The effect of endovascular treatment (EVT) for ischemic stroke due to an intracranial large vessel occlusion varies between individual patients. Treatment benefit is affected by differences in clinical characteristics at baseline and early initiation of EVT is associated with improved chances of good recovery. A possibility to reduce delay is to directly transport patients with suspected large vessel occlusion stroke to an intervention center capable of performing EVT. However, this strategy might be harmful for stroke patients without large vessel occlusion, who only benefit from rapid intravenous thrombolysis in the nearest hospital. The optimal triage strategy requires a tradeoff between the harm of delaying intravenous thrombolysis versus the potential benefit of rapid EVT.
The overall aim of this thesis was to increase the benefit of EVT by optimizing prediction of outcome and treatment effect, reducing treatment delay, and improving prehospital triage strategies.
The objective of the thesis was to study the health economic aspects of leprosy prevention through post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR). The Leprosy Post-Exposure Prophylaxis program (LPEP) was a multi-centre study, included India where single-dose rifampicin was administered to the contacts of the leprosy patients. We found that SDR is feasible to implement along with the national leprosy control programme. SDR is cost-effective with an incremental cost of US$ 443 per DALY averted over 25 years. We recommend to scale-up SDR in India.
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Decision models can be a useful tool to extrapolate information from randomized controlled trials and investigate colorectal cancer (CRC) screening in specific problem conditions. The aim of this thesis is to first describe the steps that are required to standardize the structure of a microsimulation model (as MISCAN-Colon) and make it as the core of an online user-friendly model application. Briefly, these steps include: i) assessing effectiveness of CRC screening in different screening settings; ii) validating the model structure and its assumptions; and iii) building an online user-friendly platform that allow users to easily upload country-specific data, adjust a model, and simulate future outcomes of CRC screening in their countries. Subsequently, this thesis aims to demonstrate how models can be used to help policymakers in their decisions about CRC screening regarding populations at different risk of CRC.