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Sample records for achieve cost-effective medical

  1. The Cost Effectiveness of 22 Approaches for Raising Student Achievement

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2010-01-01

    Review of cost-effectiveness studies suggests that rapid assessment is more cost effective with regard to student achievement than comprehensive school reform (CSR), cross-age tutoring, computer-assisted instruction, a longer school day, increases in teacher education, teacher experience or teacher salaries, summer school, more rigorous math…

  2. Cost-Effectiveness of Comprehensive School Reform in Low Achieving Schools

    ERIC Educational Resources Information Center

    Ross, John A.; Scott, Garth; Sibbald, Tim M.

    2012-01-01

    We evaluated the cost-effectiveness of Struggling Schools, a user-generated approach to Comprehensive School Reform implemented in 100 low achieving schools serving disadvantaged students in a Canadian province. The results show that while Struggling Schools had a statistically significant positive effect on Grade 3 Reading achievement, d = 0.48…

  3. Fibromyalgia: disease synopsis, medication cost effectiveness and economic burden.

    PubMed

    Skaer, Tracy L

    2014-05-01

    Fibromyalgia (FM) primarily affects women, and it is increasingly recognized by health care providers as more patients seek assistance for their chronic pain conditions. FM patients suffer from reduced quality of life, daily functioning and productivity. A single FM patient can cost society tens of thousands of dollars each year, with the overall expense increasing alongside disease severity. Indirect costs account for the majority of total expenditures and involve losses in productivity, reduced work hours, absenteeism, disability, unemployment, early retirement, informal care and other out-of-pocket costs. Health care utilization increases in concert with the severity of illness. Moreover, FM patients often have several comorbid illnesses (e.g. depression, anxiety and sleep disturbances), resulting in extreme escalation of overall health care expenditures. Medications with the best efficacy in the treatment of FM include the tricyclic antidepressants amitriptyline and nortriptyline, cyclobenzaprine (a skeletal muscle relaxant), tramadol, duloxetine, milnacipran, pregabalin and gabapentin. Corticosteroids, nonsteroidal anti-inflammatory drugs, benzodiazepines and opioid analgesics, with the exception of tramadol, are not considered efficacious. Medication selection should be individualized and influenced by the severity of illness and the presence of comorbidities and functional disabilities. PMID:24504852

  4. Cost-Effectiveness of a Computerized Provider Order Entry System in Improving Medication Safety Ambulatory Care

    PubMed Central

    Forrester, Sara H.; Hepp, Zsolt; Roth, Joshua A.; Wirtz, Heidi S.; Devine, Emily Beth

    2014-01-01

    Background Computerized provider order entry (CPOE) is the process of entering physician orders directly into an electronic health record. Although CPOE has been shown to improve medication safety and reduce health care costs, these improvements have been demonstrated largely in the inpatient setting; the cost-effectiveness in the ambulatory setting remains uncertain. Objective The objective was to estimate the cost-effectiveness of CPOE in reducing medication errors and adverse drug events (ADEs) in the ambulatory setting. Methods We created a decision-analytic model to estimate the cost-effectiveness of CPOE in a midsized (400 providers) multidisciplinary medical group over a 5-year time horizon— 2010 to 2014— the time frame during which health systems are implementing CPOE to meet Meaningful Use criteria. We adopted the medical group’s perspective and utilized their costs, changes in efficiency, and actual number of medication errors and ADEs. One-way and probabilistic sensitivity analyses were conducted. Scenario analyses were explored. Results In the base case, CPOE dominated paper prescribing, that is, CPOE cost $18 million less than paper prescribing, and was associated with 1.5 million and 14,500 fewer medication errors and ADEs, respectively, over 5 years. In the scenario that reflected a practice group of five providers, CPOE cost $265,000 less than paper prescribing, was associated with 3875 and 39 fewer medication errors and ADEs, respectively, over 5 years, and was dominant in 80% of the simulations. Conclusions Our model suggests that the adoption of CPOE in the ambulatory setting provides excellent value for the investment, and is a cost-effective strategy to improve medication safety over a wide range of practice sizes. PMID:24968993

  5. Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations.

    PubMed

    van Boven, Job F M; Ryan, Dermot; Eakin, Michelle N; Canonica, Giorgio W; Barot, Aji; Foster, Juliet M

    2016-01-01

    Adherence to medication comprises a multiphased temporal process involving (1) initiation of prescribed therapy, (2) implementation as prescribed, and (3) subsequent persistence. Medication adherence remains suboptimal in most patients with long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Interventions have been shown to effectively improve treatment initiation, implementation, and persistence when delivered at the health care professional level or the system level, but demonstration of the cost-effectiveness of these interventions is necessary to ensure their widespread use. This review summarizes how health care professionals can intervene to improve medication adherence in patients with asthma and COPD, provides some examples of effective primary care interventions, and illustrates some of the challenges to optimal implementation arising from cost-effectiveness modeling. Improving adherence is shown to be an economically viable treatment option for patients with asthma and COPD, but there are differences in the health economics pertaining to each condition and setting that can affect whether an intervention is considered cost-effective. Targeting adherence interventions at patients with the greatest to gain, and tailoring them to individual patient needs, may help to optimize cost-effectiveness ratios and improve the probability of positive reimbursement decisions, systemwide implementation, and resultant health benefits. PMID:27587317

  6. Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence

    PubMed Central

    2013-01-01

    Background High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention. Methods Costs of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios. Results The intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for

  7. Long-acting medications for the hyperkinetic disorders. A note on cost-effectiveness.

    PubMed

    Schlander, Michael

    2007-10-01

    New long-acting medications for attention-deficit/ hyperactivity disorder (ADHD) have become available, which combine certain advantages over conventional short-acting drugs with higher acquisition costs. Choices between these drugs should thus be driven by their clinical profiles and by an acceptable balance of increased costs and additional benefits. Accordingly, the notion of relative cost-effectiveness should be central to recommendations about the use of these drugs in practice. A recent technology assessment on behalf of the National Institute for Health and Clinical Excellence (NICE) did not identify differences between compounds in terms of clinical efficacy and described drug cost as the major driver of cost-effectiveness. The underlying economic model was restricted to a cost-utility analysis that used only a fraction of the available clinical evidence base and did not address the distinction between efficacy and effectiveness. Cost-effectiveness evaluations including the potential impact of improved treatment compliance indicate a relatively more attractive cost-effectiveness of long-acting medications than suggested by the NICE assessment. These evaluations provide health economic support to treatment recommendations recently published by the European Network for Hyperkinetic Disorders. Limitations of currently available economic evaluations include their short time horizon, and future research should assess treatment effects on long-term sequelae associated with ADHD. PMID:17401606

  8. Incremental Cost-effectiveness of Combined Therapy vs Medication Only for Youth With Selective Serotonin Reuptake Inhibitor–Resistant Depression

