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Andrew Siroka: Setting Priorities

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Doctoral student Andrew Siroka aims to promote a more scientific and cost-effective approach to allocating scarce global public health resources.

Global Health Aid has more than tripled since 1995, but the amount invested each year to improve health in low and middle-income countries – $30 billion – is less than half of what is needed to fight the myriad public health challenges these nations face, according to the World Health Organization (WHO). How to get the most out of limited health resources? Andrew Siroka is interested in conducting research that will help to set global public health spending priorities, while pointing policy makers toward the most cost-effective treatments.

Siroka, a second-year Ph.D. student in the school’s Department of Health Policy and Management, notes that such studies can facilitate a more rational approach to addressing global health needs. “Currently, these decisions are heavily influenced by lobbying groups and the popularity of combating certain global health issues,” he says. “Some funding priorities may be deemed sexier because famous people are promoting them or they produce more immediate results than investing in something like infrastructure, which might be more important in the long run. Given the scarcity of resources, a more scientific system of allocation is needed, based on the global burden of disease and efficiency of treatments.”

“Delving into the data, it was shocking how many millions of people die from something that is totally treatable. Seeing that hardened my resolve to do what I can.”

Siroka believes such research will underscore the cost-effectiveness of public health interventions for infectious diseases that disproportionately affect low and middle-income countries. For example, the WHO-promoted strategy to control tuberculosis, known as directly observed treatment, short-course (DOTS), enlists family members, friends and neighbors to help ensure that people with active tuberculosis adhere to their daily medication regimen. “This takes very little of the clinician’s time and helps to keep people from developing drug-resistant tuberculosis, which can be very expensive to treat,” Siroka explains.

During an internship with WHO’s STOP TB program in Geneva, Switzerland, Siroka helped to measure the global burden of the disease as well as evaluating national policies to improve treatment. “Delving into the data, it was shocking how many millions of people die from something that is totally treatable,” Siroka says. “Seeing that hardened my resolve to do what I can.”
 
The application of cost-effectiveness to the U.S. health care system has often been underappreciated. “In the United States we’ve been slow to recognize the scarcity of resources, and coverage decisions aren’t supposed to be made based on cost-effectiveness analyses,” Siroka notes. “It’s very politically unpopular, having inspired talk of ‘death panels’ during the health care reform debate. People don’t want to get into pitting diseases against one another, and advocates for diseases that are better funded don’t want to lose their funding.” But Siroka, who prior to enrolling in the Ph.D. program conducted comparative cost-effective analyses in his job at the Health Economics Resource Center (part of the U.S. Department of Veterans Affairs), believes that given the fiscal constraints domestically and abroad, it’s just a matter of time before such studies are embraced. “This is about priority-setting, not pitting diseases against each other,” he says. “And I’m hoping that by shining the light on how cost-effective some of these treatments are, we can help to increase aid.”