Research in Action: Dr. Beate Sander
Getting the greatest value for our health care dollars
Hear Dr. Sander discuss her research.
Dr. Beate Sander explains how evaluating the cost-effectiveness of public health programs can have positive impacts on policy and decision-making.
Working as a nurse in an intensive-care unit in the 1990s, Dr. Beate Sander never imagined where life would someday take her. An interest in economics, combined with her clinical background, would led her into an emerging field called health economics.
Now a PHO scientist, Dr. Sander conducts economic evaluations of health interventions, such as new vaccines, drugs and technologies. The goal: to show whether such approaches offer good value for money. Her findings are informing health policy decision-making.
“There’s been a growing interest in health economics in recent years as people ask whether we are spending in the right places or whether we could potentially get greater benefit by putting those dollars somewhere else,” says Dr. Sander, who is also an assistant professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto and an adjunct scientist at the Institute for Clinical Evaluative Sciences.
One of Dr. Sander’s first studies, which grew out of her doctoral work at the University of Toronto, captured widespread attention. It was an economic appraisal of Ontario’s universal influenza immunization program. In 2000, Ontario became the first place in the world to offer a free flu vaccine to the entire population. The cost-effectiveness of the new program had yet to be evaluated.
With colleagues, Dr. Sander compared the health outcomes and costs associated with the universal program to outcomes and costs if Ontario offered a more limited, targeted program. The results were clear: the universal program made good economic sense.
Specifically, the researchers found that, although the universal program was approximately twice as costly as a targeted one, the number of flu cases declined by 61% and mortality by 28%. Moreover, reducing flu cases decreased health-care services cost by 52%.
Since the study’s publication in 2010 in PLoS Medicine, several other Canadian provinces have introduced free seasonal flu vaccines for the entire population. In the US, Dr. Sander’s paper was cited in a recommendation for universal vaccination for influenza, made by the Advisory Committee on Immunization Practices (ACIP).
Sometimes, Dr. Sander has to peer far into the future to inform the present. Using computer simulations, she is able to assess public health interventions that haven’t been implemented.
“It’s tricky because, in a way, you have to predict the future,” she explains.
For example, Dr. Sander recently evaluated a novel childhood vaccine for meningococcal serogroup B (invasive MenB). With Dr. Hong Anh Thi Tu, she looked at the cost-effectiveness and potential impact of the MenB vaccine in Ontario, which has a very low incidence of the disease.
Their findings, published in 2014 in the journal Vaccine, showed that routinely using the new vaccine would cost over $46 million for a birth cohort of 150,000 infants. The researchers discovered that this investment would prevent 4.6 MenB cases and 0.5 related deaths. “It just doesn’t make economic sense in Ontario and comparable jurisdictions,” says Dr. Sander.
Two important medical bodies paid close attention to these findings: Canada’s National Advisory Committee on Immunization (NACI) and Ontario’s Provincial Infectious Diseases Advisory Committee on Immunization (PIDAC-I). In the end, neither group recommended public funding of a routine MenB vaccination program.
Dr. Sander is also interested in the actual economic burden of infectious diseases. She notes that infectious diseases have seen a resurgence in Canada over the past decade, with outbreaks of Escherichia coli (E. coli), West Nile virus, severe acute respiratory syndrome (SARS), and pandemic influenza H1N1.
Funded by the Canadian Institutes of Health Research, she and colleagues are coming up with better ways to estimate the longitudinal health care cost of different infectious diseases. They will use these methods to calculate the economic burden in Ontario of Clostridium difficile, Streptococcus pneumonia and hepatitis B. The cost of Lyme disease, West Nile virus, mycobacteria and meningococcal disease is the focus of other studies by Dr. Sander.
Why tally these costs? “If we don’t have accurate costs, then we can’t do a good economic evaluation to determine which interventions we should be focusing on in terms of value for money.”
To do her analyses, Dr. Sander works with many different people, from general clinicians and infectious disease specialists to microbiologists, mathematicians, epidemiologists, and computer scientists. She also works in an operational role with program staff within PHO to assist with answering policy-relevant immunization questions. She’s even conferring with entomologists on a study of the cost-effectiveness of West Nile virus mitigation strategies.
At PHO, Dr. Sander collaborates closely with clinicians and other scientists, public health units, and experts based at the public health laboratories. “I’m fortunate to be able to use the lab data, which I can then link to health administrative data.”
The availability, these days, of large databases packed with information on health resource use and costs makes this “a really exciting time to be doing my kind of research.”
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