Impact of Mebendazole Sam Debaveye 1 Claudia Virginia Gonzalez Torres 1 Delphine De Smedt 2 Bert Heirman 3 Shane Kavanagh 4 Jo Dewulf 1 20032018 1 Research Group Environmental Organic Chemistry and Technology ID: 780289
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Slide1
The Health Benefit and Burden of Mass Donation Programs in Vietnamese Schoolchildren: Impact of Mebendazole
Sam Debaveye1, Claudia Virginia Gonzalez Torres1, Delphine De Smedt2, Bert Heirman3, Shane Kavanagh4, Jo Dewulf120/03/20181 Research Group Environmental Organic Chemistry and Technology (EnVOC), Faculty of Bioscience Engineering, Ghent University, Campus Coupure, Coupure Links 653, B-9000 Ghent, Belgium2 Department of Public Health, Ghent University, Campus UZ, De Pintelaan 185, B-9000 Ghent, Belgium3 Johnson & Johnson EHS&S, Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse, Belgium4 Health Economics, Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse, Belgium
department OF GREEN CHEMISTRY AND TECHNOLOGYresearch group EnVOC
Slide2The sustainability assessment toolbox today
2
Source: Dewulf et al., 2016
EC Communication on Integrated Product Policy (COM (2003) 302):
“
Life Cycle Assessments provide the best framework for
assessing
the potential environmental impacts of products currently available
”
European Platform for LCA
(EPLCA)
Life
Cycle Assessment (LCA):
Policy level:
Slide3Patient (Human Health)
Including the benefit of a health care pathway3
Human Health burden
in
created Disability-Adjusted
Life Years (DALYs
)
R
= Resources
E = Ecosystems
HHbur = Human Health burdenHHben = Human Health benefit
->
DALY as a common metric to directly compare
Slide4Case study structure: mebendazole Mass Drug Administration
Mebendazole: production data available from Janssen PharmaceuticaEnvironmental Life Cycle Assessment -> Global Human Health burdenMarkov model to estimate treatment effect -> Patient Human Health benefitComparison between burden and benefitConclusions4
Slide5Case study: mebendazole Mass Drug Administration
Disease area: Soil-Transmitted HelminthiasesThree main worm infections: Hookworm, Ascaris lumbricoides and Trichuris trichiuraPatients suffer from anaemia, wasting, abdominopelvic problems, …Reduction in worm burden achieved with anthelmintic medicationRe-infection often occurs within months5
Slide6Case study: mebendazole Mass Drug Administration6
Comparison of 2 scenariosAnthelmintic mebendazole 500 mg 2x/year treatment (WHO regimen)No TreatmentTime horizon: 2006-2011Target: 13 million Vietnamese school-aged children (5-14y), reaching 80% coverage
WHO
2012. Eliminating Soil-Transmitted Helminthiases as a public health problem in children: progress report 2001-2010 and strategic plan 2011-2020. Geneva
Slide7Data: Janssen Pharmaceutica supply chain
Environmental Life Cycle Assessment - Human Health burdenIncludes full cradle-to-grave assessment of pharmaceutical supply chain7
Envelops:
- Excretion of mebendazole molecule into the environment
- Packaging waste
Data: National
Institute of Malariology, Parasitology and Entomology,
Vietnam
Slide8Environmental Life Cycle Assessment - Human Health burden
8e.g. kg CO2-equivalentsΔ°C incr. / kg CO2-eqDALY / Δ°C incr.(malnutrition,diseases, …)
Slide99
Results: Global Human Health burden - DALYs createdMebendazole 2x/year for 13 M children for five years
10.5 DALYs associated with pharmaceutical supply chain
Slide10Markov model structure – Hookworm example10
Montresor, A., et al. 2013. Trans R Soc Trop Med Hyg 107 (5), 313-318.Pullan, R. L., et al. 2014. Parasit Vectors 7 (1), 1-19.One-year cycles
Disability is multifactorialKey drivers listed
Disability:Disability:
Disability:
Slide1111
Calculation of disabilityBased on literature review for all disabilitiesDisability weights from Global Burden of Disease 2013Focus on anaemia: responsible for largest disability fractionTotal Hookworm prevalence varies, but relative prevalence anaemia by intensity are assumed constant0.149(moderate)(severe)Disability:0.0040.052(mild)
×
×
×E.g. at model start: 8M children with hookworm light infectionMild anaemia: 8M x 42.07% x 0.004 = 14.000 DALYs
Slide1212Results: Patient Human Health benefit - DALYs avoided
Mebendazole 2x/year for 13 M children for five years, compared to No Treatment
84%
reduction
85%
reduction
88%
reduction
144,000 DALYs avoided
+34,000 DALYs avoided
+26,000 DALYs avoided
=204,000 DALYs avoided
No. infected
2.5 M → 500,000
3.7 M → 1 M
10 M
→
2 M
Slide1313Comparison between benefit and burden
Patient health benefit outweighs burdenFactor 19,000
Treatment
Global
Human Health
burden (DALY)
Increment
Human
Health
benefit (DALY)
Increment
No Treatment
0.00
242,000
Mebendazole
10
.50
+
10
.50
38,000
–
204,000
85%)
(–
Patient
Slide14Conclusions
API synthesis causes highest environmental burdenModelling WHO anthelmintic regimen: an estimated 85% DALY improvement during five years treatmentTreatment reduces total Human Health burdenDALY medicationDALY patients New methodology to assess Mass Drug Administration programs: patient health benefit may outweigh environmental burden in health care14
→ 19,000 times more DALYs avoided than created
Slide15Thank you!For additional info contact:
Sam DebaveyeSam.Debaveye@UGent.beVLAIO, Baekeland mandate grant no. 140249department OF GREEN CHEMISTRY AND TECHNOLOGYresearch group EnVOC
Slide1616Improved Markov model structure and progression
STH total prevalence at year 0:76% 19% 29%
63.39%
8.32%
4.29%
13.89%
4.79%
0.32%
24.95%
3.97%
0.09%
Input for next model cycle of 1 year
Treatment
Slide17Disclosure of competing financial interests
Shane Kavanagh and Bert Heirman are employees of Janssen Pharmaceutica, an operating company of Johnson & Johnson and also hold stock and options in Johnson & JohnsonThis work was carried out as part of a PhD program jointly funded by the Flemish government (Flemish Innovation and Entrepreneurship, VLAIO) and Janssen Pharmaceutica as a Baekeland mandate grant (no. 140249) of Sam DebaveyeSam Debaveye received travel funding through the Baekeland mandate grantJo Dewulf worked as a consultant for Janssen PharmaceuticaDelphine De Smedt and Claudia Virginia Gonzalez Torres declare no actual or potential competing financial interests17