Ponte a prueba. Put yourself to the test.

As he explained during the recent Rosenkranz Prize Symposium, Stefano M. Bertozzi used this slogan to promote health reform in the Mexico City prison system. By encouraging inmates to step up and get themselves tested for HIV and other chronic illnesses, Bertozzi, dean and professor of health policy and management at the UC Berkeley School of Public Health, was able to decrease the spread of illnesses in Mexican prisons and the surrounding communities.

The Rosenkranz Prize Symposium celebrated research projects that—like Bertozzi’s—address the health care needs of the world’s most vulnerable populations. With support from the Rosenkranz Prize for Health Care Research in Developing Countries, Stanford scholars have stepped up to tackle health issues in regions in need.

Since 2010, the award has funded six young Stanford researchers who aim to improve health in developing countries. The symposium celebrated their achievements.

The award honors the work of Dr. George Rosenkranz who spent his career reducing health disparities around the globe. Rosenkranz, who was the first to synthesize cortisone and the active ingredient in the first oral contraceptive, also celebrated his 100^th birthday at the symposium.

Producing research that will increase care for vulnerable populations globally is the ultimate goal of the Rosenkranz Prize.

Andrés Moreno-Estrada, the 2012 winner, has used the award to study genetics in Latin American and Caribbean populations, aiming to increase knowledge of potential genetic illnesses. He said, “The Rosenkranz Prize is a clear, important step forward to demonstrate that we can do cutting edge science in developing countries that is of international relevance.”

Other winners include Eran Bendavid, Sanjay Basu, Marcella Alsan, Jason Andrews and Ami Bhatt. Their projects range from the effect of AIDS relief efforts on health care delivery to the treatment of diabetes in India to low-cost diagnostic tools for regions lacking infrastructure.

“I can’t think of a better way to celebrate (my father’s) birthday than listening to the bright future of science,” said Ricardo T. Rosenkranz, son of Dr. George Rosenkranz and a prize donor. “We can’t wait to hear what the next Rosenkranz Prize winners tell us.”

Click below for event photo gallery:

The 12th annual Draper Hills Summer Fellows Program gathered 25 democracy leaders from around the developing world for a three-week training program on democracy, good governance, and the rule of law reform. Selected from a large pool of applicants, the fellows have diverse backgrounds across sectors and geographies, working in civil society, public service, social enterprise, media and technology.

Fellows were instructed by an all-star roster of Stanford scholars and policy experts, including former U.S. Secretary of State Condoleezza Rice; FSI Director and former U.S. Ambassador to Russia Michael McFaul; CDDRL Mosbacher Director Francis Fukuyama and Larry Diamond, senior fellow at the Freeman Spogli Institute for International Studies. Fellows also met industry leaders such as Eric Schmidt of Google, democracy leaders such as Carl Gershman of the National Endowment for Democracy and others. During the program, they shared their personal stories about the struggle in their home countries, but also stories of their fight for justice, equality, and democracy, stories of optimism and endurance.

You can find some of their talks below and for more videos visit our YouTube channel. 

Kasha Nabagesera (Uganda)

The founding member of Uganda's LGBTI Movement

"I am the only founding member of Uganda's LGBTI movement who is still based in the country"

Kasha Nabagesera is the executive director of Kuchu Times Media Group, the first LGBTI media platform in Africa. She is known as the “founding mother” of the LGBTI movement in Uganda - where homosexuality is illegal - advocating for equal rights and the eradication of all forms of discrimination based on sexual orientation. Listen to her story about big losses and big wins, everyday dangers and hope.

Rafael Marques de Morais (Angola)

Investigative reporter, MakaAngola

"Why the government is after you when you are sleeping so much?"

Rafael Marques de Morais is an award-winning journalist and human rights activist in Angola, working to investigate corruption and abuse of power by the country’s ruling family. He founded Makaangola, a watchdog website dedicated to exposing corruption and human rights abuses in Angola. Find out why his son thinks that his father is harmless for the government.

Belabbes Benkredda (Algeria)

The founder of Munathara Initiative

"Debate is the central part of the democratic equation."

Belabbes Benkredda is an award-winning social innovator and the founder of the Munathara Initiative, the Arab world’s largest online and television debate forum highlighting voices of youth, women, and marginalized communities. Operating in 11 Arab countries, Munathara’s monthly prime-time TV debates are the only civil society-run, independent political talk program on Arabic television. Munathara Initiative organized over 650 workshops with more than 10 thousand participants from 12 countries. They have around 90 thousand of registered users. More importantly, Munathara Initiative provided safe public space for young women to voice their opinions and mark their presence in public, traditionally dominated by the middle-aged men.  

An independent panel of medical experts has updated 20-year-old guidelines for evaluating cost-effectiveness in health and medicine, in an effort to help everyone from policymakers to patients make more informed decisions about tests and treatments.

Released in a special communication in the Journal of the American Medical Association, the panelists spent more than three years building on the work of the 1996 Panel on Cost-Effectiveness in Health and Medicine, originally convened by the U.S. Public Health Service. They developed recommendations by consensus.

The new recommendations are intended to guide decision-makers in using new methods for analyzing evidence, reporting standardized results, incorporating both health-care system and societal perspectives, as well as weighing ethical issues in the use of cost-effectiveness analysis (CEA).

“Some people question the use of economic analyses in health care, but cost-effective analysis is a way to ensure that we are proving high-value care,” said Stanford Health Policy’s Douglas K. Owens, a professor of medicine and senior investigator of the VA Palo Alto Heath Care System, who sat on the panel.

“If we do interventions without understanding their value, we may well spend money on something that may not really be worth it,” said Owens. “Cost effectiveness analysis is one approach to understanding how we can help control health-care costs and provide high-value health care.”