    PubMed Central

    Lynch, Frances L.; Dickerson, John F.; Clarke, Greg; Vitiello, Benedetto; Porta, Giovanna; Wagner, Karen D.; Emslie, Graham; Asarnow, Joan Rosenbaum; Keller, Martin B.; Birmaher, Boris; Ryan, Neal D.; Kennard, Betsy; Mayes, Taryn; DeBar, Lynn; McCracken, James T.; Strober, Michael; Suddath, Robert L.; Spirito, Anthony; Onorato, Matthew; Zelazny, Jamie; Iyengar, Satish; Brent, David

    2013-01-01

    Context Many youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors (SSRIs), and this is associated with higher costs. More effective treatment for these youth may be cost-effective. Objective To evaluate the incremental cost-effectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI. Design Randomized controlled trial. Setting Six US academic and community clinics. Patients Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression. Intervention Participants were randomly assigned to (1) switch to a different medication only or (2) switch to a different medication plus cognitive behavior therapy. Main Outcome Measures Clinical outcomes were depression-free days (DFDs), depression-improvement days (DIDs), and quality-adjusted life-years based on DFDs (DFD-QALYs). Costs of intervention, nonprotocol services, and families were included. Results Combined treatment achieved 8.3 additional DFDs (P=.03), 0.020 more DFD-QALYs (P=.03), and 11.0 more DIDs (P=.04). Combined therapy cost $1633 more (P=.01). Cost per DFD was $188 (incremental cost-effectiveness ratio [ICER]=$188; 95% confidence interval [CI], −$22 to $1613), $142 per DID (ICER=$142; 95% CI, −$14 to $2529), and $78 948 per DFD-QALY (ICER=$78 948; 95% CI, −$9261 to $677 448). Cost-effectiveness acceptability curve analyses suggest a 61% probability that combined treatment is more cost-effective at a willingness to pay $100 000 per QALY. Combined treatment had a higher net benefit for subgroups of youth without a history of abuse, with lower levels of hopelessness, and with comorbid conditions. Conclusions For youth with SSRI-resistant depression, combined treatment decreases the number of days with depression and is more costly. Depending on a decision

  9. A cost-effectiveness analysis of an in-house corporate occupational medical department.

    PubMed

    Fitko, J; Kalina, C M; Fisher, A M; Mitchell, J H

    1994-02-01

    There is a current trend for corporations to switch from in-house medical departments to outside contract organizations for provision of occupational health services. Although this may be driven by a desire to reduce expenses, there is little objective data on which to base this decision. This study compares the costs to a corporation of an in-house medical department with the costs for the same services if rendered by outside providers. Costs of the in-house department were obtained from company records. Prevailing charges for outside provider services were determined by an invoice survey and from other sources. We found that the cost for the in-house medical department was 42% less than that of the outside providers at the prevailing rates. Thus, the in-house medical department is more cost-effective than the outside providers. We also discuss other advantages of an in-house department that are more difficult to quantify. PMID:8176514

  10. Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

    PubMed Central

    Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

    2014-01-01

    Objective We determined the minimum mortality reduction that helicopter emergency medical services (HEMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of minor injury patients. Methods We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective over a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality adjusted life year (QALY) gained compared to ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma (NSCOT), National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. Results HEMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the NSCOT cohort) to cost less than $100,000 per QALY gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per QALY. HEMS becomes more cost-effective with significant reductions in minor injury patients triaged to air transport or if long-term disability outcomes are improved. Conclusions HEMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably to other interventions considered cost-effective. Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction. Reducing overtriage of minor injury patients to HEMS would improve its cost-effectiveness. PMID:23582619

  11. Temporal aneurysmal bone cyst: cost-effective method to achieve gross total resection.

    PubMed

    Sodhi, Harsimrat Bir Singh; Salunke, Pravin; Agrawal, Parimal; Gupta, Kirti

    2016-08-01

    Aneurysmal bone cyst (ABC) is a vascular benign bony expansile lesion. The treatment is gross total resection. Surgery for a skull base aneurysmal bone cyst poses a significant challenge because of its vascularity and the adjacent neurovascular structures. We present the case of a young male with a temporal aneurysmal bone cyst who underwent gross total resection of the lesion. The external carotid artery (ECA) was temporarily clamped to cut off the vascular supply. There was no intraoperative event, and the patient made a good postoperative clinical recovery. This technique was used as an alternative to subselective endovascular embolization of the ECA branches. This case represents a simple yet cost-effective surgical technique to control bleeding for a highly vascular lesion such as ABCs, especially in resource-deficient countries. PMID:27334736

  12. Rapid, simple, and cost-effective treatments to achieve long-term hydrophilic PDMS surfaces

    NASA Astrophysics Data System (ADS)

    Hemmilä, Samu; Cauich-Rodríguez, Juan V.; Kreutzer, Joose; Kallio, Pasi

    2012-10-01

    This paper describes rapid, simple, and cost-effective treatments for producing biocompatible and long-term hydrophilic polydimethylsiloxane (PDMS) surfaces identified in an experimental study investigating 39 treatments in all. The wetting of the surfaces was monitored during six months. Changes in surface morphology and chemical composition were also analyzed. Some of the treatments are presented here for the first time, while for earlier presented treatments the selection of investigated parameters was wider and the observation period for the surface wetting longer. The PDMS surfaces were modified by surface activation, physisorption, and synthesis of both “grafting to” and “grafting from” polymer brushes. In surface activation, the PDMS sample was exposed to oxygen plasma, with several combinations of exposure time and RF power. In the physisorption and synthesis of polymer brushes, three commercially available and biocompatible chemicals were used: 2-hydroxyethyl methacrylate (HEMA), polyethylene glycol (PEG), and polyvinylpyrrolidone (PVP). Thirty-three of the 39 treatments rendered the PDMS hydrophilic, and in 12 cases the hydrophilicity lasted at least six months. Seven of these long-term hydrophilic coatings supported a contact angle of 30° or less. Three of the long-lasting hydrophilic coatings required only minutes to prepare.

  13. Achievement motivation in medical students.

    PubMed

    Robbins, L; Robbins, E S; Katz, S E; Geliebter, B; Stern, M

    1983-11-01

    Medical students were assessed by questionnaire in their third and fourth years regarding attitudes about sex role, medical school, and career plans and in the third year about fear of success. Nine percent of each sex were judged to fear success. Stereotypical responses were reported by the students. Males, anticipating that they would work more than 60 hours per week, looked forward to academic careers, while females more often desired the sharing of financial and child care responsibilities with spouses. Attitudes toward chores were egalitarian, but in reality women performed most routine household activities. Both sexes agreed upon the characteristics that are necessary to be a good student as well as to succeed in later life. Women were more inclined toward artistic and domestic interests and helping others, while men were more interested in scientific investigation, athletics, and adventure. The implications of these similarities and differences for the students' future careers are discussed. PMID:6631923

  14. The Cost-Effectiveness of 22 Approaches for Raising Student Achievement

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2011-01-01

    As a consequence of the federal "No Child Left Behind" (NCLB) law, there is tremendous pressure on school principals, teachers, school superintendents, district staff, state departments of education and governors to maximize the increase in student achievement that is obtained with every dollar of expenditure. Currently, teachers are forced to…

