Center for Disease Dynamics, Economics & Policy

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Center for Disease Dynamics, Economics & Policy
Cddep logo standard rgb.gif
Abbreviation CDDEP
Formation 2009
Headquarters 1616 P Street NW
Location
Director
Ramanan Laxminarayan
Website cddep.org

The Center for Disease Dynamics, Economics & Policy (CDDEP) is a public health research organization with headquarters in Washington, D.C. and New Delhi. Its mission is "to produce independent, multidisciplinary research to advance the health and well-being of human populations in the United States and around the world."

Overview[edit]

CDDEP’s team of economists, epidemiologists, disease modelers, policy and risk analysts carry out research on malaria, antibiotic resistance, disease control priorities, environmental health, alcohol and tobacco, and various other diseases. Research is divided across four areas: disease dynamics and behavior, disease dynamics and information structure, delivery of new technologies for disease control, and innovative financing.[1]

Two key CDDEP initiatives focus on antibiotic resistance as a public health crisis. Within the United States, the Extending the Cure (ETC) project has received widespread media attention for work examining the costs of hospital acquired infections (HAIs)[2] and designing novel incentive-based strategies to encourage antibiotic conservation.[3] ETC researchers have contributed to Roll Call,[4] the Wall Street Journal,[5] and the Baltimore Sun,[6] among others. In addition, The Global Antibiotic Resistance Partnership is developing actionable policy proposals on antibiotic resistance for five low- and middle-income countries: China, India, Kenya, South Africa, and Vietnam.[7]

CDDEP staff are also well known in the field of malaria research. Senior fellows were pioneers of the global subsidy idea that became Affordable Medicines Facility-malaria (AMFm),[8] an innovative financing mechanism designed to expand access to the most effective treatment for malaria through the public, private and NGO sectors.[9] CDDEP has contributed to malaria elimination planning in Zanzibar, and to efforts to promote the use of multiple first-line therapies (MFTs) to slow resistance to antimalarial drugs.[10]

Current projects[edit]

Extending the Cure[edit]

The Extending the Cure (ETC) project is a research and consultative effort that frames the growing problem of antibiotic resistance as a challenge in managing a shared societal resource. The ETC inaugural report and its subsequent papers examine the range of issues around resistance and look at innovative policy solutions to encourage the conservation of antibiotics without stifling new drug development.

Extending the Cure is funded in part by the Robert Wood Johnson Foundation through its Pioneer Portfolio, which supports innovative projects that may lead to breakthrough improvements in health and health care.[11]

Global Antibiotic Resistance Partnership[edit]

The Global Antibiotic Resistance Partnership (GARP) was started in 2009 to create a platform for developing actionable policy proposals on antibiotic resistance in low-income and middle-income countries.

During the first three years, Phase 1 of GARP established national working groups in four countries: India, Kenya, South Africa and Vietnam. Those working groups—multidisciplinary, with representatives from all sectors, dealing with both human and animal antibiotic use—have become national resources for their expertise and linkages to the current global activities in antibiotic resistance. GARP Phase 1 culminated in the 1st Global Forum on Bacterial Infections: Balancing Treatment Access and Antibiotic Resistance on October 3–5, 2011, in New Delhi, India. Since GARP Phase 2 began in 2012, national working groups have been established in Mozambique, Nepal, Tanzania and Uganda.

The GARP secretariat at the Center for Disease Dynamics, Economics & Policy (CDDEP), in Washington, DC and New Delhi, provides technical support to each working group, creates links within the GARP network and involves the working groups in global discussions and policy development. GARP is a CDDEP project, funded by the Bill & Melinda Gates Foundation.

Affordable Medicines Facility--Malaria[edit]

The Affordable Medicines Facility-malaria (AMFm) is an innovative financing mechanism designed to expand access to the most effective treatment for malaria, artemisinin-based combination therapies (ACTs) through the public, private and NGO sectors. It will reduce the use of drugs that no longer work because of drug resistance, and reduce the use of artemisinin by itself, as monotherapy, thereby delaying the onset of resistance to that drug and preserving its effectiveness. AMFm is being managed by the Global Fund with directed financing from UNITAID, the UK Department for International Development (DFID), and other donors.

