Christine Poulos | Research Triangle Institute International (original) (raw)

Papers by Christine Poulos

Value in Health, 2015

Background: Meningococcal disease is rare but can cause death or disabilities. Although the Advis... more Background: Meningococcal disease is rare but can cause death or disabilities. Although the Advisory Committee on Immunization Practices has recommended meningococcal vaccination for at-risk children aged 9 through 23 months, it has not endorsed universal vaccination. Health insurance payments for the vaccination of children who are not at risk are likely to be limited. Use of infant meningococcal vaccines by these families will thus depend on the preferences of physicians who might recommend vaccination to parents, as well as parents' preferences. Objective: To quantify pediatricians' preferences for specific features of hypothetical infant meningococcal vaccines. Methods: A sample of pediatricians (n ¼ 216) completed a Web-enabled, discrete choice experiment survey in which respondents chose between pairs of hypothetical vaccines in a series of trade-off questions. The questions described vaccines with six attributes. A random-parameters logit regression model was used to estimate the relative importance weights physicians place on vaccine features. These weights were used to calculate the predicted probability that a physician chooses hypothetical vaccines with given characteristics. Results: Pediatricians' choices indicated that increases in vaccine effectiveness were among the most important factors in their vaccine recommendations, followed by increases in the number of injections. The age at which protection begins and the number of additional office visits were less important. Whether a booster was required after 5 years was the least important factor in vaccine recommendations. The results suggest that virtually all (99.9%) physicians in the sample would recommend a vaccine even with the least-preferred features rather than no infant meningococcal vaccine. Conclusions: Physicians' responses indicate a strong preference for infant meningococcal vaccination.

January 2000Despite the great benefits from preventing malaria, the fact that vaccine demand is p... more January 2000Despite the great benefits from preventing malaria, the fact that vaccine demand is price inelastic suggests that it will be difficult to achieve significant market penetration unless the vaccine is subsidized. The results are similar for bed nets treated with insecticide.Cropper, Haile, Lampietti, Poulos, and Whittington measure the monetary value households place on preventing malaria in Tembien, Tigray Region,

The burden of typhoid fever remains high in impoverished settings, and increasing antibiotic resi... more The burden of typhoid fever remains high in impoverished settings, and increasing antibiotic resistance is making treatment costly. One strategy for reducing the typhoid morbidity and mortality is vaccination with the Vi polysaccharide vaccine. We use a wealth of new economic and epidemiological data to evaluate the cost-effectiveness of Vi vaccination against typhoid in sites in four Asian cities: Kolkata (India), Karachi (Pakistan), North Jakarta (Indonesia), and Hue (Vietnam). We report results from both a societal as well as a public sector financial perspective.

We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, u... more We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects. Methods: Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older. Results: We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates. Conclusions: Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings.

IOP Conference Series: Earth and Environmental Science, 2009

This innovative new feature generates a list of articles' also read'by other users base... more This innovative new feature generates a list of articles' also read'by other users based on them reading the original article. Article abstracts citations and references are all considered and weighted accordingly. We hope that this will help you find relevant papers for your ...

Canadian Journal of Agricultural Economics/Revue canadienne d'agroeconomie, 2007

SSRN Electronic Journal

This paper examines how demand for preventive health care differs depending on whose preferences ... more This paper examines how demand for preventive health care differs depending on whose preferences in the household are assessed. The analysis indicates that married women are willing to pay more to prevent malaria in their household malaria than married men. There are, however, no significant differences in the rate at which male and female respondents substitute teenagers and children for

Infectious disease such as malaria, dengue, and diarrhea that are spread by vectors such as mosqu... more Infectious disease such as malaria, dengue, and diarrhea that are spread by vectors such as mosquitoes and flies are rife in the much of the developing world, potentially impacting more than two-third of the world's population. Environmental conditions that favor the transmission of such diseases are, in turn, affected by human activity such as deforestation, livestock rearing, irrigated farming, migration, road construction, dam-building, and water and sanitation infrastructure provision through their impact on the survival and abundance of disease vectors. Therefore, the prevention and control of these diseases relies on the interplay of public policies (e.g., reducing microbial pathogen load in public water supplies) and private choices (e.g., safe storage, treatment, and handling of drinking water and food inside the house). As described, externalities play important roles in disease dynamics, demonstrating the need for public policies such as subsidies/taxes, information and technical assistance to achieve socially desirable outcomes. This paper presents an application in public economics that tests analytical models of economic epidemiology. The first part of the paper reviews and synthesizes the early literature that has focused on the behavioral basis of disease control and prevention. The second part presents empirical applications where we use the analytical models to shape the econometric analyses, permitting perhaps the first tests of untested hypotheses about the effectiveness of disease control interventions and how they related to private disease control. We draw on several data sets, including a large multi-year, multi-scale on going study from rural India to build econometric models of disease outcomes and public interventions. We conclude with a discussion of policy implications and conceptual and empirical research extensions.

SSRN Electronic Journal, 2000

This article considers the investment case for using the Vi polysaccharide vaccine (Vi) in develo... more This article considers the investment case for using the Vi polysaccharide vaccine (Vi) in developing countries from two perspectives: reducing typhoid cases and limiting new health care spending. Consumer demand functions that predict probabilities of adults and children purchasing typhoid vaccinations at different prices are incorporated in a formal mathematical model. This optimisation model solves for the optimal vaccine prices to charge adults and children to maximise the number of typhoid cases avoided subject to the constraint that the sum of 1) vaccination revenues, 2) the public savings from avoided cases, and 3) an external (e.g., donor) contribution (if any), is sufficient to pay for the costs of the vaccination program. Using values from the recent literature for South and Southeast Asia for typhoid incidence, Vi vaccine effectiveness, public cost of illness, and vaccination program cost, three mass vaccination policy alternatives are evaluated: charging adults and children different (optimal) prices, charging uniform prices, and providing free vaccines. Assuming differential pricing is politically feasible, the vaccine price for children should be zero (because their incidence is much higher than adults), and fees for adults should cover most of costs of the vaccination program (because the savings from reduced public sector treatment are small). Equal prices for children and adults produce very similar results to the optimal solution. Alternatively, if vaccines are free, the number of cases is not significantly reduced compared to either pricing policy, but a large external financial contribution would be required.