  15. Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients

    PubMed Central

    Cubro, Hajrunisa; Somun-Kapetanovic, Rabija; Thiery, Guillaume; Talmor, Daniel; Gajic, Ognjen

    2016-01-01

    AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit (ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed. RESULTS: Out of 148 patients, seventy patients (47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR) 0.49-0.76]. Median number of life years gained per patient was 30 (IQR 16-40) or 18 quality adjusted life years (QALYs) (IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and 20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category, ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to 35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria. CONCLUSION: The ICU treatment of critically ill medical patients in a resource poor country is cost effective and compares favorably with other medical interventions. Public health authorities in low and middle income countries should encourage development of critical care services. PMID:27152258

  16. Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis

    PubMed Central

    Kopp Kallner, Helena; Simeonova, Emilia; Madestam, Andreas; Gemzell-Danielsson, Kristina

    2016-01-01

    Objective The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. Study design A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. Results The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Conclusion Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women’s access to safe abortion. PMID:27362270

  17. Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence

    PubMed Central

    Chen, Mingsheng; Si, Lei; Winzenberg, Tania M; Gu, Jieruo; Jiang, Qicheng; Palmer, Andrew J

    2016-01-01

    Aims Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medication persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods We used a previously developed and validated osteoporosis state-transition microsimulation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medication persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness-to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost-effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost-effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion Given the willingness-to-pay threshold

  18. The Growth Patterns of General Medical Achievement.

    ERIC Educational Resources Information Center

    Shen, Linjun

    This longitudinal study investigates the growth of medical achievement as a multilevel process and emphasizes the structure of the growth. Subjects were students in all 15 U.S. osteopathic medical schools, a total of 1,060 (78 percent of the 1987 osteopathic cohort). Students took appropriate portions of the National Board of Osteopathic Medical…

  19. A Structural Model of Medical Student Achievement.

    ERIC Educational Resources Information Center

    Sheehan, T. Joseph; Sanford, Keat

    1990-01-01

    The theoretical model of medical student performance begins with 38 measures, reduced to 18 without loss of information. These measures are shown to reflect five underlying theoretical interrelated variables: medical knowledge; clinical performance; science aptitude; college achievement; and attitudes and values. Results should be useful in…

  20. Toward a treaty on safety and cost-effectiveness of pharmaceuticals and medical devices: enhancing an endangered global public good

    PubMed Central

    Faunce, Thomas Alured

    2006-01-01

    • Expert evaluations of the safety, efficacy and cost-effectiveness of pharmaceutical and medical devices, prior to marketing approval or reimbursement listing, collectively represent a globally important public good. The scientific processes involved play a major role in protecting the public from product risks such as unintended or adverse events, sub-standard production and unnecessary burdens on individual and governmental healthcare budgets. • Most States now have an increasing policy interest in this area, though institutional arrangements, particularly in the area of cost-effectiveness analysis of medical devices, are not uniformly advanced and are fragile in the face of opposing multinational industry pressure to recoup investment and maintain profit margins. • This paper examines the possibility, in this context, of States commencing negotiations toward bilateral trade agreement provisions, and ultimately perhaps a multilateral Treaty, on safety, efficacy and cost-effectiveness analysis of pharmaceuticals and medical devices. Such obligations may robustly facilitate a conceptually interlinked, but endangered, global public good, without compromising the capacity of intellectual property laws to facilitate local product innovations. PMID:16569240

  1. Cost-Effectiveness of Financial Incentives to Promote Adherence to Depot Antipsychotic Medication: Economic Evaluation of a Cluster-Randomised Controlled Trial

    PubMed Central

    Henderson, Catherine; Knapp, Martin; Yeeles, Ksenija; Bremner, Stephen; Eldridge, Sandra; David, Anthony S.; O’Connell, Nicola; Burns, Tom; Priebe, Stefan

    2015-01-01

    Background Offering a modest financial incentive to people with psychosis can promote adherence to depot antipsychotic medication, but the cost-effectiveness of this approach has not been examined. Methods Economic evaluation within a pragmatic cluster-randomised controlled trial. 141 patients under the care of 73 teams (clusters) were randomised to intervention or control; 138 patients with diagnoses of schizophrenia, schizo-affective disorder or bipolar disorder participated. Intervention participants received £15 per depot injection over 12 months, additional to usual acute, mental and community primary health services. The control group received usual health services. Main outcome measures: incremental cost per 20% increase in adherence to depot antipsychotic medication; incremental cost of ‘good’ adherence (defined as taking at least 95% of the prescribed number of depot medications over the intervention period). Findings Economic and outcome data for baseline and 12-month follow-up were available for 117 participants. The adjusted difference in adherence between groups was 12.2% (73.4% control vs. 85.6% intervention); the adjusted costs difference was £598 (95% CI -£4 533, £5 730). The extra cost per patient to increase adherence to depot medications by 20% was £982 (95% CI -£8 020, £14 000). The extra cost per patient of achieving 'good' adherence was £2 950 (CI -£19 400, £27 800). Probability of cost-effectiveness exceeded 97.5% at willingness-to-pay values of £14 000 for a 20% increase in adherence and £27 800 for good adherence. Interpretation Offering a modest financial incentive to people with psychosis is cost-effective in promoting adherence to depot antipsychotic medication. Direct healthcare costs (including costs of the financial incentive) are unlikely to be increased by this intervention. Trial Registration ISRCTN.com 77769281 PMID:26448540

  2. A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students

    PubMed Central

    Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

    2015-01-01

    Background Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. Objective This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. Methods The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. Results The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a

  3. Multimedia OC12 parallel interface using VCSEL array to achieve high-performance cost-effective optical interconnections

    NASA Astrophysics Data System (ADS)

    Chang, Edward S.

    1996-09-01

    The multimedia communication needs high-performance, cost- effective communication techniques to transport data for the fast-growing multimedia traffic resulting from the recent deployment of World Wide Web (WWW), media-on-demand , and other multimedia applications. To transport a large volume, of multimedia data, high-performance servers are required to perform media processing and transfer. Typically, the high- performance multimedia server is a massively parallel processor with a high number of I/O ports, high storage capacity, fast signal processing, and excellent cost- performance. The parallel I/O ports of the server are connected to multiple clients through a network switch which uses parallel links in both switch-to-server and switch-to- client connections. In addition to media processing and storage, media communication is also a major function of the multimedia system. Without a high-performance communication network, a high-performance server can not deliver its full capacity of service to clients. Fortunately, there are many advanced communication technologies developed for networking, which can be adopted by the multimedia communication to economically deliver the full capacity of a high-performance multimedia service to clients. The VCSEL array technology has been developed for gigabit-rate parallel optical interconnections because of its high bandwidth, small-size, and easy-fabrication advantages. Several firms are developing multifiber, low-skew, low-cost ribbon cables to transfer signals form a VCSEL array. The OC12 SONET data-rate is widely used by high-performance multimedia communications for its high-data-rate and cost- effectiveness. Therefore, the OC12 VCSEL parallel optical interconnection is the ideal technology to meet the high- performance low-cost requirements for delivering affordable multimedia services to mass users. This paper describes a multimedia OC12 parallel optical interconnection using a VCSEL array transceiver, a multifiber

