Research team

Expertise

I have extensive expertise in health economic evaluations, in particular on how to account for uncertainty in such analyses, and how to interpret results with uncertainty. I obtained a Master in Biology, a Master in Biostatistics and a PhD in Health Economics. I conduct both conceptual-methodological and applied research. My research includes developing: (1) methods on dealing with uncertainty in health economic evaluation; (2) international standards for the conduct and interpretation of health economic evaluations, particularly in relation to infectious diseases; (3) methods for health-related quality of life assessment; (4) surveys to analyze people's health care consumption and health-related quality of life; and profound literature studies. I have undertaken numerous methodological and policy studies in various countries, including burden of disease and economic evaluation studies applied to influenza, respiratory syncytial virus (RSV), pneumococcus, varicella- zoster, rotavirus and typhoid fever.

MACSiMiSE-BRAIN: Metformin Add-on Clinical Study in Multiple Sclerosis to Evaluate Brain Remyelination And Neurodegeneration 01/10/2021 - 30/09/2025

Abstract

Multiple Sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease leading to focal and diffuse damage of myelin sheath and axons in the central nervous system (CNS). Pathophysiologically, the adaptive and innate immune system are involved in the inflammatory process, while mitochondrial dysfunction, oxidative stress and failure of remyelination are the main mechanisms in chronic neurodegeneration. Despite currently available disease modifying treatments (DMTs) that target the immune system, patients continue to accumulate disability leading to progression. Unfortunately, no neuroprotective or remyelinating agents are available as therapy for progressive MS. Hence, drugs to tackle disease progression in MS represent a major unmet need. In this respect, metformin is a very interesting drug to investigate in MS patients as a neuroprotective and remyelinating therapy. Several preclinical studies in animal models of MS have shown that metformin has both anti-inflammatory, neuroprotective and remyelinating properties. A clinical study with metformin in a limited sample of MS patients did not demonstrate significant adverse events. As metformin is available as generic drug and the price is low (0.10 eurocent per tablet), pharmaceutical companies have no interest is sponsoring clinical trials with this agent. However, major gains for patients and society may be reached if metformin proves to be a neuroprotective and remyelinating agent. In this research proposal we aim to provide evidence for the neuroprotective and remyelinating effects of metformin (I) in MS patients (P) via measurement of clinical and MRI outcome measures (O), via a multicentre randomized placebo-controlled (C) clinical trial.

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  • Research Project

Cervical cancer screening based on first-void urine self-sampling to reach screening non-responders: ScreenUrSelf trial. 01/10/2021 - 30/09/2025

Abstract

The goal of the ScreenUrSelf trial is to increase cervical cancer screening attendance and compliance to follow-up by offering a first-void urine self-sampling alternative to women who are currently not participating in the organized screening program (non-responders). Offering a cost-effective, fully molecular (primary high-risk Human Papillomavirus (hrHPV) testing, and if positive methylation marker triage) first-void urine self-test with high preference and compliance to follow-up has the potential to increase screening coverage among non-responders whilst reducing cervical cancer related morbidity and mortality. If embedded in the organized cervical cancer screening program, this could positively impact both the patient's health as well as reduce costs for the Flemish healthcare system. Thus, the primary scientific goal of this project is to evaluate the (cost-)effectiveness of four different self-sampling strategies (first-void urine vs vaginal self-sampling, via an opt-in or opt-out strategy) to women who do not participate in the Flemish organized cervical screening program, compared to the standard recall letter and no intervention. Secondly, a novel follow-up "reflex" test will be evaluated in self-samples that tested positive for hrHPV.

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  • Research Project

Accelerating availability and access to typhoid conjugate vaccines (TyVac). 01/01/2021 - 31/10/2021

Abstract

To date, only a handful of studies have generated cost-effectiveness estimates for Vi-polysaccharide vaccines, and all of these have been based on static modeling approaches. We will conduct cost-effectiveness analyses (CEAs) to assess the costs and effects of new and existing TCV vaccination strategies compared to no vaccination from the health care perspective based on dynamic models. We will build off of CEAs currently being led by Dr. Pitzer (funded by BMGF) by incorporating primary data from sentinel hospitals in the surveillance sites to inform immunization rates and estimates of costs of vaccine administration and disease.

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  • Research Project

Respiratory Syncytial virus consortium in Europe (RESCEU). 01/01/2017 - 30/09/2022

Abstract

Respiratory syncytial virus (RSV) is not well known outside medical circles, yet most people have probably suffered from it in childhood, as it is the most common cause of severe respiratory illness in infants and children worldwide. The elderly and people with weakened immune systems are also vulnerable to RSV infection. While most people's symptoms are mild, it can result in pneumonia and 3.4 million cases annually require hospitalisation. There is no specific treatment or vaccine for RSV. The goal of the RESCEU project is to gather information on the scale of RSV infection in Europe and its economic impacts. It will then use this information to design best practice guidelines to improve the way RSV cases are monitored in Europe, and to shape future vaccination programmes. The team will also gather and analyse patient samples to identify biological markers associated with severe RSV infection. This information could aid in diagnosis and facilitate the development of new treatments and vaccines.

