the fiscal consequences of vaccination for government

1 University of Groningen – Postma, Connolly, Kotsopoulos

The Fiscal Consequences of Vaccination for Government: A

Government Perspective Assessment of Tax Revenue and Transfers

Associated to Changes in Population Health Status Attributed to

Immunisation

Research Team:

Principal investigator: Professor Maarten J. Postma, University of Groningen

Project Leader: Dr. Mark P. Connolly, Post-doctoral Researcher, University of

Groningen, and Global Market Access Solutions, St-Prex, Switzerland

Research Analyst: Nikos Kotsopoulos, Researcher, Global Market Access Solutions, St-

Prex, Switzerland


Contents Background to study ............................................................................................................................ 3

Conceptual foundations ................................................................................................................... 3

Health and taxes................................................................................................................................... 4

Application in low and middle income countries .......................................................................... 4

Research proposal ............................................................................................................................... 5

Methodological approach ................................................................................................................ 5

Benefits of vaccination for government ......................................................................................... 7

Application of generational accounts to health investments ...................................................... 8

Application of Research ................................................................................................................ 10

Research limitations ....................................................................................................................... 10

Project Deliverables ....................................................................................................................... 11

Research Budget ................................................................................... Error! Bookmark not defined.

References .......................................................................................................................................... 12

Curriculum vitaes .................................................................................................................................. 13


Background to study

In 2009 the WHO released the WHO Guide to Identify the Economic Consequences of

Disease and Injury (WHO, 2009). Within the WHO guide the impact of population health on

government was described. Specifically the report acknowledged that poor health can

impact government fiscal accounts both in terms of lost tax revenue and increased transfers

costs (WHO, 2009). Despite acknowledging that population health status will have fiscal

consequences for governments, the report provided few examples of the ways in which

population health does impact government revenues and transfers. The research described

in this proposal aims at understanding, mapping out and quantifying the fiscal

consequences for governments associated with population health changes – in particular

those that relate to immunization programmes and policies in low and middle income

countries.

Conceptual foundations

The fiscal consequences of population health have been evaluated in a limited number of

studies in developed economies. The impact of ill health in working aged adults was

described in a study conducted by the British government in 2009. The assessment of the

economic consequences associated with ill health in working aged adults revealed that 89%

of the costs of illness to the government was attributed to disability costs and lost tax

revenue (Black, 2008). In contrast, government health costs on disease in this population

which are typically considered in cost-effectiveness analysis represented only 11% of the

total costs to government (see Table 1). This finding suggests that the typical health-service

and societal perspectives applied to evaluate health programs would not encapsulate the

broader economic effects of poor health to governments. Whilst these costs are often

considered as transfers between individuals from the societal perspective, these fiscal

transfers represent real costs for governments.

Table 1 Fiscal consequences of poor health in working-aged populations United

Kingdom (Black, 2008)

Annual cost to

government Billion £

(2007)

Percentage of

government cost

Workless benefits Cost £29 43%

Healthcare Cost £5 – £11 11%

Foregone taxes Revenue loss* £28 – £36 46%

Total costs to government £62 - £76

* This may represent an underestimate of lost tax receipts because it does not account for lost consumption taxes associated with lower disability incomes.

The fiscal consequences at the disease specific level have also been assessed. For

example, estimates from the United States indicate that lost tax revenue attributed to obesity

will result in $60 billion in lost tax revenue in 2004 – 2050 (Goldman, 2010).

Applying a fiscal perspective to medical technologies highlights the limitations of the societal

perspective typically applied in cost-effectiveness analysis. Because the societal perspective


excludes the economic consequences of health status changes for governments, the impact

of health status changes on transfers and taxes would not be captured (Garrison, 2010).

Whilst the societal perspective is useful for reflecting societal welfare, the actuarial and fiscal

consequences of changes in health status represent real costs to governments (WHO, 2009;

Black, 2008). Consequently, typical cost-effectiveness that ignores transfer and tax changes

attributed to health gains is divorced from the budgetary reality that exists in all countries and

within which funding decisions, for example, vaccination programs are often made on. With

the above in mind, the analytic framework described here departs from welfare economics

and focuses in tangible fiscal accounting and budgeting principles applied by governments.

Whilst achieving welfare maximisation is a worthwhile goal to pursue, for many countries,

fiscal constraints, especially in developing economies are equally important and need to be

considered with respect to funding decisions to achieve sustainable financing, reduce future

deficits and public debts.

Health and taxes The fiscal consequences of health status changes are reliant on estimating productivity

changes and how these changes translate into increased earnings and consequently

increased tax revenue for government. Deriving estimates from health gains is an

unconventional approach for valuing health gains and is seldom considered in the health

economics literature. In contrast, valuing human lives in future tax revenue is fundamental to

analytic approaches used by Treasury departments and international organisations such as

the World Bank and IMF which often apply a generational accounting framework to analyse

policy decisions (Auerbach, 1999). Inherent in these methodologies is the value of health

human capital translated into future tax revenue for government. Because of this, the

generational accounting methodology is increasingly applied in public finances as a means

of forecasting fiscal sustainability (Bonin, 2004).

At the core of generational accounting is population age-structure (i.e. demography), the

proportions of people of working-aged populations, future workers in the case of children,

and productivity. These core measures are intricately linked to population health status and

investments within the health sector. Consequently, it is possible to measure using the

generational accounting framework how investments in health programs that influence the

population age-structure and productivity will influence current and future government taxes

and transfers. Furthermore, as implied by the name, the generational accounting framework

assesses the fiscal dynamics of population health over very long time periods. Therefore, the

methodology is well placed to evaluate vaccination programs because benefits from

vaccination also accrue over very long time horizons.

