., Breman, J. G., & Tozan, Y. (n.d.).Publication year
2010Journal title
The LancetVolume
376Issue
9756Page(s)
1910-1915Dichlorodiphenyltrichloroethane (DDT) for indoor residual spraying in Africa: How can it be used for malaria control?
AbstractSadasivaiah, S., Tozan, Y., & Breman, J. G. (n.d.).Publication year
2007Journal title
American Journal of Tropical Medicine and HygieneVolume
77Page(s)
249-263AbstractIn 2006, the World Health Organization issued a position statement promoting the use of indoor residual spraying (IRS) with dichlorodiphenyltrichloroethane (DDT) for malaria vector control in epidemic and endemic areas. Other international organizations concurred because of the great burden of malaria and the relative ineffectiveness of current treatment and control strategies. Although the Stockholm Convention of 2001 targeted DDT as 1 of 12 persistent organic pollutants for phase-out and eventual elimination, it allowed a provision for its continued indoor use for disease vector control. Although DDT is a low-cost antimalarial tool, the possible adverse human health and environmental effects of exposure through IRS must be carefully weighed against the benefits to malaria control. This article discusses the controversy surrounding the use of DDT for IRS; its effective implementation in Africa; recommendations for deployment today, and training, monitoring, and research needs for effective and sustainable implementation. We consider the costs and cost effectiveness of IRS with DDT, alternative insecticides to DDT, and the importance of integrated vector control if toxicity, resistance, and other issues restrict its use.Coming to grips with malaria in the new millennium
Teklehaimanot, A., & Tozan, Y. (n.d.). (1–).Publication year
2005Emerging consensus in HIV/AIDS, malaria, tuberculosis, and access to essential medicines
Ruxin, J., Paluzzi, J. E., Wilson, P. A., Tozan, Y., Kruk, M., & Teklehaimanot, A. (n.d.).Publication year
2005Journal title
LancetVolume
365Issue
9459Page(s)
618-621The economic payoffs of integrated malaria control in the Zambian copperbelt between 1930 and 1950
AbstractUtzinger, J., Tozan, Y., Doumani, F., & Singer, B. H. (n.d.).Publication year
2002Journal title
Tropical Medicine and International HealthVolume
7Issue
8Page(s)
657-677AbstractIt has long been suggested that malaria is delaying the economic development of countries that are most severely affected by the disease. Several studies have documented the economic consequences of malaria at the household level, primarily in communities engaged in subsistence farming. A missing element is the appraisal of the economic impact of malaria on the industrial and service sectors that will probably become the backbone of many developing economies. We estimate the economic effects of integrated malaria control implemented during the colonial period and sustained for 20 years in four copper mining communities of the former Northern Rhodesia (now Zambia). Integrated malaria control was characterized by strong emphasis on environmental management, while part of the mining communities also benefited from rapid diagnosis and treatment and the use of bednets. The programmes were highly successful as an estimated 14 122 deaths, 517 284 malaria attacks and 942 347 work shift losses were averted. Overall, 127 226 disability adjusted life years (DALYs) were averted per 3-year incremental period. The cumulative costs of malaria control interventions were US$ 11 169 472 (in 1995 US$). Because the control programmes were so effective, the mining companies attracted a large reservoir of migrant labourers and sustained healthy work forces. The programmes averted an estimated US$ 796 622 in direct treatment costs and US$ 5 678 745 in indirect costs as a result of reduced work absenteeism. Within a few years of programme initiation, Northern Rhodesia became the leading copper producer in Africa, and mining generated the dominant share of national income. Copper production and revenues, which increased dramatically during malaria control interventions, amounted to the equivalent of US$ 7.1 billion (in 1995 US$). Integrated malaria control in copper mining communities was a sound investment. It had payoff for public and occupational health, generally, and without it copper extraction and social and economic development would have been impossible.Efficacy and cost-effectiveness of environmental management for malaria control
AbstractUtzinger, J., Tozan, Y., & Singer, B. H. (n.d.).Publication year
2001Journal title
Tropical Medicine and International HealthVolume
6Issue
9Page(s)
677-687AbstractRoll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement efficacious and cost-effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3-5 years, malaria-related mortality, morbidity and incidence rates were reduced by 70-95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161 205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3-5 years start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524-591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower: US$ 22-92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management - integrated with pharmacological, insecticidal and bednet interventions - could substantially increase the chances of rolling back malaria.