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  • Research Project

Including uncertainty from transmission-dynamic models in health economic evaluations: applications for rotavirus and typhoid fever vaccination. 01/10/2016 - 01/10/2020

Abstract

BACKGROUND: Dynamic models and sensitivity analysis are valued as crucial to inform decision makers on the cost-effectiveness of interventions against infectious diseases. But currently, sensitivity analyses fail to account for the uncertainty from dynamic models, as such overestimating the confidence in the cost-effectiveness estimate and potentially setting wrong priorities for future research. AIM: To include the uncertainty from transmission-dynamic models in health economic evaluations based on these models. METHODS: We will conduct health economic evaluations of vaccination against rotavirus in Belgium and typhoid in low-income countries, based on existing transmission-dynamic models, and will use probabilistic methods to incorporate the estimated uncertainty from the dynamic models. EXPECTED RESULTS: Identification of the factors that are most influential for (1) the cost- effectiveness of rotavirus vaccination in Belgium when accounting for herd immunity and potential serotype replacement, and (2) the cost-effectiveness of implementing the newly developed typhoid vaccine strategies in low-income countries. (3) Software tool that allows for easy re- assessment of cost-effectiveness and future research priorities when new information becomes available. (4) Recommendations on how to apply different types of sensitivity analysis in the context of health economic evaluations based on dynamic disease transmission models.

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  • Research Project

Typhoid modeling studies for typhoid conjugate vaccine cost effectiveness and for typhoid delivery strategy. 01/01/2016 - 10/11/2017

Abstract

Evaluating typhoid conjugate vaccine delivery strategies for controlling typhoid fever in endemic countries. Improvements in sanitation and the provision of clean drinking water led to the elimination of typhoid fever from developed countries in the beginning of the 20th century. However, Salmonella Typhi and Paratyphi A remain a major source of morbidity and mortality in many developing countries today. The dynamics of typhoid transmission are poorly understood. Two vaccines against typhoid are currently licensed and used worldwide, and new and improved conjugate vaccines are on the horizon, but there is conflicting evidence as to whether these vaccines are expected to confer benefit for the population. During this project, mathematical models are developed to compare the transmission dynamics of typhoid in present-day endemic settings, including Vellore, India; Dhaka, Bangladesh; Kathmandu, Nepal; and Blantyre, Malawi. These models will be used to evaluate the effectiveness and cost-effectiveness of different methods of typhoid control, including vaccination. Currently data on typhoid disease and economic burden are scarce. Therefore in-depth sensitivity analysis will be used to identify key areas for future research. This project is in collaboration with the Yale School of Public Health (Pitzer lab, http://campuspress.yale.edu/pitzer/) and funded by the Bill&Melinda Gates Foundation.

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    • Research Project

    Advancing the way uncertainty is accounted for in health economic evaluations based on dynamic infectious disease transmission models. 01/02/2015 - 31/12/2015

    Abstract

    The BOF grant would support my personal research line, which is to improve fundamentally the way uncertainty is accounted for in transmission-model based health economic evaluations of infectious disease interventions. The grant will be used to collect the data needed to be able to use the currently most advanced technique to account for the uncertainty.

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      • Research Project

      Improving (cost-) effectiveness analyses of rotavirus vaccination programmes: combining dynamic modelling with in-depth uncertainty analysis. 01/10/2012 - 30/09/2016

      Abstract

      Research objectives General research objective - To advance the field of health economics of vaccines with respect to transmission-dynamic modelling and uncertainty analysis. This will be done by applying the most advanced techniques within these two key-areas to the real-world example of rotavirus disease and vaccination. Specific research objective - In particular, the proposed project aims to develop a model which best represents current knowledge on rotavirus infection and vaccination (including herd immunity and genotype replacement), and to determine the uncertainties that influence the most the effectiveness and cost-effectiveness of a universal rotavirus vaccination programme.

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        • Research Project

        Functional and ecological morphology of aquatic feeding in snakes. 01/10/2003 - 30/09/2004

        Abstract

        Because water is 800 times denser and 50 times more viscous than air, it puts very strong demands on the feeding system of vertebrates. An aquatic predator that approaches a prey will generate bow waves that can either push the prey further away or along a predator's jaws. To avoid or compensate for those bow waves, we find two systems among aquatic vertebrates: filter feeding and suction feeding. However, aquatic snakes seem not able to perform filter- or suction feeding because of their very specialised head morphology (for the consumption of large prey). Still more than 300 snake species feed in an aquatic environment on a variety of prey and with a range of different feeding morphologies and behaviours. High-speed video recordings and Particle Image Velocimetry on the strikes of Natrix maura and N. tesselata with altered predator and prey characteristics will allow us to gain insight in how the process of aquatic feeding in snakes precisely works and through which factors this process is influenced. This information will be completed with measurements on a physic snake model to look at the effects of a broader range of prey- and predator characteristics (functional morphology part). Finally we will try to consider if it is possible with the obtained insights, to link the large variation in head morphology and feeding behaviour among aquatic snakes, to the variety of different prey they eat (ecomorphological part). Data on the head morphology of aquatic snake species will be obtained by measuring museum species; data on the feeding behaviour and diet of aquatic snake species will be collected from literature.

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        • Research Project