  4. Cost-effectiveness analysis of a hospital electronic medication management system

    PubMed Central

    Gospodarevskaya, Elena; Li, Ling; Richardson, Katrina L; Roffe, David; Heywood, Maureen; Day, Richard O; Graves, Nicholas

    2015-01-01

    Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS). Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors. PMID:25670756

  5. Medical Biotechnology Trends and Achievements in Iran

    PubMed Central

    Mahboudi, Fereidoun; Hamedifar, Haleh; Aghajani, Hamideh

    2012-01-01

    A healthcare system has been the most important priority for all governments worldwide. Biotechnology products have affected the promotion of health care over the last thirty years. During the last several decades, Iran has achieved significant success in extending healthcare to the rural areas and in reducing the rates of infant mortality and increasing population growth. Biomedical technology as a converging technology is considered a helpful tool to fulfill the Iranian healthcare missions. The number of biotechnology products has reached 148 in 2012. The total sales have increased to 98 billion USD without considering vaccines and plasma derived proteins in 2012. Iran is one of the leading countries in the Middle East and North Africa in the area of Medical biotechnology. The number of biotechnology medicines launched in Iran is 13 products until 2012. More than 15 products are in pipelines now. Manufacturers are expecting to receive the market release for more than 8 products by the end of 2012. Considering this information, Iran will lead the biotechnology products especially in area of biosimilars in Asia after India in next three years. The present review will discuss leading policy, decision makers’ role, human resource developing system and industry development in medical biotechnology. PMID:23407888

  6. The key role of health insurance in a cost-effective health care system. Towards regulated competition in the Dutch medical market.

    PubMed

    van de Ven, W P

    1987-04-01

    The previous two sessions of this Symposium have dealt with incentives for cost-effective provider behaviour. Although incentive-reimbursement, which rewards the providers for delivery medical care in a cost-effective way, can be an important step towards a cost-effective health care system, it is not rewards the providers for delivering medical care in a cost-effective way, can be an important step towards a cost-effective health care system, it is not sufficient. As long as the insured consumers have both comprehensive health insurance coverage and freedom of choice of provider, providers will have great difficulty in resisting consumers' demand for ever more costly medical care, and politicians or other decision-makers will have great difficulty in restricting capacity and in preventing overcapacity. Fear of losing patients or voters might dominate. Therefore, in this session we shall focus on the key role of health insurance in a cost-effective health care system and on consumer incentives and insurer behaviour. If the consumers have a choice between several provider-insurer organizations. Although market forces do play an important role in a competitive health-care system, competition should not be confused with a "free market". Besides financial arrangements to protect the poor, pro-competitive regulation is needed to guarantee a "fair competition". Currently there is much consensus that the present Dutch health insurance system, in which 60% of the population is publicly insured and 40% is privately insured, should be replaced by a national health insurance scheme, which uniformly applies to the entire population. A few years ago, I made a proposal for such a scheme, which was based largely on the ideas of Ellwood, McClure, and Enthoven on competition between alternative delivery systems. The main features of this proposal will be discussed. In my opinion, the long-term prospects for regulated competition in the Dutch medical market seem rather favourable

  7. Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records

    PubMed Central

    Holbrook, Anne; Blackhouse, Gordon; Troyan, Sue; Goeree, Ron

    2011-01-01

    Background Computerized decision support systems (CDSSs) are believed to enhance patient care and reduce healthcare costs; however the current evidence is limited and the cost-effectiveness remains unknown. Objective To estimate the long-term cost-effectiveness of a CDSS linked to evidence-based treatment recommendations for type 2 diabetes. Methods Using the Ontario Diabetes Economic Model, changes in factors (eg, HbA1c) from a randomized controlled trial were used to estimate cost-effectiveness. The cost of implementation, development, and maintenance of the core dataset, and projected diabetes-related complications were included. The base case assumed a 1-year treatment effect, 5% discount rate, and 40-year time horizon. Univariate, one-way sensitivity analyses were carried out by altering different parameter values. The perspective was the Ontario Ministry of Health and costs were in 2010 Canadian dollars. Results The cost of implementing the intervention was $483 699. The one-year intervention reduced HbA1c by 0.2 and systolic blood pressure by 3.95 mm Hg, but increased body mass index by 0.02 kg/m2, resulting in a relative risk reduction of 14% in the occurrence of amputation. The model estimated that the intervention resulted in an additional 0.0117 quality-adjusted life year; the incremental cost-effectiveness ratio was $160 845 per quality-adjusted life-year. Conclusion The web-based prototype decision support system slightly improved short-term risk factors. The model predicted moderate improvements in long-term health outcomes. This disease management program will need to develop considerable efficiencies in terms of costs and processes or improved effectiveness to be considered a cost-effective intervention for treating patients with type 2 diabetes. PMID:22052900

  8. Cost-Effectiveness Analysis of Stereotactic Body Radiotherapy and Radiofrequency Ablation for Medically Inoperable, Early-Stage Non-Small Cell Lung Cancer

    SciTech Connect

    Sher, David J.

    2011-12-01

    Purpose: The standard management of medically inoperable Stage I non-small-cell lung cancer (NSCLC) conventionally has been fractionated three-dimensional conformal radiation therapy (3D-CRT). The relatively poor local control rate and inconvenience associated with this therapy have prompted the development of stereotactic body radiotherapy (SBRT), a technique that delivers very high doses of irradiation typically over 3 to 5 sessions. Radiofrequency ablation (RFA) has also been investigated as a less costly, single-day therapy that thermally ablates small, peripheral tumors. The cost-effectiveness of these three techniques has never been compared. Methods and Materials: We developed a Markov model to describe health states of 65-year-old men with medically inoperable NSCLC after treatment with 3D-CRT, SBRT, and RFA. Given their frail state, patients were assumed to receive supportive care after recurrence. Utility values, recurrence risks, and costs were adapted from the literature. Sensitivity analyses were performed to model uncertainty in these parameters. Results: The incremental cost-effectiveness ratio for SBRT over 3D-CRT was $6,000/quality-adjusted life-year, and the incremental cost-effectiveness ratio for SBRT over RFA was $14,100/quality-adjusted life-year. One-way sensitivity analysis showed that the results were robust across a range of tumor sizes, patient utility values, and costs. This result was confirmed with probabilistic sensitivity analyses that varied local control rates and utilities. Conclusion: In comparison to 3D-CRT and RFA, SBRT was the most cost-effective treatment for medically inoperable NSCLC over a wide range of treatment and disease assumptions. On the basis of efficacy and cost, SBRT should be the primary treatment approach for this disease.