CDDEP researchers have been involved with the global subsidy idea behind AMFm since 2002, when the U.S. Institute of Medicine committee first deliberated on the questions of how to expand access to ACTs while maintaining the effectiveness of artemisinin compounds.[12]

Disease Control Priorities Project[edit]

A joint effort of The World Bank, the Fogarty International Center of the National Institutes of Health, and the World Health Organization, with substantial technical input from CDDEP researchers, DCPP was launched in 2001 as a four-year initiative to improve the health of people in developing countries by identifying disease control priorities based on scientific evidence and cost-effectiveness. Researchers at CDDEP were involved in carrying out the economic analysis for a number of chapters as well as in writing the cross-cutting chapter summarizing the main economic messages of the project, as well as the Lancet paper summarizing the main messages of the project. CDDEP researchers also co-led DCPP in India. That effort resulted in a book, “Choosing Health: An Entitlement for All Indians.”[13] The overarching paradigm for DCPP is of quantitative evaluation of health system interventions and prioritizing interventions on the basis of cost-effectiveness.[14]

Malaria Atlas Project--Elimination[edit]

A compliment to the Malaria Atlas Project, this research seeks to develop an improved bio-economic model for trans-boundary malaria control financing that considers imported malaria. Research couples economic models to the stochastic spatial models largely based on malaria transmission intensity data assembled by the Malaria Atlas Project. Research includes modeling vectors and malaria transmission to develop the further spatial components. The end product of this effort will be the development of a tool for making estimates of malaria transmission intensity and burden as a function of financing strategies.[15]

Golden Mustard[edit]

CDDEP’s Golden Mustard project, funded by the International Center for Tropical Agriculture (CIAT), Colombia, examines the potential impact of biofortification of mustard in India. The Indian context presents specific challenges: widely dispersed food production systems and sporadic health center access have hampered interventions to distribute vitamin A supplements, industrially fortified foods, or biofortified seed products in the past. CDDEP’s Golden Mustard project looks at how mustard biofortification could be an advantageous addition to a portfolio of strategies to alleviate Vitamin A deficiency in this context.[16]

Multiple First-line Therapies[edit]

If two drugs (in combination) are good, are three or more being used concurrently by different patients better at keeping drug resistance at bay? The question has practical consequences, as nearly every malaria-endemic country adopts a single first-line treatment (now, a combination drug) as policy. National policies are difficult to change and to implement in these relatively poor countries, and good evidence would be needed to adopt a more complex approach. CDDEP researchers began investigating MFT in 2006 using an evolutionary-epidemiological modeling framework. They compared MFT with single combination drugs and with cycling strategies where therapies are rotated, either on a fixed cycling schedule or when resistance levels or treatment failure become too high. Compared with these alternatives, the analysis predicts that MFT strategies will delay the emergence and slow the fixation of resistant strains.[17]

Notable Work[edit]

The Center for Global Development describes CDDEP as a complement to "the CDC, WHO, and other agencies who fulfill basic surveillance and public health roles, but can’t give us much (if any) insight into the economic consequences of pandemic flu and other health disasters, nor can they use this insight to promote needed policy reform in the U.S. and globally."[18]

Extending the Cure’s inaugural report Extending the Cure: Policy Responses to the Growing Threat of Antibiotic Resistance, has been widely debated at a series of consultations with representatives from the medical, insurance, pharmaceutical, government, and academic communities. It set the stage for continued research in the form of technical papers and policy briefs to prevent the impending health crisis of widespread antibiotic resistance.[19]

ETC received national media attention for its study on the costs of Hospital-Acquired Infections, including coverage by NPR, ABC, CNN, and Reuters.[20] Published in Archives of Internal Medicine, the study demonstrated that two conditions caused by HAIs killed 48,000 people and ramped up health care costs by $8.1 billion in 2006 alone.[21]

The 2010 ETC-sponsored paper Fighting Antibiotic Resistance: Marrying New Financial Incentives to Meeting Public Health Goalswas cited by the Guardian as “a radical plan to save antibiotics.” The study, published in Health Affairs, examined novel strategies for conserving antibiotics while also encouraging new drug development.[22]

