Yoel Lubell: The economics of tropical diseases

This is a podcast from the Nuffield Department of Medicine. Today we speak with Dr Yoel Lubell about the economics of tropical diseases.

Q: What is the link between economics and how we understand and treat diseases?

Yoel Lubell: Economics and health are interlinked in many ways. One example is the vicious cycle we see between poverty and ill health, which is true at the patient level and for households, but it is also true for countries. You may see associations between malaria transmission and slower GDP growth for instance. My own research focuses more on economic evaluation of new interventions. For example, if we have a new diagnostic test for malaria, I would be looking at how beneficial it is, what the health gains are, what the costs are, and then try and put those together and say whether or not this is an efficient use of inevitably scarce resources.

Q: What has your research found?

YL: We have looked at diagnostics for malaria and treatments for malaria. We have identified some of these which are very efficient and very cost effective. I would like to think that it was somewhat informative in a lot of the policy making over the past few years, in terms of moving from treating all fevers as malaria to requiring that all fevers are tested for malaria before patients receive treatment. That has been one potential contribution to global health.

Q: Have you found it has changed the way in which we understand diseases such as malaria?

YL: The work I do is not normally lab based, looking at things like parasites. But I think it has been very informative in how we manage malaria, so that we now treat fevers as a whole. It is very important to diagnose and treat malaria which can be a deadly disease, but we have really highlighted with a lot of modelling the importance of considering the benefits and the health gains that could be obtained by better management of what we call the non-malarial fevers.

What I have been doing more recently is trying to identify potential tests that could be used to try and direct the use of antibiotics within these non-malarial fevers. We have identified bio-markers that could be very effective at this and we are moving towards developing simple tests that could be used by relatively untrained community health workers to say ‘now that I know that this patient does not have malaria, do they require an antibiotic or not?’

Q: What are they most important lines of research which have emerged over the past 5-10 years?

YL: When I started approximately 10 years ago, very advanced methodologies were being used in high income settings to evaluate new interventions, while things were much more basic for malaria and other tropical diseases. I was very lucky that I got my PhD just by applying relatively simple methods that were being used routinely, to malaria, an area they had almost never been applied before. What we have seen over the past decade or so is that the field is catching up: now in our own research units for instance, we are focusing on merging transmission dynamic models, where we try and do some kind of projection for how diseases are transmitted, with economic models where we can have economic inputs and outputs. Again, this is to estimate what the most cost effective of combinations of interventions are, to try and impact on transmission.

Q: Why is your research important? Why should we fund it?

YL: The main value of doing these economic models is that it seems to be the final point before the research goes out to policy making and we bring together evidence from many different fields: epidemiology, data from clinical trials, social sciences. They all come together in economic models, along with costs as well, to say: given what we know from all of these different areas and given the resource constraints, what would we advise policy makers to actually invest in.

Q: How does your research fit within transitional medicine, within the department?

YL: The focus of economic evaluation is very much on that ‘hands-on’, ‘what is going on’, in the field, in routine care, and how we can improve on that with whatever new interventions are being developed. It is not only looking at new interventions once they are developed: economic evaluation can also inform what interventions we should be looking for, even if they don’t exist yet. It is what we call the value of information. We can look at what the uncertainties are, where we might invest more in research, in order to reduce uncertainties or to develop new interventions that could have the greatest impact on public health.

This interview was recorded in June 2015.