  9. The implications of cost-effectiveness analysis of medical technology. Background paper number 2: case studies of medical technologies. Case study number 13: cardiac radionuclide imaging and cost effectiveness

    SciTech Connect

    Not Available

    1982-05-01

    Cardiac radionuclide imaging is a new and rapidly expanding diagnostic technology that promises to make significant contributions to the diagnosis and management of heart disease. Dynamic changes are occurring in the technology at the same time diffusion is taking place. The combination of diffusion and technological development creates an imperative for careful evaluation and prospective planning. Clinical applications of cardiac imaging include the diagnosis of coronary artery disease, evaluation of cardiac function abnormalities, verification of the diagnosis of acute myocardial infarction (heart attack), and monitoring of patients under treatment for establishing cardiac disease. The report describes the dimensions of the technology of cardiac radionuclide imaging. Information is summarized on the industry producing radionuclide imaging equipment, on clinical applications of technology, and on the costs and efficacies of the various techniques. Finally, formulation of some of the issues involved in the assessment of the technology's cost effectiveness is presented.

  10. PPD-QALY-an index for cost-effectiveness in orthopedics: providing essential information to both physicians and health care policy makers for appropriate allocation of medical resources.

    PubMed

    Dougherty, Christopher P; Howard, Timothy

    2013-09-01

    Because of the increasing health care costs and the need for proper allocation of resources, it is important to ensure the best use of health benefits for sick and injured people of the population. An index or indicator is needed to help us quantify what is being spent so that comparisons with other options can be implemented. Cost-effective analysis seems to be well suited to provide this essential information to health care policy makers and those charged with distributing disability funds so that the proper allocation of resources can be achieved. There is currently no such index to show whether the benefits paid out are the most cost-effective. By comparing the quality-adjusted life year (QALY) of a treatment method to the disability an individual would experience, on the basis of lost wages as measure of disability, we provide decision makers more information for the basis of cost allocation in health care. To accomplish this, we describe a new term, the PPD-QALY (permanent partial disability-quality of life year). This term was developed to establish an index to which musculoskeletal care can be compared, to evaluate the cost-effectiveness of a treatment on the basis of the monetary value of the disability. This term serves to standardize the monetary value of an injury. Cost-effective analysis in arthroscopic surgery may prove to be a valuable asset in this role and to provide decision makers the information needed to determine the societal benefit from new arthroscopic procedures as they are developed and implemented. PMID:23924750

  11. Using agent-based technology to create a cost effective, integrated, multimedia view of the electronic medical record.

    PubMed Central

    Lowe, H. J.; Walker, W. K.; Vries, J. K.

    1995-01-01

    Image Engine is multi-user, client-server database for the storage, retrieval and sharing of a wide range of digitized biomedical images under development at the University of Pittsburgh. This paper provides an overview of the system and describes the use of agent-based technology to integrate clinical information from the Image Engine database and the MARS clinical information system at the University of Pittsburgh Medical Center. Agent-mediated links provide a mechanism for combining clinical data from multiple databases to create a unified, multimedia view of the electronic medical record. Images Figure 1 PMID:8563320

  12. Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

    PubMed Central

    De Salas-Cansado, Marina; Olivares, José M; Álvarez, Enrique; Carrasco, Jose L; Barrueta, Andoni; Rejas, Javier

    2012-01-01

    dominant 149,430) per quality-adjusted life years gained for health care costs and €25,454 (dominant 124,562) when drug costs were considered alone. Eighty-six percent of resamples fell below the threshold of €30,000 per quality-adjusted life years. Conclusion This evaluation suggests that pregabalin may be cost-effective in comparison with SSRIs/SNRIs in benzodiazepine-refractory outpatients with GAD treated in mental health care settings under usual medical practice in Spain. PMID:22745564

  13. Effects of shared medical appointments on quality of life and cost-effectiveness for patients with a chronic neuromuscular disease. Study protocol of a randomized controlled trial

    PubMed Central

    2011-01-01

    Background Shared medical appointments are a series of one-to-one doctor-patient contacts, in presence of a group of 6-10 fellow patients. This group visits substitute the annual control visits of patients with the neurologist. The same items attended to in a one-to- one appointment are addressed. The possible advantages of a shared medical appointment could be an added value to the present management of neuromuscular patients. The currently problem-focused one-to-one out-patient visits often leave little time for the patient's psychosocial needs, patient education, and patient empowerment. Methods/design A randomized, prospective controlled study (RCT) with a follow up of 6 months will be conducted to evaluate the clinical and cost-effectiveness of shared medical appointments compared to usual care for 300 neuromuscular patients and their partners at the Radboud University Nijmegen Medical Center. Every included patient will be randomly allocated to one of the two study arms. This study has been reviewed and approved by the medical ethics committee of the region Arnhem-Nijmegen, the Netherlands. The primary outcome measure is quality of life as measured by the EQ-5D, SF-36 and the Individualized neuromuscular Quality of Life Questionnaire. The primary analysis will be an intention-to-treat analysis on the area under the curve of the quality of life scores. A linear mixed model will be used with random factor group and fixed factors treatment, baseline score and type of neuromuscular disease. For the economic evaluation an incremental cost-effectiveness analysis will be conducted from a societal perspective, relating differences in costs to difference in health outcome. Results are expected in 2012. Discussion This study will be the first randomized controlled trial which evaluates the effect of shared medical appointments versus usual care for neuromuscular patients. This will enable to determine if there is additional value of shared medical appointments to the

  14. Conduct a Cost Effectiveness Study of Postgraduate Medical Education Programs. Part I, Part II (Appendixes). Final Report.

    ERIC Educational Resources Information Center

    Manning, Phillip R.; And Others

    To gather data on the effects of different modes of instruction on physician achievement in plotting mean P, O, RS, and T receptiors in electrocardiography, researchers chose a random sample of physicians who had taken a correspondence course on electrocardiography during the previous 5 years from the University of Southern California School of…

  15. Type A Behavior and Achievement of Freshman Medical Students.

    ERIC Educational Resources Information Center

    Wolf, Thomas M.; Kissling, Grace E.

    1983-01-01

    Type A behavior of freshmen medical students was assessed at the beginning and at the end of the school year. Type A behavior was also examined in relation to measures of academic achievement. It was hypothesized that Type A behavior would increase over the course of the first year. (MLW)

  16. The Octopus Study: rationale and design of two randomized trials on medical effectiveness, safety, and cost-effectiveness of bypass surgery on the beating heart.