Image

The panel was led by co-chairs Gillian D. Sanders, Professor in the Department of Medicine and a member of both the Duke Clinical Research Institute and the Duke-Margolis Center for Health Policy, and Peter J. Neumann, Director, Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and Professor of Medicine at Tufts University.

Sanders said CEA could help inform decisions about how to apply new or existing medical tests, therapies, and prevention techniques so that decision-makers use health-care resources wisely.

“As health-care costs continue to rise at unsustainable rates, these recommendations provide a framework for comparing the relative value of different health-care interventions, and help decision-makers across the spectrum from policymakers to patients sort through alternatives and decide what tests and treatments make sense,” she said.

Neumann noted that in the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced, as has the need to deliver health-care efficiently.

“Updating the guidelines provides an opportunity to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers,” he said.

Primarily funded by grants from the Robert Wood Johnson Foundation and the Bill & Melinda Gates Foundation, the panel recommends several key changes to the guidelines, while confirming other principles from the first panel, including:

1. Broadening the scope and number of reference cases in a cost analysis, which describe standard methodology that should be followed to ensure quality analysis by creating comparable measurements. The panel is recommending that all CEAs should not report two reference cases: one based on a health-care sector perspective and another based on a societal perspective.
2. Using an “impact inventory” that lists the health and non-health effects of a health-care intervention to ensure that all consequences are considered, including those to patients, caregivers, social services and others outside the health-care sector. This tool also allows analysts to look at categories of impacts that may be most important to stakeholders.
3. Measuring health effects in terms of quality adjusted life years, a common measure used by health researchers that includes both the quality and quantity of life lived.
4. Including both costs reimbursed by third-party payers and those paid for out-of-pocket by patients in health-care sector analyses.
5. Including a reporting checklist and guidelines for transparency that includes assumptions in any analysis and the disclosure of potential conflicts of interest.

The complete report of the so-called Second Panel will be published in October.

The panelists noted that the field of CEA has emerged dramatically since the last guidelines 20 years ago. For example, the Advisory Committee for Immunization Practices, which establishes national immunization policy recommendations on behalf of the Centers for Disease Control and Prevention, now uses CEA in its calculations.

“The need to deliver health-care efficiently and the importance of using analytic techniques to understand clinical and economic consequences of strategies to improve health, have only increased,” the Second Panel authors wrote in the JAMA paper.

Health-care spending in the United States comprised 13 percent of GDP in 1995; today it approaches 18 percent. And the total national health expenditures have tripled during that period, jumping to more than $3 trillion in 2014, according to the Kaiser Family Foundation.

“The goal of the Second Panel is to promote the continued evolution of CEA and its use to support judicious, efficient, and fair decisions regarding the use of health-care resources,” the experts wrote in the JAMA article.

Imagine there’s a new pill on the market. It promises you a one in 200 chance of avoiding a heart attack, stroke, heart failure or death over the next year — if you take it religiously.

It also promises a one in 60 chance of landing you in the hospital for some serious complication: Maybe you passed out. Maybe the pill affected your kidney function. Maybe you developed a severe electrolyte imbalance.

Would you take it? How would you decide?

This question is confronting some patients with hypertension as well as their health-care providers who, like me, help manage their blood pressure. The “pill” is not a pill per se, but a treatment strategy.

In November of 2015, researchers published results of a large NIH-sponsored trial known as SPRINT, which compared two systolic blood pressure treatment targets for hypertensive adults: a higher, conventional target of 140 mm mercury compared to a more stringent target of 120.  Participants in the trial were older, did not have diabetes, and were generally at high risk of developing cardiovascular disease. They were prescribed commonly used blood pressure medications, which were carefully adjusted by investigators to achieve target blood pressures.

The trial demonstrated a large relative benefit: Those in the lower target group had about a 25 percent reduction in the rate of cardiovascular disease or death. The absolute benefit, though, was small, with only about one in 200 patients avoiding cardiovascular disease or death as a result of treatment. The trial also showed that complications in the lower target group were relatively common.

As a physician, I’d love to be able to tell the patient in my exam room whether she will be the lucky one out of 200 who will benefit. That dream is still a few years off. I can, though, answer a related question. If I treat a large group of patients, on the whole, will my patients benefit? Or will the harms of treatment outweigh the benefits? And if the treatment is overall beneficial, what investment will we need to achieve this gain in health?

Image

To answer this question, I teamed up with a group of researchers at Stanford. Our team included experts in cost-effectiveness analysis as well as students developing clinical and analytic expertise in this area. We used data from SPRINT along with other published sources to project the expected benefits, harms and costs from targeting a lower or higher blood pressure over the course of a lifetime.

Results of our study were published this week in JAMA Cardiology. We found that targeting a lower blood pressure results in a substantial net benefit, even after accounting for harms from common, serious adverse events. This net benefit, though, doesn’t come free: An investment of about $23,777 is required for every year of life gained from this strategy.

Is $23,777 “worth it?” It’s a hard question to answer and it depends, in part, on who is paying. But in the spectrum of medical interventions that we routinely use here in the United States, this would be considered a good deal, a bargain even.

So should we go all in? Should we push stringent blood pressure targets for everyone?

No. There are a number of other considerations. SPRINT answered a specific question about hypertension treatment in a specific group of patients. Whether other groups of patients, like those at lower risk of cardiovascular disease, would benefit is unclear. There were also methodological quirks that have left the trial open to criticism.

But if we believe that the findings from SPRINT are generally correct, a lower blood pressure target seems to provide significant health gains for a reasonable cost in patients who are at high risk of developing cardiovascular disease.

Ilana B. Richman, MD, is a VA Health Services Research and Development Fellow at Stanford Health Policy.