Application in low and middle income countries

In low and middle income countries the fiscal consequences of poor health are poorly

understood. This is mostly attributed to limited availability of data in these countries and the

limited number of government transfers available to citizens.

There are two fundamental economic relationships that underpin the analytic approach

described here. Firstly, the established relationship between health and economic growth

that is applicable to both low and middle income countries (WHO, 2002). Secondly, the

known economic relationship between increasing economic growth and increases in


government tax revenue (Sancak, 2010). The following figure depicts the two theoretical

foundations on which the fiscal model described will be based:

Research proposal In this study we propose developing a government perspective fiscal accounting model that

demonstrates the economic consequences for government associated with changes in

population health status attributed to immunisation programs. The economic metrics

considered in the model will be discounted net tax revenue and gross tax receipts attributed

to changes in population health status and labour force participation attributed to

immunization. Labour force participation will be defined mainly in terms of survival and

labour supplied by the immunized subjects. In addition, the corresponding labour loss for

families that will care for the not-immunized and thus sick subjects will also be factored in the

analysis.

Methodological approach

Changes in population dynamics attributed to changes in health status have the capacity to

influence economic growth and numerous other macroeconomic parameters. The fiscal

consequences of vaccination and associated changes in morbidity and mortality can

influence government both positively and negatively.

One of the aims of this project is to develop a modelling framework based on the

generational accounting approach used by Treasury and other international organisations for

modelling the fiscal consequences of population change and associated transfers and taxes

(Auerbach, 1999; Bonin, 2004).

The following descriptions are helpful for understanding the fiscal effects of vaccination

captured using the generational accounting framework.

Positive fiscal effects:

Increased survival influences the number of working-aged adults able to supply

labour to the market and influence government tax receipts.

Many parents are unable to participate in the labour force because they need to care

for a sick child. Therefore, decreased morbidity from vaccination can influence the

work force participation rate for adults. From the ‘government perspective’ this has

positive fiscal consequences for government from increased tax receipts and

possibly reduced transfers.

Changes in health status can impact cognition in learning and will have positive

labour effects (Lucas, 2005).

Defined by: WHO Commission on

Macroeconomics and Health

Defined by: Sancak, 2010 (IMF)


- Improved earning capacity can increase tax transfers to government from

increased taxes

- Cognitive skills may influence educational attainment which, in human capital

economics is known to have an impact on wages and labour participation rates

- Education may alter health seeking behaviours thus, result in effective disease

prevention generating health and economic benefits

Increased survival leads to increased consumption and consequently value added

taxes paid to government

Increased survival leads to higher earnings thus, higher savings and capital formation

which impacts on tax receipts

Negative fiscal effects:

Decreased child mortality leads to increased numbers of children attending school.

This effect would be applicable over the short term, however over the long-term

adjustments in total fertility may arise from reduced child mortality.

Increased survival could increase costs for other government transfers in the form of

education and health, but could also increase unemployment.

Decreased child mortality from one condition could lead to increased mortality from

another condition for which vaccination may or may not be available


Benefits of vaccination for government

The model will follow the health benefit framework described by Bärnighausen (2010), with

the exception that benefits attributed to vaccination will be considered applying a

government fiscal perspective. An example of the core components of the proposed model

framework aligned with the Bärnighausen framework are described below.

Benefit category Description of benefit (Bärnighausen, 2011)

‘Government perspective’ benefit interpretation

Na

rro

w

Health gains Reduction in mortality through vaccination

Increased labour supply and persons paying taxes; including consumption taxes

Health-care cost savings

Savings of medical expenditures because vaccination prevents illness episodes

Reduce public expenditure on health for vaccine treatable conditions

Care-related productivity gains

Savings of parents’ productive time because vaccination avoids the need for taking care of a sick child

Increased labour supply and persons paying taxes

Bro

ad

Outcome‐related productivity gains

Increased productivity because vaccination improves cognition, physical strength, and school attainment

Wage growth is linked to productivity growth; this would result in increased tax revenue for government.

Improve cognitive skills and education attainment translates into higher wages which benefits government

Behaviour‐related productivity gains

Benefits accruing because vaccination improves child health and survival and thereby changes household behaviour

Changes in behaviour either through improved education, total fertility or work force participation will have fiscal consequences for government. These changes could positively and negatively influence government accounts.

Community externalities

Benefits accruing because vaccination improves outcomes in unvaccinated community members

The community externality would also be reflected in government accounts.

Building on the Bärnighausen framework the modelling framework will capture how both the

narrow and broad benefits of vaccination will influence government accounts applying the

“government perspective” framework.

Depending on the individual country identified for the case study and data inputs, all six

domains described by Bärnighausen may not be incorporated in the model. This is

dependent on the extent to which they influence government fiscal accounts.


Application of generational accounts to health investments

Previous examples are available applying the generational accounting framework to

evaluate the fiscal consequences of investments in medical technologies. The analysis

described by Connolly et al. reported that investments in assisted reproduction represent an

8- 10 fold return on investments in assisted reproduction based on discounted net tax

revenue attributed to resulting live births (Connolly, 2009a; Connolly, 2008). The underlying

premise of the approach is that assisted reproduction, namely in-vitro fertilisation,

contributes live births which influence population dynamics. As these children age and enter

the work force they represent future tax payers for government.