    PubMed

    van Dijk, D; Nierich, A P; Eefting, F D; Buskens, E; Nathoe, H M; Jansen, E W; Borst, C; Knape, J T; Bredée, J J; Robles de Medina, E O; Grobbee, D E; Diephuis, J C; de Jaegere, P P

    2000-12-01

    The Octopus Study consists of two multicenter randomized clinical trials in which coronary artery bypass grafting on the beating heart (off-pump CABG) using the Utrecht Octopus Method is compared to intracoronary stent implantation and conventional CABG. The primary endpoint in the comparison of off-pump CABG versus stent implantation (OctoStent Trial) is medical effectiveness (i.e., absence of reintervention and major adverse cardiac and cerebrovascular events at 1 year after treatment). The primary endpoint in the comparison of off-pump CABG versus conventional CABG (OctoPump Trial) is cerebral safety (i.e., absence of cognitive deficits and cerebrovascular events at 3 months after treatment). Secondary endpoints in both trials include presence and severity of angina, quality of life, exercise capacity, and cost-effectiveness. A total of 560 patients will be enrolled. A random sample of 210 patients will undergo repeat angiography at 1 year to assess angiographic restenosis rate and graft patency. Including 1-year follow-up, the study will last for 3 years. Control Clin Trials 2000;21:595-609 PMID:11146152

  17. Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis

    PubMed Central

    Haacker, Markus; Gorgens, Marelize

    2016-01-01

    Background Empirical studies and population-level policy simulations show the importance of voluntary medical male circumcision (VMMC) in generalized epidemics. This paper complements available scenario-based studies (projecting costs and outcomes over some policy period, typically spanning decades) by adopting an incremental approach—analyzing the expected consequences of circumcising one male individual with specific characteristics in a specific year. This approach yields more precise estimates of VMMC’s cost-effectiveness and identifies the outcomes of current investments in VMMC (e.g., within a fiscal budget period) rather than of investments spread over the entire policy period. Methods/Findings The model has three components. We adapted the ASSA2008 model, a demographic and epidemiological model of the HIV epidemic in South Africa, to analyze the impact of one VMMC on HIV incidence over time and across the population. A costing module tracked the costs of VMMC and the resulting financial savings owing to reduced HIV incidence over time. Then, we used several financial indicators to assess the cost-effectiveness of and financial return on investments in VMMC. One circumcision of a young man up to age 20 prevents on average over 0.2 HIV infections, but this effect declines steeply with age, e.g., to 0.08 by age 30. Net financial savings from one VMMC at age 20 are estimated at US$617 at a discount rate of 5% and are lower for circumcisions both at younger ages (because the savings occur later and are discounted more) and at older ages (because male circumcision becomes less effective). Investments in male circumcision carry a financial rate of return of up to 14.5% (for circumcisions at age 20). The cost of a male circumcision is refinanced fastest, after 13 y, for circumcisions at ages 20 to 25. Principal limitations of the analysis arise from the long time (decades) over which the effects of VMMC unfold—the results are therefore sensitive to the

  18. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

    PubMed

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-05-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

  19. Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs

    PubMed Central

    Sgaier, Sema K.; Reed, Jason B.; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-01-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009–2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up.” The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

  20. Constructing a Measure for Longitudinal Medical Achievement Studies by the Rasch Model One-Step Equating.

    ERIC Educational Resources Information Center

    Shen, Linjun

    As part of a longitudinal study of the growth of general medical knowledge among osteopathic medical students, a simple, convenient, and accurate vertical equating method was developed for constructing a scale for medical achievement. It was believed that Parts 1, 2, and 3 of the National Board of Osteopathic Medical Examiners' (NBOME) examination…

  1. Cost Effective Prototyping

    NASA Technical Reports Server (NTRS)

    Wickman, Jerry L.; Kundu, Nikhil K.

    1996-01-01

    This laboratory exercise seeks to develop a cost effective prototype development. The exercise has the potential of linking part design, CAD, mold development, quality control, metrology, mold flow, materials testing, fixture design, automation, limited parts production and other issues as related to plastics manufacturing.

  2. e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison

    PubMed Central

    2015-01-01

    Background The economic cost of depression is becoming an ever more important determinant for health policy and decision makers. Internet-based interventions with and without therapist support have been found to be effective options for the treatment of mild to moderate depression. With increasing demands on health resources and shortages of mental health care professionals, the integration of cost-effective treatment options such as Internet-based programs into primary health care could increase efficiency in terms of resource use and costs. Objective Our aim was to evaluate the cost-effectiveness of an Internet-based intervention (myCompass) for the treatment of mild-to-moderate depression compared to treatment as usual and cognitive behavior therapy in a stepped care model. Methods A decision model was constructed using a cost utility framework to show both costs and health outcomes. In accordance with current treatment guidelines, a stepped care model included myCompass as the first low-intervention step in care for a proportion of the model cohort, with participants beginning from a low-intensity intervention to increasing levels of treatment. Model parameters were based on data from the recent randomized controlled trial of myCompass, which showed that the intervention reduced symptoms of depression, anxiety, and stress and improved work and social functioning for people with symptoms in the mild-to-moderate range. Results The average net monetary benefit (NMB) was calculated, identifying myCompass as the strategy with the highest net benefit. The mean incremental NMB per individual for the myCompass group was AUD 1165.88 compared to treatment as usual and AUD 522.58 for the cognitive behavioral therapy model. Conclusions Internet-based interventions can provide cost-effective access to treatment when provided as part of a stepped care model. Widespread dissemination of Internet-based programs can potentially reduce demands on primary and tertiary services

  3. Effects of lecture information density on medical student achievement.

    PubMed

    Russell, I J; Hendricson, W D; Herbert, R J

    1984-11-01

    With the virtual explosion of biomedical information, the medical educator regularly faces a quandary regarding how much to include in the medical curriculum. Opinions differ regarding how much of the available information on a particular topic should be presented in a medical school lecture. To understand better the effect of lecture information density on learning by medical students, one of the authors gave a basic clinical lecture only or clinical lectures with varying amounts of semirelated information. Tests which measured only retention of the basic material were given before lecture attendance, immediately after the lecture, and 15 days later. The results indicated that increasing the information density of a lecture reduced retention of the basic information. The memory loss apparently was due to information presented late in the lecture displacing facts learned by the students earlier in the same hour. The data suggest that lectures to medical students are more effective aids to learning when the information density is limited to a few main points that are "essential to know." PMID:6492106

  4. Assessment in Medical Education; What Are We Trying to Achieve?

    ERIC Educational Resources Information Center

    Ferris, Helena; O'Flynn, Dermot

    2015-01-01

    Within the arena of medical education, it is generally acknowledged that assessment drives learning. Assessment is one of the most significant influences on a student's experience of higher education and improving assessment has a huge impact on the quality of learning (Liu, N. and Carless, D, 2006). Ideally we want to enhance student's capacity…

  5. Relationships among the MCAT Reading Subtest, Nelson-Denny Reading Test, and Medical School Achievement.

    ERIC Educational Resources Information Center

    Jackson, James R.; Brooks, C. Michael

    1985-01-01

    The relationship between reading scores on the Medical College Admission Test (MCAT) and scores on the Nelson-Denny Reading Test (NDRT) was investigated, along with the tests' predictive validities for medical school achievement. Although NDRT was better as a single predictor of achievement, it has limitations as a predictive device. (SW)

  6. Ion propulsion cost effectivity

    NASA Technical Reports Server (NTRS)

    Zafran, S.; Biess, J. J.

