Stefano Bertozzi

Instituto Nacional de Salud Pública

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Juan Pablo Gutiérrez

University of Chile

Prabhat Jha

Rutgers, The State University of New Jersey

Sergio Bautista‐Arredondo

Instituto Nacional de Salud Pública

Holmes Kk

University of Washington

Bloom Br

Sandra I. McCoy

University of California, Berkeley

Lalit Dandona

University of Washington

Sam McPherson

Itad (United Kingdom)

Paul Gertler

National Bureau of Economic Research

Barry R. Bloom

Harvard University

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University of California, San Francisco

University of California, Berkeley

Instituto Nacional de Salud Pública

University of Washington

Harvard University

Johns Hopkins University

Centers for Disease Control and Prevention

World Health Organization

National Institutes of Health

University of Maryland, College Park

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The direct and indirect cost of HIV infection in developing countries: the cases of Zaire and Tanzania.

Mead Over Stefano Bertozzi Jerome H. Chin Ngaly Bosenge K Nyamuryekunge

The direct costs of a disease are the costs of treating the patient; the indirect costs of a disease are the costs in terms of the value of healthy years of life lost. In Zaire the estimated direct cost of treating an AIDS patient ranges from a low of $132 to a high of $1585. In Tanzania the cost ranges from a low of $104 to a high of $631. The determination of the indirect costs of a disease in terms of healthy years lost because of disability and death serves as a guide to health officials in allocating resources among specific diseases. In Africa preventing a case of AIDS saves an estimated 8.8 years of healthy life which means that AIDS ranks 5th among 14 diseases making AIDS less costly than sickle cell anemia neonatal tetanus birth injury or malnutrition but more costly than prematurity childhood or adult pneumonia cerebrovascular disease tuberculosis measles malaria gastroenteritis or accidents. If one divides up the morbidity from these 14 diseases by age group and thus by productivity implications one finds that a case prevented saves 6.6 productive years or more than all the diseases except sickle cell anemia birth injury neonatal tetanus and malnutrition. In order to provide guidance in intersectorial resource allocation one must employ the human capital approach i.e. years lost times average yearly income to assign a monetary value to the years of life lost. AIDS still ranks 5th among the 14 diseases with an indirect cost ranging from $890 to $2663 in Zaire and from $2425 to $5903 in Tanzania The total costs (direct + indirect) per HIV+ individual range from a low of $936 to a high of $3230 in Zaire and from a low of $2462 to a high of $5316 in Tanzania. Thus the indirect costs are roughly 95% of the total costs.

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Cost-Effectiveness of Interventions to Prevent HIV Acquisition -- Major Infectious Diseases

Holmes Kk Stefano Bertozzi Bloom Br Prabhat Jha

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Major Infectious Diseases: Key Messages from Disease Control Priorities, Third Edition

The World Bank eBooks (2017)

King K. Holmes Stefano Bertozzi Barry R. Bloom Prabhat Jha Hellen Gelband

Recognizes that infectious diseases, such as smallpox, cholera, and influenza, are responsible for the largest global burden of premature death and disability until the end of the twentieth century when noncommunicable diseases surpassed them. The decline of the vaccine-preventable diseases has contributed to a recognition that vaccines may be able to prevent other infectious diseases, including HIV/AIDS, tuberculosis, malaria, hepatitis C, and a variety of neglected tropical diseases. Differential diagnosis holds the key to population infection control. For each major infectious disease—HIV/AIDS, tuberculosis, malaria, viral hepatitis, and neglected tropical diseases—interventions are considered for costs and cost-effectiveness. Because of increased bacterial resistance, interventions look to decrease the need for antibiotics by preventing infections and the unnecessary use of antibiotics in humans and animals. Four challenges must be addressed to achieve meaningful progress countering infectious diseases: (1) targeting of intervention strategies; (2) scaling-up of interventions; (3) integrating services more effectively across disease areas; and (4) developing new technologies including drugs, vaccines, diagnostics, behavioral interventions, and delivery methods.

Disease Control

10.1596/978-1-4648-0524-0_ch1

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Costing of scaling up HIV/AIDS treatment in Mexico

Salud Pública de México (2008)

Sergio Bautista‐Arredondo Tania Dmytraczenko Gilbert Kombe Stefano Bertozzi

OBJECTIVE: To determine the net effect of introducing highly active antiretroviral treatment (HAART) in Mexico on total annual per-patient costs for HIV/AIDS care, taking into account potential savings from treatment of opportunistic infections and hospitalizations. MATERIAL AND METHODS: A multi-center, retrospective patient chart review and collection of unit cost data were performed to describe the utilization of services and estimate costs of care for 1003 adult HIV+ patients in the public sector. RESULTS: HAART is not cost-saving and the average annual cost per patient increases after initiation of HAART due to antiretrovirals, accounting for 90% of total costs. Hospitalizations do decrease post-HAART, but not enough to offset the increased cost. CONCLUSIONS: Scaling up access to HAART is feasible in middle income settings. Since antiretrovirals are so costly, optimizing efficiency in procurement and prescribing is paramount. The observed adherence was low, suggesting that a proportion of these high drug costs translated into limited health benefits.

10.1590/s0036-36342008001000004

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Integration: An Ever-Closer Challenge

SSRN Electronic Journal (2007)

Stefano Bertozzi

This article argues for closer integration to be a key part of the EU's migration policy. It accepts that migration is necessary for a prosperous Europe and looks at the role of the EU and how best to integrate immigrants. Countries' experiences and the need for better aligned policies among member states are examined. The European Commission's role in sharing experiences and best practices is considered, as well as the need for the many stakeholders involved to work together. Integration is a complex and delicate process, and ultimately the EU must be bolder in its promotion of integration if it is to benefit from migration.