A similar framework has also been applied to evaluate vaccination programs. In a similar

manner, vaccination programs that influence morbidity and mortality will change the life

course and population age structures. Consequently investments in immunisation can be

assessed using the generational accounting framework. Two prior examples of applying the

generational framework to rotavirus and malaria vaccination have been evaluated (Connolly

2012; Connolly 2009b).

In the proposed case study only those benefits that have fiscal consequences will be

considered in the case study. From this perspective the approach likely undervalues

vaccination investments because only those health benefits with tangible fiscal

consequences for government either in the form of increased transfers and tax revenue are

considered. The intangible benefits of good health that are normally reflected using quality-

adjusted life years and disability-adjusted life years will more adequately reflect the health

benefits from the patient perspective.

Generational accounting is based on intertemporal fiscal accounting principles. In practice,

one of the reasons for developing GA was to assess fiscal sustainability in light of ageing

populations in developed countries and for ensuring equitable intertemporal tax burden

across generations. When applied in low and middle income countries the approach can be

used to translate vaccination costs to government into future “tax receipts” associated with

gains in population health status. The methodology also highlights the benefits of a

functional tax system.

Analytic Perspective

The perspective applied for evaluating health programs is an important analytical

consideration as this will dictate the costs and outcomes considered in the analysis. To date,

the two dominant factors considered have been the societal and health service perspectives.

However, both of these perspectives are limited as they fail to take into consideration the

fiscal consequences that changes in population health can have on government accounts.

This points was previously mentioned in the WHO report on the costs of illness, however few

supporting studies are available to highlight the fiscal consequences (WHO, 2009).

Population health status is an important determinant of productivity which has been shown to

be a determinant of economic growth. The relationship between health and economic growth

is one of the cornerstones of development economics use to influence funding decisions in

low and middle income countries. Because of the relationship between health and economic

growth and the relationship between economic growth and government tax revenue, a

rationale can be put forward for exploring the ‘government perspective’ associated with


investments in health. The underlying premise of such analyses is that changes in health

status in current and future working populations will have fiscal implications for government.

Therefore, health status changes can be shown to influence government tax revenue in

those countries with functioning tax collection agencies.

Model inputs

In order to construct the government perspective model for the case study, it will be

necessary to develop a government balance sheet for transfers and taxes at different stages

of life. The table below depicts some of the potential costs that will be included in the

government perspective fiscal health model.

Government transfer costs Tax transfers to government

Health costs non-communicable disease related

Vaccine program(s)

Education

Allowances

Unemployment benefits

Pensions

Income taxes

Excise taxes

Property taxes

Sales taxes

Corporate taxes

Depending on the country identified for the case study not all transfers and taxes will be

relevant.

Disease and economic modelling

The focal point of the model will be the quantification of fiscal benefits deriving from

population immunizations against a group of preventable diseases. Thus, emphasis will be

put on modelling the long-term effects of vaccination on earnings and taxes rather than the

long-term and short-term modelling of the disease. Given the macro nature of the analysis, it

is expected that treatment costs for not immunised subjects will be a small proportion of the

total cost. In addition, whilst the natural course of the modelled diseases will be reflected in

the model, crude assumptions on the patient journey and the vaccine efficacy will be used.

Project Proposal Specifics

A two stage approach is proposed that will result in two peer review manuscripts. Stage 1 of

the project is to define the fiscal consequences of vaccination in two case study countries.

Stage 2 of the framework will be a methodological overview/operational guide for how to

analyse the fiscal consequences of changes in health status attributed to vaccination.

Stage 1 country case studies

The modelling framework described here will be applied to two country examples. We

propose to conduct the analysis applied to rotavirus and the fiscal consequences of

vaccinating against rotavirus. After further consideration amongst the investigators it was felt

that case examples applied to a specific vaccine would be more appropriate to analyse as

the specific immunisation effect could be isolated.


The analysis for the two country case studies will then be used to compare and contrast

findings

Choice of case study countries

Several factors will need to be taken into consideration with respect to identifying the case

study country. Developing fiscal consequences for government associated with changes in

health status is data intensive and requires numerous inputs for reflecting the value of

vaccination back to government. The case study will be developed in one low or middle

income country. The following caveats will be applied in selecting the target country.

Access to national accounts data and national household surveys

Functional tax collection agency available within the case example country

Information on health service delivery and costs of care

Furthermore, the choice of country for the case study will be made in conjunction with WHO

QUIVER members.

Stage 2 Methodological Overview / Operational Guide

The “government perspective” fiscal accounting approach applied to changes in health

status changes has been applied in a limited number of health related publications.

However, the government perspective approach discussed here is widely applied in actuarial

sciences for assessing fiscal consequences. In addition, human capital economics have

addressed several of the issues that the proposed framework encapsulates particularly, the

estimation of lifetime earnings, taxes and government costs.

To bridge the gap between fiscal accounting principles and changes in health status we

propose to develop a peer review paper that provides an overview of the method and

theoretical foundations. It is envisaged that the second peer review paper can serve as an

operational overview/guide for future researchers that are interested to apply the

methodology. Furthermore, the paper will encompass a review of the methods used to

quantify the inputs that the proposed framework encapsulates.

Application of Research

Modelling the fiscal consequences of changes in health status attributed to vaccination can

inform local decision-making regarding vaccine funding. Because the model translates

health status changes to productivity benefits and to fiscal benefits, the methodology should

be highly relevant to funding decisions in these countries. Especially as vaccine funding

decisions are often made outside of the health service. The methodology highlights the

sustainability of health funding and the long-term benefits from vaccination. Since the

analysis applies an analytical framework familiar to Treasury departments, the health gains

from vaccination are expected to be communicated in a language familiar to governments.