ETC research featured in the CDC's Emerging Infectious Diseases also received widespread national media coverage.[23] The study found the community-associated strain of the deadly superbug MRSA—an infection-causing bacteria resistant to most common antibiotics—poses a far greater health threat than previously known and is making its way into hospitals. The new threat is easily picked up in fitness centers, schools, and other public places and has increased the overall burden of MRSA within hospitals. The study analyzed data from more than 300 microbiology labs serving hospitals all over the United States, found a seven-fold increase in the proportion of "community-associated" strains of methicillin-resistant Staphylococcus aureus, or MRSA, in outpatient hospital units between 1999 and 2006.[24]

CDDEP Senior Fellow David L. Smith’s 2010 study in Nature, "Climate Change and the Global Malaria Recession", rebuked the widespread claim that climate change will be linked to increasing malaria incidence.[25]

CDDEP researchers are contributing to the Lancet Series on Malaria Elimination as well as to the 5th report in Roll Back Malaria’s Progress & Impact Series.[26]

CDDEP is known as a pioneer in researching Multiple First-line Therapies as a means of slowing the spread of drug resistance to antimalarials.[27]

Key Researchers[edit]

Ramanan Laxminarayan is director and senior fellow at the Center for Disease Dynamics, Economics & Policy. He is also visiting scholar and lecturer at Princeton University. His research deals with the integration of epidemiological models of infectious diseases and drug resistance into the economic analysis of public health problems. He has worked to improve understanding drug resistance as a problem of managing a shared global resource. Laxminarayan has worked with the World Health Organization (WHO) and the World Bank on evaluating malaria treatment policy, vaccination strategies, the economic burden of tuberculosis, and control of non-communicable diseases. He has served on a number of advisory committees at WHO, Centers for Disease Control and Prevention, and the [Institute of Medicine]. In 2003-04, he served on the National Academy of Science/Institute of Medicine Committee on the Economics of Antimalarial Drugs and subsequently helped create the Affordable Medicines Facility-malaria (AMFm), a novel financing mechanism for antimalarials. Laxminarayan received his undergraduate degree in engineering from the Birla Institute of Technology and Science in Pilani, India, and his master’s degree in public health (Epidemiology) and doctorate in economics from the University of Washington in Seattle.[28]

Hellen Gelband focuses on health policy issues in the United States and internationally. During her career, she has used the evaluation of medical evidence to inform a wide range of both American and global health policies. Her work at CDDEP explores the growing resistance to antibiotic and anti-malarial drugs, as well as access to and cost of such pharmaceuticals. She is coordinating the Global Antibiotic Resistance Partnership – a project that will establish centers in five developing countries to foster rational policies governing the use of antibiotics. Gelband spent 15 years at the Congressional Office of Technology Assessment and ten years at the Institute of Medicine of the National Academies. She also has worked for the World Health Organization, the University of Oxford, Doctors without Borders, and a number of foreign governments and U.S.-based consulting companies.[29]

David L. Smith’s work focuses on the ecology, epidemiology, and economics of infectious diseases. The majority of his research is on malaria and the policy-oriented science related to its outbreak, spread and management. He also works on other emerging diseases, including influenza, rabies, and methicillin-resistant Staphylococcus aureus (MRSA). He has worked on problems such as the development of resistance to anti-malarial drugs and bacterial resistance to antibiotics. With regard to malaria, his work focuses on fine-tuning policy strategies for deploying multiple drugs --- such as highly effective artemisinin-based combination therapies for malaria --- so as to increase their treatment effectiveness while also decreasing opportunities for the pathogen to develop resistance to an individual drug.[30]

Anup Malani is a Professor of Law at the University of Chicago. He is also a Research Affiliate for the Joint Center for Poverty Research at Northwestern University and the University of Chicago. Mr. Malani teaches, among other classes, Health Law, Corporations, and Bankruptcy. His research examines the control of infectious disease, placebo effects, antibiotic resistance, medical malpractice liability, and the conduct of and inferences from medical trials. Mr. Malani graduated from the University of Chicago Law School in 2000. He clerked for the Hon. Stephen F. Williams, U.S. Court of Appeals for the D.C. Circuit in 2000-2001 and for U.S. Supreme Court Justice Sandra Day O'Connor in 2001-2002. Mr. Malani received a Ph.D. from the University of Chicago's Department of Economics in 2003. Between 2002 and 2006, Mr. Malani was an Associate Professor at the University of Virginia Law School and the Health Evaluation Sciences Department of the University of Virginia Medical School.[31]

