Economic aspects of public health programmes for infectious disease control:studies on human immunodeficiency virus & human papillomavirus

Opportunities exist to improve public health prevention of new HIV and HPV infections. This thesis used different economic analytical methods, including cost-effectiveness, budget impact analyses, and systematic reviews, to address some of the key policy questions around commissioning of public health HIV and HPV control programmes in England. The main interventions studied included HIV pre-exposure prophylaxis (PrEP), HIV screening, and HPV vaccination.A public health PrEP programme could be cost-effective when given to high-risk persons. High intervention cost and coverage needed pose an affordability challenge. Evaluation of new HIV-related interventions involve comparison with current care, where many existing antiretrovirals are beginning to lose market exclusivity. Current lifetime cost could reduce from ~£200,000 per person to ~£70,000 with generic availability. Besides primary prevention, secondary HIV prevention could be considered, including population screening, which was estimated to cost less in hospital admissions compared with general practices, cost per reactive test being most sensitive to staff cost and prevalence.HPV vaccination of men who have sex with men (MSM) up to 40 years is likely cost-effective. Systematic review of different models found results most sensitive to assumed vaccination efficacy and price. Substantial differences exist in cost and utility estimates for HPV-related outcomes, attributable to different disease sites, stages and management, warranting careful consideration of background economic assumptions.Key learnings include that cost-effectiveness should not be considered independently of budget impact and affordability considerations. Health economists need to be mindful of the evolving and dynamic disease management landscape, which affects cost of treatment