Research limitations

One limitation of the approach described here is that not all countries in need of vaccination

have reliable and functional taxation systems. Applying the generational accounting

approach to population health changes requires that productivity, labour force participation


and wage changes can be translated into fiscal revenue for government. This suggests that

the choice of country for the case study be critical for applying the analysis.

Despite the lack of functional tax system in some countries the methodology can be useful

convey benefits to countries without domestic taxation services. Firstly, the benefits are

translated into metrics which would be familiar to government in terms of productivity and

labour force participation. Secondly, taxation and development has been a cornerstone of

much of the development economics literature (IMF, 2011). Therefore, the methodology

would simultaneously convey the benefits of taxation to governments without functional

domestic tax systems. Additionally, when communicated to countries with domestic tax

structures, it can be used to enforce the benefits of improved tax compliance.

Project Deliverables

A peer review manuscript will be developed that describes the following:

1. Excel model for calculating the fiscal consequences of changes in health status

attributed to rotavirus vaccination

2. Peer review manuscript defining the fiscal consequences of vaccination in two case

study countries

3. Peer review paper defining the methodological framework, theoretical foundations for

constructing a government perspective fiscal accounting model applied to vaccination

and operational overview.


References

Alan J. Auerbach, Laurence J. Kotlikoff and Willi Leibfritz, editors. Generational Accounting

around the World. Published in January 1999 by University of Chicago Press. © 1999 by the

National Bureau of Economic Research http://www.nber.org/books/auer99-1.

Dame Carol Black's Review of the health of Britain's working age population. Working for a

healthier tomorrow. Crown Copyright 2008 ISBN 978 0 11 702513 4.

Bonin, Holger and Patxot, Concepcio, Generational Accounting as a Tool to Assess Fiscal

Sustainability: An Overview of the Methodology (January 2004). IZA Discussion Paper No.

990. Available at SSRN: http://ssrn.com/abstract=494223.

Connolly MP, Topachevskyi O, Standaert B, Ortega O, Postma M. The impact of rotavirus

vaccination on discounted net tax revenue in Egypt: A government perspective analysis.

PharmacoEconomics in press 2012.

Connolly M, et al. Assessing long-run economic benefits attributed to an IVF-conceived

singleton based on projected lifetime net tax contributions in the UK. Human Reprod 2009a;

24(3):626-32.

Connolly MP, Constenla D. Assessing economic benefits for government and society

attributed to malaria investment strategies: An exploratory analysis based on malaria

vaccination. The Multilateral Initiative on Malaria (MIM), Nairobi, 2-6 November 2009b.

Poster 856.

Connolly M, et al. Long-term economic benefits attributed to IVF conceived children: A

lifetime tax calculation. Am J ManagCare 2008; 14(9):598-604.

Goldman DP, Michaud PC, Lakdawalla D, Zheng Y, Gailey A, Vaynman I. "The Fiscal

Consequences of Trends in Population Health" National Tax Journal 63.2 (2010): 307-330.

Available at: http://works.bepress.com/dana_goldman/68.

International Monetary Fund (IMF). Revenue Mobilization in Developing Countries. Prepared

by the Fiscal Affairs Department; Approved by Carlo Cottarelli March 8, 2011

Lucas AM. Economic Effects of Malaria Eradication: Evidence from the Malarial Periphery

(2005). (Link).

Sancak C, Velloso R, Jing X. Tax Revenue Response to the Business Cycle. International

Monetary Fund (IMF) Working Paper No. 10/71(2010).

World Health Organization (WHO). (2009) WHO Guide to Identifying the Economic

Consequences of Disease and Injury. Geneva, Switzerland: WHO Press.

WHO Commission on Macroeconomics and Health. Working Group 1. Health, economic

growth and poverty reduction: the report of Working Group I of the Commission on

Macroeconomics and Health. © World Health Organization 2002, ISBN 92 4 159009 2.

http://www.nber.org/books/auer99-1

http://ssrn.com/abstract=494223

http://works.bepress.com/dana_goldman/68

https://editorialexpress.com/cgi-bin/conference/download.cgi?db_name=NEUDC2005&paper_id=105


Curriculum vitaes

Prof Maarten J Postma (29/01/1960) holds the chair in Pharmacoeconomics at the

University of Groningen (Netherlands). Also, he holds an honorary chair in Health

Economics at the University Medical Center Groningen. He did his MSc in econometrics and

his PhD in health economics. Next to being head of the Unit PharmacoEpidemiology &

PharmacoEconomics (30 employees) of the Department of Pharmacy and being in the board

of directors of the Department, he specifically leads a team of 15 PhD and post-doc

researchers in health- and pharmacoeconomics, contributing to many international research

networks (co-operations with the University of London, Mario Negri in Italy, University of

Ghent, the University of Munich, University la Rioja) and scientific communications. He

serves (served) on various committees advising the Dutch government on reimbursement of

drugs (“Commissie Farmaceutische Hulp”) and vaccines (Health Council). Also, he is advisor

to various health-economics consultancy companies worldwide, member of editorial boards

of scientific journals, on advisory boards for pharmaceutical companies and consultant for

WHO. He has approximately 160 MEDLINE-publications and an H-factor of 20.


Mark Connolly Ph.D.