    1978-01-01

    Ion propulsion modules employing 8-cm thrusters and 30-cm thrusters were studied for Multimission Modular Spacecraft (MMS) applications. Recurring and nonrecurring cost elements were generated for these modules. As a result, ion propulsion cost drivers were identified to be Shuttle charges, solar array, power processing, and thruster costs. Cost effective design approaches included short length module configurations, array power sharing, operation at reduced thruster input power, simplified power processing units, and power processor output switching. The MMS mission model employed indicated that nonrecurring costs have to be shared with other programs unless the mission model grows. Extended performance missions exhibited the greatest benefits when compared with monopropellant hydrazine propulsion.

  7. Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis

    PubMed Central

    Ciaranello, Andrea L.; Myer, Landon; Kelly, Kathleen; Christensen, Sarah; Daskilewicz, Kristen; Doherty, Katie; Bekker, Linda-Gail; Hou, Taige; Wood, Robin; Francke, Jordan A.; Wools-Kaloustian, Kara; Freedberg, Kenneth A.; Walensky, Rochelle P.

    2015-01-01

    Background Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. Methods We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO “Option A”): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). Results In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. Conclusions In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection. PMID:25756498

  8. Severe symptomatic aortic stenosis: medical therapy and transcatheter aortic valve implantation (TAVI)—a real-world retrospective cohort analysis of outcomes and cost-effectiveness using national data

    PubMed Central

    Aldalati, Omar; Lacey, Arron; King, William; Anderson, Richard A; Smith, Dave

    2016-01-01

    Objectives Determine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability of transcatheter aortic valve implantation (TAVI) following formal surgical outpatient assessment, and patients managed with a TAVI implant. Design Retrospective cohort study from real-world data. Setting Electronic patient letters were searched for patients with a diagnosis of severe aortic stenosis and a formal outpatient STD prior to the availability of TAVI (1999–2009). The second group comprised the first 90 cases of TAVI in South Wales (2009 onwards). 2 years prior to and 5 years following TAVI/STD were assessed. Patient data were pseudoanonymised, using the Secure Anonymized Information Linkage (SAIL) databank, and extracted from Office National Statistics (ONS), Patient-Episode Database for Wales (PEDW) and general practitioner databases. Population 90 patients who had undergone TAVI in South Wales, and 65 STD patients who were medically managed. Main outcome measures Survival, hospital admission frequency and length of stay, primary care visits, and cost-effectiveness. Results TAVI patients were significantly older (81.8 vs 79.2), more likely to be male (59.1% vs 49.3%), baseline comorbidities were balanced. Mortality in TAVI versus STD was 28% vs 70% at 1000 days follow-up. There were significantly more hospital admissions per year in the TAVI group prior to TAVI/STD (1.5 (IQR 1.0–2.4) vs 1.0 IQR (0.5–1.5)). Post TAVI/STD, the TAVI group had significantly lower hospital admissions (0.3 (IQR 0.0–1.0) vs 1.2 (IQR 0.7–3.0)) and lengths of stay (0.4 (IQR 0.0–13.8) vs 11.0 (IQR 2.5–28.5), p<0.05). The incremental cost-effectiveness ratio (ICER) for TAVI was £10 533 per quality-adjusted life year (QALY). Conclusions TAVI patients were more likely to survive and avoid hospital admissions compared with the medically

  9. The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: systematic review, stakeholder focus groups and feasibility randomised controlled trial.

    PubMed Central

    Bhattacharya, Debi; Aldus, Clare F; Barton, Garry; Bond, Christine M; Boonyaprapa, Sathon; Charles, Ian S; Fleetcroft, Robert; Holland, Richard; Jerosch-Herold, Christina; Salter, Charlotte; Shepstone, Lee; Walton, Christine; Watson, Steve; Wright, David J

    2016-01-01

    BACKGROUND Medication organisation devices (MODs) provide compartments for a patient's medication to be organised into the days of the week and the recommended times the medication should be taken. AIM To define the optimal trial design for testing the clinical effectiveness and cost-effectiveness of MODs. DESIGN The feasibility study comprised a systematic review and focus groups to inform a randomised controlled trial (RCT) design. The resulting features were tested on a small scale, using a 2 × 2 factorial design to compare MODs with usual packaging and to compare weekly with monthly supply. The study design was then evaluated. SETTING Potential participants were identified by medical practices. PARTICIPANTS Aged over 75 years, prescribed at least three solid oral dosage form medications, unintentionally non-adherent and self-medicating. Participants were excluded if deemed by their health-care team to be unsuitable. INTERVENTIONS One of three MODs widely used in routine clinical practice supplied either weekly or monthly. OBJECTIVES To identify the most effective method of participant recruitment, to estimate the prevalence of intentional and unintentional non-adherence in an older population, to provide a point estimate of the effect size of MODs relative to usual care and to determine the feasibility and acceptability of trial participation. METHODS The systematic review included MOD studies of any design reporting medication adherence, health and social outcomes, resource utilisation or dispensing or administration errors. Focus groups with patients, carers and health-care professionals supplemented the systematic review to inform the RCT design. The resulting design was implemented and then evaluated through questionnaires and group discussions with participants and health-care professionals involved in trial delivery. RESULTS Studies on MODs are largely of poor quality. The relationship between adherence and health outcomes is unclear. Of the limited

  10. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia.

    PubMed

    Lindenmayer, David B; Wood, Jeff; MacGregor, Christopher; Buckley, Yvonne M; Dexter, Nicholas; Fortescue, Martin; Hobbs, Richard J; Catford, Jane A

    2015-01-01

    Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray) proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession) were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management objectives at

  11. A Long-Term Experimental Case Study of the Ecological Effectiveness and Cost Effectiveness of Invasive Plant Management in Achieving Conservation Goals: Bitou Bush Control in Booderee National Park in Eastern Australia

    PubMed Central

    Lindenmayer, David B.; Wood, Jeff; MacGregor, Christopher; Buckley, Yvonne M.; Dexter, Nicholas; Fortescue, Martin; Hobbs, Richard J.; Catford, Jane A.