Dean Jamison is a Professor of Global Health at the University of Washington. Concurrently, he is Adjunct Professor at both the Peking University Guanghua School of Management and at the University of Queensland School of Population Health in Australia. Before joining CDDEP and the University of Washington, Dr. Jamison served as T & G Angelopoulos Visiting Professor of Public Health and International Development in the Harvard Kennedy School and the Harvard School of Public Health, while in tandem holding a position as Professor of Development Economics at the University of California, San Francisco. Prior to that, Dr. Jamison was at the World Bank for more than a decade, where he was a senior economist in the research department, division chief for education policy, and division chief for population, health and nutrition. In the 1990s, he temporarily rejoined the World Bank to serve as Director of the World Development Report Office and as lead author for the bank’s 1993 World Development Report, Investing in Health. In 1994, Dr. Jamison was elected to membership in the Institute of Medicine of the U.S. National Academy of Sciences. He has served frequently on advisory groups to national and international organizations. Jamison recently led the Disease Control Priorities Project, for which he was senior editor of Disease Control Priorities in Developing Countries, 2nd edition, and an editor of Global Burden of Disease and Risk Factors, both published by Oxford University Press in 2006.[32]

See also[edit]

References[edit]

  1. ^ CDDEP Research Accessed 10/20/2010
  2. ^ Clinical and Economic Outcomes Attributable to Health Care–Associated Sepsis and Pneumonia
  3. ^ Fighting Antibiotic Resistance: Marrying New Financial Incentives To Meeting Public Health Goals
  4. ^ Health Reform Should Tackle the Rising Threat of Hospital Infections. Roll Call 6/30/2009. Accessed 10/20/2010
  5. ^ Study: Half of Infection Deaths Linked Directly to Hospital Care Wall Street Journal 4/2/2009. Accessed 10/20/2010
  6. ^ Fighting infection: Combat superbugs, other threats with multifaceted, regional approach The Baltimore Sun 2/24/2009. Accessed 10/20/2010
  7. ^ Global Antibiotic Resistance Partnership Accessed 10/20/2010
  8. ^ AMFm Teaching Case Accessed 10/20/2010
  9. ^ The Affordable Medicines Facility for Malaria (AMFm) Roll Back Malaria Partnership Accessed 10/20/2010
  10. ^ Multiple First-line Therapies Accessed 10/20/2010
  11. ^ Extending the Cure. What We Do Accessed: 01/21/2010
  12. ^ Affordable Medicines Facility--malaria Accessed 10/20/2010
  13. ^ Choosing Health: An Entitlement for All Indians May 2009
  14. ^ Disease Control Priorities Project
  15. ^ Strategic Planning Tools for Spatially Progressive Malaria Elimination. Center for Disease Dynamics, Economics & Policy 01/21/2010
  16. ^ Golden Mustard
  17. ^ Multiple First-line Therapies
  18. ^ Nugent, Rachel. A New Center on Disease Outbreaks Global Health Policy 10/01/2009 Accessed: 01/21/2010
  19. ^ Extending the Cure: Policy Responses to the Growing Threat of Antibiotic Resistance
  20. ^ Extending the Cure Blog Post 2/24/2010
  21. ^ Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia
  22. ^ Fighting Antibiotic Resistance: Marrying New Financial Incentives to Meeting Public Health Goals
  23. ^ Final Coverage Report
  24. ^ New Paper on CA-MRSA
  25. ^ Climate Change and the Global Malaria Recession
  26. ^ Progress & Impact Series Roll Back Malaria Partnership Accessed 10/20/2010
  27. ^ Multiple First-line Therapies Accessed 10/20/2010
  28. ^ Ramanan Laxminarayan
  29. ^ Hellen Gelband
  30. ^ David Smith
  31. ^ Anup Malani
  32. ^ Dean Jamison

External links[edit]