Ch. De Penguey 6B, St Prex, 1162, Switzerland

Tel: office +41 (0)21 806 1543, mobile +41 (0)78 922 8896

Email: [email protected]; [email protected]

Citizenship: Australian & United States; Swiss Resident

PROFESSIONAL EXPERIENCE

January 2008 - present Managing Director and Owner, Global Market Access Solutions Sàrl

(www.gmasoln.com), Switzerland

- Established market access consultancy providing range of pricing, reimbursement, and health economic services to a broad range of pharmaceutical, medical device and not-for-profit organisations with offices in Geneva and London.

- Perform economic evaluations (eg, CUA, CEA), health technology appraisals, and pharmaceutical policy analyses

- Performed health economic analyses to support pricing and reimbursement applications in several European and International markets

- Develop and execute health investment strategy and economic models to support market access activities and stakeholder involvement

- Provide full range of medical writing services including pricing & reimbursement applications, publication strategy development, product value dossiers, peer reviewed publications, medical symposia, press materials, on-line publications

January 2009 – Present Guest Researcher and Guest Lecturer, University of Groningen. Unit

of PharmacoEconomics and PharmacoEpidemiology, Netherlands

- Research the fiscal consequences of assisted reproduction for doctoral thesis

- Lecturer on health economics and role of productivity and taxation in health

May 2005 – January 2008 Director (Global) Market Access & Pricing, Ferring Pharmaceuticals,

Global Marketing, Switzerland

- Lead and develop global market access and pricing strategies in conjunction with R&D and local marketing organisations across four therapeutic areas

- Developed health economic tools to support market access activities and facilitate local implementation. Successfully published pharmacoeconomic results in recognised medical journals and at international conferences

- Health policy analysis and development of policy response to drive commercial strategy

- Responsibility for development of junior health economist and encourage development of local market access capabilities for Ferring

- Developed and launched media activities in conjunction with corporate communications to shape policy environment, influence government, and support product launches

mailto:[email protected]


http://www.gmasoln.com/


Jun 2003 – Apr 2005 Health Outcomes Manager, GlaxoSmithKline, United Kingdom

- Delivery of reimbursement strategy and health outcome/economic tools to support successful reimbursement and market access in US, Europe and International markets

- Provide strategic health economic and outcome input into R&D clinical trial development to support future reimbursement

- Provide health economic/outcome perspective to drug target selection for products in early stage clinical development

Nov 2000 - May 2003 Health Economics Manager, Aventis Pharma, Australia

- Accountable for development and delivery of all aspects of pharmaceutical reimbursement and pricing in Australia

- Coordinate key activities with medico-marketing and commercial groups to ensure effective product launches

- Appointed member to Australian pharmaceutical industry association, Medicines Australia, for 2 years

- Provide assessment of government health policies and free trade agreements to senior management

Mar 1998 - Oct 2000 Health Economics Associate, Department of Health Economics,

Covance, Australia (Held 2 different positions)

- Perform economic evaluations and technology appraisals to support pricing and reimbursement submissions to Australian Pharmaceutical Benefits Advisory Committee (PBAC)

- Conduct market forecasts and drug utilisation assessments - Design and validate clinical trial questionnaires - Develop sociodemographic recruitment model to determine impact

on generalisability of trial results

Dec 1996 - Mar 1998 Research Officer, Cardiopulmonary Transplant Unit, St Vincent's

Hospital, Australia

- Conduct and manage phase III-IV clinical trials for the treatment of heart disease

- Data management and statistical analysis of local trial results, and presentation of clinical trial results to hospital staff and at scientific meetings

Dec 1994 - Dec 1996 Senior Research Assistant, Victor Chang Cardiac Research

Institute, Australia

- Investigated cardiac receptor stimulation and intracellular activation

TERTIARY EDUCATION

- Doctorate in Health Economics (2010), University of Groningen, Netherlands

- Management Development Certificate (2007), Université de Genève, Switzerland

- Masters in Health Economics by treatise (2003), Curtin University of Technology, Australia


- Graduate Diploma Health Economics (2001), Sydney University, Australia

- Master of Science in Pharmacology (1994), University of Michigan, USA

- Bachelor of Arts in Biology (Honours; 1992), University of Toledo, USA

PROFESSIONAL AFFILIATIONS

- Member of the European Society for Human Reproduction and Embryology (ESHRE) Task Force on demography, epidemiology, and health economics

- Occassional reviewer of fertility policy documents for RAND Corporation, Cambridge, UK

PUBLICATIONS

Connolly MP, Topachevskyi O, Standaert B, Ortega O, Postma M. The impact of rotavirus vaccination

on discounted net tax revenue in Egypt: A government perspective analysis. PharmacoEconomics in

press.

Connolly MP. Cross-border reproductive care: market forces in action or market failure? An

economic perspective. Reproductive BioMedicine Online. DOI information:

10.1016/j.rbmo.2011.09.006.

Connolly MP, Simoens S. Kiovig for primary immunodeficiency: Reduced infusion and cost per

infusion. Int Immunopharmacol 2011 11(9):1358-61.

Connolly MP, Hoorens S, Chambers GM, on behalf of the ESHRE Infertility and Society Task Force.

The costs and consequences of assisted reproductive technology: an economic perspective. Human

Reproduction Update 2010; 16(6):603-61. Article quoted in Newsweek July 2010 (Link).

Poole CD, Connolly MP, Nielsen SK, Currie CJ, Marteau P. A comparison of physician-rated disease

severity and patient reported outcomes in mild to moderately active ulcerative colitis. J. of Crohn's

and Colitis 2010;4:275-282.