Vaccine, Jan 4, 2009

This article considers the investment case for using the Vi polysaccharide vaccine in developing ... more This article considers the investment case for using the Vi polysaccharide vaccine in developing countries from two perspectives: reducing typhoid cases and limiting new health care spending. A case study is presented using data from South and Southeast Asia. The purpose of the paper, however, is to draw broad implications that may apply to developing countries in general. Typical consumer demand functions developed from stated preference household surveys in South and Southeast Asia are used to predict probabilities of adults and children purchasing typhoid vaccinations at different prices. These functions are incorporated in a formal mathematical model. Using data from the recent literature for South and Southeast Asia for typhoid incidence, Vi vaccine effectiveness, public cost of illness, and vaccination program cost, three mass vaccination policy alternatives are evaluated: charging adults and children different (optimal) prices, charging uniform prices, and providing free vacc...

Journal of health, population, and nutrition, 2004

Many economic analyses of immunization programmes focus on the benefits in terms of public-sector... more Many economic analyses of immunization programmes focus on the benefits in terms of public-sector cost savings, but do not incorporate estimates of the private cost savings that individuals receive from vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid immunization policy by examining how community-level incidence estimates and information on distribution of costs of illness among patients and the public-health sector can be used in the economic analysis of vaccination-programme options. The findings illustrate why typhoid vaccination programmes may often appear to be unattractive to public-health officials who adopt a public budgetary perspective. Under many plausible sets of assumptions, public-sector expenditure on typhoid vaccination does not yield comparable public-sector cost savings. If public-health officials adopt a societal perspective on the economic benefits of vaccination, there are many situations in which dif...

IOP Conference Series: Earth and Environmental Science, 2009

World Development, 2009

The ''old" familiar diseases of cholera and typhoid remain a serious health threat in many develo... more The ''old" familiar diseases of cholera and typhoid remain a serious health threat in many developing countries. Health policy analysts often argue that vaccination against cholera and typhoid should be provided free because poor people cannot afford to pay for such vaccines and because vaccination confers positive economic externalities on unvaccinated individuals. In 2004, we conducted a contingent valuation (CV) survey of 835 randomly selected adults from two neighborhoods in Kolkata, India to provide information on private demand for cholera and typhoid vaccines for themselves and for household members to support more nuanced financial and economics analyses of such vaccination programs. The median private economic benefits of providing a typhoid vaccine to a household with five members is about US$23 in a middle-income neighborhood (US$27 for a cholera vaccine) and US$14 in a lowincome slum (US$15 for a cholera vaccine). Our research raises an intriguing possibility. If user charges were set at a level to recover the costs of a vaccination program, there could be sufficient demand for the vaccine so that coverage of the vaccinated population might ensure that all the remaining unvaccinated individuals would be protected as well through indirect herd protection.

Journal of health, population, and nutrition, 2004

Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to... more Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to facilitate the use of available anti-typhoid vaccines in developing countries. This one-year prospective surveillance was carried out in an urban slum community in Delhi, India, to estimate the costs of illness for cases of typhoid fever. Ninety-eight culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified during the surveillance. Estimates of costs of illness were based on data collected through weekly interviews conducted at home for three months following diagnosis. Private costs included the sum of direct medical, direct non-medical, and indirect costs. Non-patient (public) costs included costs of outpatient visits, hospitalizations, laboratory tests, and medicines provided free of charge to the families. The mean cost per episode of blood culture-confirmed typhoid fever was 3,597 Indian Rupees (US$ 1=IN...

Nearly one billion people worldwide rely on unimproved sources of drinking water, which are not p... more Nearly one billion people worldwide rely on unimproved sources of drinking water, which are not protected from outside contamination. Unhygienic handling of water after collection may further contaminate household drinking water. In recognition of these obstacles, usage of household water treatment and storage (HWTS) products (e.g., water filters, chlorine-based tablets or liquid) is regarded as a potentially important step in

Benefit estimates for policies that affect the health of children or elderly adults require the a... more Benefit estimates for policies that affect the health of children or elderly adults require the analyst to account for potential interactions among individual members of a given household. Addressing this task for air quality improvements is particularly important as these policies disproportionately affect children with asthma and older adults. Often these individuals are cared for by their parents and by grown children. These dependency relationships have the potential to affect benefit measurement. We propose a conceptual framework that underscores the importance of recognizing their role in the choice models used to recover estimates of the willingness to pay for policy changes. This paper summarizes results from a pilot survey that tests hypotheses about the effect of different dependencies on respondents' choices. Our findings indicate an apparent implicit delineation of personal responsibilities to household members of different ages. Respondents' choices appear to ...

Value in Health, 2015

IOP Conference Series: Earth and Environmental Science, 2009

Canadian Journal of Agricultural Economics/Revue canadienne d'agroeconomie, 2007

SSRN Electronic Journal

SSRN Electronic Journal, 2000

Vaccine, Jan 4, 2009

Journal of health, population, and nutrition, 2004

IOP Conference Series: Earth and Environmental Science, 2009

World Development, 2009

Journal of health, population, and nutrition, 2004