10.2139/ssrn.1338047

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Diseño mixto de evaluación de la iniciativa Salud Mesoamérica 2015

Salud Pública de México (2011)

Juan Pablo Gutiérrez Marta María Téllez-Rojo Pilar Torres‐Pereda Martín Romero Stefano Bertozzi

El propósito de la iniciativa Salud Mesoamérica 2015 (SM-2015) es mejorar el estado de salud y nutrición de la población con mayor grado de vulnerabilidad en Mesoamérica. El objetivo de la evaluación es generar evidencia sobre la efectividad conjunta de un paquete de intervenciones diseñadas para mejorar las condiciones de salud en la región. Se propone una evaluación de impacto con métodos mixtos, para conocer la magnitud de los cambios atribuibles a la SM-2015, e identificar los significados de estos cambios para la población objetivo, en el contexto de cada país. El eje conductor es un panel de localidades con el que se colectará información de individuos, hogares y unidades de salud de primero y segundo nivel de atención. El diseño que se describe en este documento fue desarrollado entre junio y diciembre de 2009, y su articulación se llevó a cabo en talleres realizados en Cuernavaca (México), Managua (Nicaragua), y San José (Costa Rica). El diseño propuesto permitirá generar evidencia sobre la efectividad conjunta del paquete de intervenciones propuesto en los planes maestros mesoamericanos. El éxito de este diseño radica en la voluntad y en el compromiso político de los países y los donantes.

Mesoamerica

10.1590/s0036-36342011000900012

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Adding the human dimension to economic analysis: why DALYs don't tell the whole story.

PubMed (1994)

Stefano Bertozzi

In order to best understand the impact of AIDS on a national level, it may be more important to understand its impact on the magnitude and severity of poverty than on national economic growth. It may also be true that the primary economic impact of AIDS is the concentrated breakdown of vulnerable structures such as the family, community, or even nations. The larger the structure, the more likely it can withstand collapse by distributing the impact, but vulnerability to collapse must be understood to avoid the catastrophe of breakdown. Rwanda may present the first example of the latter. Its AIDS prevalence was among the highest in the world, and the prevalence rate among members of the military was even higher. If studies consider the impact of HIV infection in terms of direct and indirect costs only, more dollars would be saved by preventing one case in the US than in most other countries. If, on the other hand, a hunger index is used (for each case of HIV how many people will go hungry and how many formerly hungry people will become malnourished), the greatest prevention benefit would probably occur in Uganda. In order to understand how economic factors fuel the epidemic and determine its impact, more socioeconomic data must be collected. When making the economic choices that maximize benefits to AIDS victims, the difficulty occurs in defining benefit. Most developing countries cannot provide the resources to prolong life and avert disability. However, there are ways to alleviate the impact of AIDS which all countries can afford: reducing pain, removing the barriers of discrimination, providing support groups, and helping people with the activities of daily life. In order to design the appropriate comprehensive care approaches in different settings, more data must be collected on how HIV-infected individuals perceive the impact of the disease on their lives.

Vulnerability

Economic cost

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Uso inconsistente del condón entre trabajadoras sexuales en Ecuador: resultados de una encuesta de comportamientos Inconsistent condom use among sexual workers in Ecuador: results from a behavior survey

DOAJ (DOAJ: Directory of Open Access Journals) (2006)

Juan Pablo Gutiérrez Diana Molina-Yépez Fiona Samuels Stefano Bertozzi

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Cross-Sectional Association between Length of Incarceration and Selected Risk Factors for Non-Communicable Chronic Diseases in Two Male Prisons of Mexico City

PLoS ONE (2015)

Omar Silverman-Retana Ruy López‐Ridaura Edson Serván‐Mori Sergio Bautista‐Arredondo Stefano Bertozzi

Background Mexico City prisons are characterized by overcrowded facilities and poor living conditions for housed prisoners. Chronic disease profile is characterized by low prevalence of self reported hypertension (2.5%) and diabetes (1.8%) compared to general population; 9.5% of male inmates were obese. There is limited evidence regarding on the exposure to prison environment over prisoner's health status; particularly, on cardiovascular disease risk factors. The objective of this study is to assess the relationship between length of incarceration and selected risk factors for non-communicable chronic diseases (NCDs). Methods and Findings We performed a cross-sectional analysis using data from two large male prisons in Mexico City (n = 14,086). Using quantile regression models we assessed the relationship between length of incarceration and selected risk factors for NCDs; stratified analysis by age at admission to prison was performed. We found a significant negative trend in BMI and WC across incarceration length quintiles. BP had a significant positive trend with a percentage change increase around 5% mmHg. The greatest increase in systolic blood pressure was observed in the older age at admission group. Conclusions This analysis provides insight into the relationship between length of incarceration and four selected risk factors for NCDs; screening for high blood pressure should be guarantee in order to identify at risk individuals and linked to the prison's health facility. It is important to assess prison environment features to approach potential risk for developing NCDs in this context.

Non-communicable disease

Cross-sectional study

10.1371/journal.pone.0138063

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An Investment Case for Ending Neglected Tropical Diseases -- Major Infectious Diseases

Holmes Kk Stefano Bertozzi Bloom Br Prabhat Jha

Tropical disease

Neglected Tropical Diseases

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