Connolly MP, Postma MJ. Healthcare as an investment: Implications for an era of ageing populations.

J of Medical Marketing 2010;10(1):5-14.

Connolly MP, Postma M, Silber S. What's on the mind of IVF consumers? Reproductive BioMedicine

Online 2009; 19(6):767-769.

Connolly MP. The potential economic benefit of maintaining a healthy workforce should be

considered when valuing health technologies. Pharmaceutical Marketing – Feature Article;

September 2009.

Connolly MP, et al. Quality of life improvements attributed to combination therapy with oral and

topical mesalazine in mild-to-moderately active ulcerative colitis. Digestion 2009;80:241-246.

Connolly, Ledger W, Griesinger G, Postma M. The impact of introducing patient co-payments in

Germany on the use of IVF and ICSI: A price-elasticity of demand assessment. Human Reproduction

2009; 24(11):2796-2800.

Connolly M, Bhatt A. Implementation of National Dyspepsia Guidelines to Reduce Prescribing and

Return Patients to Self Care: Results from An Educational Intervention and Prospective Clinical Audit

in England. Gastroenterology 2009;136(5):A-72.

Wex J, Connolly M, Rath W. Atosiban versus betamimetics in the treatment of preterm labour in

Germany: an economic evaluation. BMC Pregnancy and Childbirth 2009, 9:23 (highly accessed).

http://www.newsweek.com/2010/07/20/should-ivf-be-affordable-for-all.html


Connolly M, Bhatt A. Implementation of national dyspepsia guidelines to reduce prescribing and

return patients to self care: results from an educational intervention and prospective clinical audit in

England. DURG Conference published in Pharmacoepidemiology and Drug Safety 2009;18:1–11.

Connolly MP, Bhatt A. Implementation of national dyspepsia guidelines to reduce prescribing and

return patients to self care: results from an educational intervention and prospective clinical audit in

England. DDW Oral presentation June 2009.

Connolly M, et al. Assessing long-run economic benefits attributed to an IVF-conceived singleton

based on projected lifetime net tax contributions in the UK. Human Reproduction 2009; 24(3):626-

632.

Connolly M, et al. An economic evaluation comparing concomitant oral and topical mesalazine

versus oral mesalazine alone in mild-to-moderately active ulcerative colitis. J. of Crohn's and Colitis

2009; 3: 168–174.

Connolly M, De Vrieze K, Ombelet W, Schneider D, Currie CJ. A cost per live birth comparison based

on a systematic review of hMG and rFSH randomised trials. Reproductive BioMedicine Online 2008;

17(6):756-763.

Svensson A, Connolly M, Gallo F, Hägglund L. Long Term Fiscal Implications of subsidizing In-vitro

Fertilization in Sweden: A lifetime tax perspective. Scand. J. Public Health 2008;36:832-840.

Connolly M, Bhatt A. A comparison of treatment failure rates based on starting alginate therapy

observed in a large representative longitudinal UK database. Value in Health 2008;11(6):A530.

Connolly M, Nielsen SK, Currie CJ, Poole C, Travis SPL. An economic evaluation comparing once daily

with twice daily mesalazine for maintaining remission based on results from a randomised controlled

clinical trial. J. of Crohn's and Colitis 2009;3(1):32-37.

Bhatt A, Connolly M, Travis SPL. Self-diagnosis and health seeking behaviour of women for minor

bowel ailments in a large representative United Kingdom (UK) sample population. GUT 2008;57

(Suppl I):A271.

Connolly M, et al. Once daily mesalazine for maintaining remission is cost-saving compared to twice

daily mesalazine: An economic evaluation based on the PODIUM randomised controlled trial. UEGW

2008; Vienna.

Connolly M, Pollard M, Hoorens S, Kaplan B, Oskowitz S, Silber S. Long-term economic benefits

attributed to IVF conceived children: A lifetime tax calculation. American Journal of Managed Care

2008;14(9):598-604.

Connolly M, Pricing and reimbursement challenges for new pharmaceuticals and medical devices.

www.lifescience-online.com (Oct 2008).

Connolly M, et al. An economic evaluation of vasoactive agents used to treat acute bleeding

oesophageal varices in Belgium. Acta Gastro-enterologica Belgica 2008;71:230-236.

Wechowski J, Connolly M, Schneider D, McEwan P, Kennedy R. Cost saving treatment strategies in

IVF: A combined economic evaluation of two large randomized clinical trials comparing HP-hMG and

rFSH alpha. Fertility & Sterility; 2008 (in press).

Connolly MP, Hoorens S, and Ledger W. Money in babies out: Assessing the long-term economic

impact of IVF conceived children. J. of Medical Ethics 2008;34:653-654.

Nielsen S, Connolly M, Persson BE. Variation between countries in the perceived use of

antiandrogens to prevent flare symptoms: results of a comprehensive survey. EAU Milan 2008.

http://www.lifescience-online.com/


Wex J, Connolly M, Schneider D. Economic evaluation of atosiban versus beta-mimetics in the

treatment of preterm labour in Germany. ISPOR Annual Meeting Toronto, 2008.

Svensson A, Connolly MP. Long Term Fiscal Implications of subsidizing In-vitro Fertilization in

Sweden. - A study using Net Present Value. Nordic Fertility Society (oral presentation); Oslo Jan

2008.

Connolly MP, Hoorens S, Gallo F, Ledger W. Assessment of long-run economic benefits associated

with in-vitro fertilization (IVF) funding decisions: A simplified lifetime tax calculation. Value in Health

2007; 10(6):ES7.

Nielsen SK, Currie CJ, Connolly MP, Bhatt A. Evaluation of improvement in health-related quality of

life using oral mesalazine alone or in combination with mesalazine enema in active ulcerative colitis:

Results from a randomised controlled trial. Value in Health 2007; 10(6):PR8.

Connolly MP, Nielsen SK, Bhatt A, Currie CJ, Probert CS, Marteau P. Evaluation of the cost-

effectiveness of concomitant oral and topical versus oral mesalazine therapy in mild-to-moderate

active ulcerative colitis: A decision-analytic model. UEGW, Paris MON-G-308, 01 October 2007.

Wechowski J, McEwan P, Connolly MP, Kennedy R. HP-hMG (Menopur®) is cost-saving in IVF

compared to rFSH (Gonal-F®) in an economic evaluation using two large combined randomised

controlled trials. Human Reproduction 2007; 22(7):O-052.

Connolly MP, Currie CJ, Nielsen SK. Cost-saving treatment strategies in cervical ripening/labour

induction: A cost comparison of two dinoprostone formulations. J Perinat Med 2007;35:(S139)

Wechowski J, Connolly M, McEwan P, Kennedy R. An economic evaluation of HP-hMG and rFSH

based on a large randomised trial. Reproductive BioMedicine Online 2007;15:500-06.

Connolly M. Demography is destiny: the long term societal impact of assisted reproduction.

Portuguese Infertility Society Annual Meeting (Porto), May 19th 2007 (Invited speaker).

Wechowski J, Connolly M, Tetlow A, McEwan P, et al. An economic evaluation of vasoactive agents

used in the United Kingdom for acute bleeding oesophageal varices in patients with liver cirrhosis.

Curr Med Res Opin 2007; 23(7):1481-91.

McCrink L, Allen RP, Wolowacz S, Sherrill B, Connolly M, Kirsch J. Predictors of health-related quality

of life in sufferers with restless legs syndrome: A multi-national study. Sleep Medicine 2006; 8(1):73-

83.

Wechowski J, Tetlow T, Woehl A, Connolly M, Currie CJ, Burroughs AK. An economic evaluation of

terlipressin versus alternative vasoactive drug treatments for acute oesophageal variceal bleeding in

cirrhotic patients: A UK decision-analytic model. UEGW 2006, Berlin (256).

Ledger W, Gallo F, Hoorens S, Ziebe S, Connolly M. Present discounted value of children born using

IVF compared with naturally conceived children: a simplified UK calculation. Human Reproduction

vol. 21(Suppl 1); 2006 (i74).

RP. Allen, S. Wolowacz, M. Connolly, J. Kirsch. Evaluating the predictors of health-related quality of

life (HRQL) in European respondents with RLS (Abstract 14). International Congress on Parkinson`s

Disease (ICPD); Berlin 2005.

JV. Loftus, M. Connolly, R. Allen, D. Garcia-Borreguero, M. Billiard, P. Tidswell. Mapping the

International Restless Legs Syndrome Rating Scale (IRLS) to the EQ-5D By four Clinicians.

International Society for Pharmacoeconomics and Outcomes Research (ISPOR), Hamburg, 2004 (PNL

27).


A. Moore, A. Lloyd, D. Scott, M. Connolly, S. Dixon. The cost-effectiveness of treating patients with

restless legs syndrome (RLS) using ropinirole. European Federation of Neurological Societies (EFNS),

Paris, Sept 2004.

M. Connolly. Impact of introducing reference-based pricing (RBP) on prescription drug claims in

Australia. 5th European Conference on Health Economics, Abstract 63, London, Sept 2004.

M. Lees, W. Isaacson, G. Fulcer, D. Yue, M. Connolly, C.J. Currie. Cost-effectiveness of intensive

insulin therapy using insulin glargine versus NPH insulin in an Australian population. International

Diabetes Federation, Abstract 2922, Sept 2003.

M. Connolly, L Jackson, M Morrissey, J Peters, C Currie. Evaluation of the epidemiology and

impact of hypoglycemia in an Australian population by postal survey. American Diabetes

Association 2003 Annual Meeting; Abstract 2005.

M. Connolly, M. Smith, Direct health care costs associated with treating amyotrophic lateral sclerosis in the various health states of disease progression; an Australian neurologist survey. Amyotrophic Lateral Sclerosis Nov.2002; vol 3(2):Abstract P80.

P. Barnes, M. Smith, M. Connolly, P. Mullins, Combined analysis of long-term survival data from two

randomised controlled studies comparing riluzole with placebo. Amyotrophic Lateral Sclerosis (Nov.

2002); vol 3(2): P64.

M. Connolly, D. Yue, G. Fulcher, L. Campbell, J. Flack, J. Adams, C. Le Reun. Resource consumption

following severe hypoglycaemia in an Australian Type 1 Sample population, Oral Presentation,

Australian Diabetes Society Meeting September, 2002 (Abstract 139).

G. Fulcher, D. Yue, J. Flack, L. Campbell, J. Adams, C. Le Reun, M. Connolly Hypoglycaemia unawareness and its impact on behaviour and diabetes management: Does the ability to detect hypoglycaemia improve diabetic control and outcomes? European Association for the Study of Diabetes (EASD) 2002 meeting (Abstract 829).

M. Connolly, J Adams, G Fulcher, Establishing an average treatment cost for severe hypoglycaemia

in Australia. American Diabetes Association, Annual Meeting, 2002 (1102-P).

M Connolly, T Low. Assessment of patient sociodemographic variables in clinical trials- can patient

characteristics make a diference? Annals Academy of Medicine, Singapore 2000;29:570-5.

RR Neubig, M Connolly, AE Remmers, Rapid Kinetics of G protein association: a rate-limiting

conformational change? F.E.B.S. Letters 355 (1994) 251-253.


Nikos Kotsopoulos MSc Tel. +30 6942 55 55 94; +30 2610 330 379; +44 79 33 68 7014 Email: [email protected]; [email protected]

Professional experience

Apr 2011-present

: Global Market Access Solutions, Sarl, Switzerland Principal Health Economist: Producing market access and health economic deliverables for global pharmaceuticals and medical devices companies.

Dec-Mar 2009-2011

: PRMA consulting ltd. Fleet, United Kingdom Consultant: Delivered EU, US and Japan payers’ and pricing research, global access strategies and due diligence for top pharmaceutical and biotechnology companies; produced and managed the delivery of value dossiers, syndicated reports and systematic literature researches, across several therapeutic areas (oncology, CNS, dermatology and diabetes).

May-Nov 2006-2009

: GlaxoSmithKline Pharmaceuticals, Athens, Greece Government Affairs & Access Manager: In charge of local pricing and reimbursement negotiations; devised and implemented local government and corporate affairs plans and campaigns; regional (SE Europe) market access co-ordinator for the oncology portfolio; key account manager for vaccines.

Oct-Apr 2002-2006

: GlaxoSmithKline R&D, London, United Kingdom Global Health Outcomes Manager: Designed and delivered EU,US and international market access and evidence generation strategies for the infectious diseases portfolio (HIV, HBV, HSV, HPV, antibiotics and sepsis); responsible for internal training and new methodologies; developed health economic models; designed and implemented multi-national clinical and health economic protocols.

May-Sept 2002 : University Hospital, Patras, Greece Advisor to the Managing Director in operational research and management.

Sept-Sept 2000-2001

: Omikron consulting ltd. Athens, Greece Analyst: Conducted business plans, market research and cost-benefit analyses for public and private investment plans.

Education

2001 - 2002 : City University, London

MSc Health Economics (Awarded with distinction)

1995 - 2000 : University of Athens

Degree in Economics (Awarded with merit)

Spoken languages

: Greek, native. English, fluent (Cambridge Certificate of Proficiency). German, good knowledge (Zertfikat Deutsch als Fremdsprache). Italian, good knowledge.




Publications’ record

In peer reviewed journals:

Scalone L, Watson V, Ryan M, Kotsopoulos N, Patel R. Evaluation of Patients' Preferences for Genital

Herpes Treatment. Sexually Transmitted Diseases. Volume 38, number 12 (2011)

Maniadakis N, Kotsopoulos N, Prezerakos P, Yfantopoulos J. Measuring Intra-Hospital Clinic

Efficiency and Productivity: An Application to a Greek University General Hospital. European

Research Studies Journal Volume XI, Issue 1-2 (2008)

Maniadakis N, Kotsopoulos N, Prezerakos P, Yfantopoulos J. Health Care Services Performance

Measurement: Theory, Methods and Empirical Evidence. European Research Studies Journal Volume

X, Issue 1-2 (2007)

Prezerakos P, Maniadakis N, Kotsopoulos N, Yfantopoulos J. Measuring Across Hospital Efficiency

and Productivity: The Case of Second Regional Health Authority of Attica. European Research Studies

Journal Volume X, Issue 1-2 (2007)

Scalone L, Watson V, Ryan M, Kotsopoulos N, Patel R. Evaluation of Preferences in Genital Herpes

Treatment Using a Discrete Choice Experiment. Value in Health, Volume 8, Issue 6, November-

December (2005)

Podium presentations:

Maniadakis N, Prezerakos P, Kotsopoulos N, Fragoulakis B. Measuring Intra-hospital Clinic Efficiency

and Productivity. International Conference on Applied Business & Economics, Piraeus, Greece, 4-6

October 2007

Prezerakos P, Kotsopoulos N, Fragoulakis B, Maniadakis N. Measuring Across – Hospital Clinic

Efficiency and Productivity: An application of Data Envelopment Analysis to Assess Relative

Performance of Hospitals. International Conference on Applied Business & Economics, Piraeus,

Greece, 4-6 October 2007

Scalone L, Watson V, Ryan M, Patel R, Kotsopoulos N. Evaluation of Patients’ Preferences in Genital

Herpes using a Discrete Choice Experiment. ISPOR 8th Annual European congress, Florence, Italy 6-8

November 2005

Scalone L, Watson V, Ryan M, Kotsopoulos N, Patel R. Evaluation of Preferences in Genital Herpes

Treatment. 12th IHMF Annual meeting, Lisbon, Portugal, 28-30 October 2005

Quattek K, Kotsopoulos N, Garris C, Elston R. The low incidence of resistance mutations in naïve

patients receiving 908/r QD compared to NFV BID cannot be explained by adherence differences. 9th

European AIDS Conference, Warsaw, Poland 28-29 October 2003

Kotsopoulos N, Maniadakis N. Measuring intra-hospital Clinic Efficiency and Productivity: An

application to a Greek University General Hospital. 2nd Hellenic Workshop on Productivity &

Efficiency Measurement (HE.W.P.E.M.), Patras, Greece, 30 May - 1 June 2003

the fiscal consequences of vaccination for government

Documents