    2015-01-01

    Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray) proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession) were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management objectives at

  12. The Influence of Achievement before, during and after Medical School on Physician Job Satisfaction

    ERIC Educational Resources Information Center

    Schmit Jongbloed, Lodewijk J.; Schönrock-Adema, Johanna; Borleffs, Jan C. C.; Stewart, Roy E.; Cohen-Schotanus, Janke

    2014-01-01

    In this longitudinal study, we investigated the relationship between physicians' prior achievements (before, during and after medical school) and job satisfaction, and tested the two lines of reasoning that prior achievements influence job satisfaction positively or negatively, respectively. The participants were graduates who started their…

  13. Graduate Medical Education: Its Role in Achieving a True Medical Education Continuum.

    PubMed

    Aschenbrener, Carol A; Ast, Cori; Kirch, Darrell G

    2015-09-01

    Nearly half a century ago, Lowell T. Coggeshall recommended, through what has come to be known as the Coggeshall Report, that physician education-medical school (or undergraduate medical education [UME]), residency training (or graduate medical education [GME]), and continuing medical education (CME)-be "planned and provided as a continuum." While the dream of a true continuum remains unfulfilled, recent innovations focused on defining and assessing meaningful outcomes at last offer the anchor for the creation of a seamless, flexible, and ongoing pathway for the preparation of physicians. Recent innovations, including a widely accepted competency framework and entrustable professional activities (EPAs), provide key tools for creating a continuum. The competency framework is being leveraged in UME, GME, and CME and is serving as the foundation for the continuum. Learners and those who assess them are increasingly relying on observable behaviors (e.g., EPAs) to determine progress. The GME community in the United States and Canada has played-and continues to play-a leading role in the creation of these tools and a true medical education continuum. Despite some systemic challenges to implementation (e.g., premedical learner formation, time-in-step requirements), the GME community is already operationalizing these tools as a basis for other innovations that are improving transitions across the continuum (e.g., competency-based progression of residents). The medical education community's greatest responsibility in the years ahead will be to build on these efforts in GME-joining together to learn from one another and develop a continuum that serves the public and the profession. PMID:26177531

  14. The influence of achievement before, during and after medical school on physician job satisfaction.

    PubMed

    Schmit Jongbloed, Lodewijk J; Schönrock-Adema, Johanna; Borleffs, Jan C C; Stewart, Roy E; Cohen-Schotanus, Janke

    2014-10-01

    In this longitudinal study, we investigated the relationship between physicians' prior achievements (before, during and after medical school) and job satisfaction, and tested the two lines of reasoning that prior achievements influence job satisfaction positively or negatively, respectively. The participants were graduates who started their medical training in 1982 (n = 147), 1983 (n = 154), 1992 (n = 143) and 1993 (n = 153). We operationalised job satisfaction as satisfaction (on a 10-point scale) with 13 cognitive, affective and instrumental aspects of the participants' jobs. The measures of achievement before, during and after medical school included pre-university grade point average, study progress and a residency position in the specialty of first choice, respectively. We included the effect of curriculum type (problem-based learning versus traditional), gender and years of experience as moderator variables. Higher achievers before and during medical school were more satisfied about their income (β = .152, p < .01 and β = .149, p < .05), but less satisfied with their opportunities for personal development (β = -.159, p < .05). High achievers after medical school were more satisfied with professional accomplishments (β = .095, p < .05), with appreciation from support personnel (β = .154, p < .01) and from patients (β = .120, p < .05). Effect sizes were small. Prior achievements influenced job satisfaction. The direction of the influences depended on the job satisfaction aspect in question, which indicates that it is important to distinguish between aspects of job satisfaction. To optimize job satisfaction of high achievers, it is important for graduates to obtain their preferred specialty. Furthermore, it is vital to provide them with enough opportunities for further development. PMID:24464365

  15. Using a facilitation model to achieve patient-centered medical home recognition.

    PubMed

    Lane, Sandi J; Watkins, R W Chip

    2015-01-01

    This article describes how a facilitation model that included a partnership between a Community Care of North Carolina network and undergraduates at a regional university supported rural primary care practices in transforming their practices to become National Committee for Quality Assurance-recognized patient-centered medical homes. Health care management and preprofessional undergraduate students worked with 14 rural primary care practices to redesign practice processes and complete the patient-centered medical home application. Twelve of the practices participated in the evaluation of the student contribution. A semistructured interview guide containing questions about practice characteristics, student competencies, and the value of the student's contribution to their practice's achievement of patient-centered medical home recognition was used to interview practice managers or their designee. Analysis included item-descriptive statistics and qualitative analysis of narrative content. All 12 participating practices achieved 2011 National Committee for Quality Assurance patient-centered medical home recognition, with 4 practices achieving level 3, 5 practices achieving level 2, and 3 practices achieving level 1. The facilitation model using partnerships between health care agencies and universities might be an option for enhancing a practice's internal capacity for successful transformation and should be explored further. PMID:25909396

  16. Cost and Cost-Effectiveness of the COMBINE Study for Alcohol-Dependent Patients

    PubMed Central

    Zarkin, Gary A.; Bray, Jeremy W.; Aldridge, Arnie; Mitra, Debanjali; Couper, David J.; Cisler, Ron A.

    2011-01-01

    Context The COMBINE clinical trial recently evaluated the efficacy of medications, behavioral therapies, and their combinations for the outpatient treatment of alcohol dependence. The costs and cost-effectiveness of these combinations are unknown and of interest to clinicians and policy makers. Objective To evaluate the costs and cost-effectiveness of the COMBINE interventions at the end of 16 weeks of treatment. Design, Setting, and Participants A prospective cost and cost-effectiveness study of patients in COMBINE, a randomized controlled clinical trial (RCT) involving 1383 patients with diagnoses of primary alcohol dependence across 11 US clinical sites. Interventions Nine treatment arms, with 4 arms receiving medical management with 16 weeks of naltrexone (100 mg/d) or acamprosate (3 g/d), both, and/or placebo; 4 arms receiving the same options as above but delivered with combined behavioral intervention (CBI); and 1 arm receiving CBI only. Main Outcomes Measures Incremental cost per percentage point increase in percent days abstinent (PDA), incremental cost per patient of avoiding heavy drinking, and incremental cost per patient of achieving a good clinical outcome. Results Based on the mean values of cost and effectiveness, 3 interventions are cost-effective options relative to the other interventions for all three outcomes: medical management (MM) with placebo ($409 cost per patient), MM + naltrexone ($671 cost per patient), and MM + naltrexone + acamprosate ($1003 cost per patient). Conclusions This is only the second prospective RCT-designed cost-effectiveness study that has been performed for the treatment of alcohol dependence. Focusing just on effectiveness, MM + naltrexone + acamprosate is not significantly better than MM + naltrexone. However, looking at cost and effectiveness, MM + naltrexone + acamprosate may be a cost-effective choice, depending on whether the cost of the incremental increase in effectiveness is worth it to the decision maker. PMID

  17. Graduate-Entry Medical Student Variables that Predict Academic and Clinical Achievement

    ERIC Educational Resources Information Center

    Blackman, Ian; Darmawan, I Gusti Ngurah

    2004-01-01

    A hypothetical model was formulated to explore factors that influenced academic and clinical achievement for graduate-entry medical students completing their third year of university studies. Nine latent variables were considered including the students' background, previous successes with their undergraduate and postgraduate studies and their…

  18. Psychological Type and Undergraduate Student Achievement in Pharmacy Course in Military Medical University

    ERIC Educational Resources Information Center

    Shi, Ru; Shan, Shou-qin; Tian, Jian-quan

    2007-01-01

    The Myers-Briggs Type Indicator (MBTI) was given to 264 students in an undergraduate Pharmacy course at a military medical university. Selected MBTI personality types were compared for achievement in the course using a t-test to compare total points earned. High grades were earned by students stronger in the traits of introversion (I) and judgment…

  19. Learning styles and academic achievement among undergraduate medical students in Thailand

    PubMed Central

    Jiraporncharoen, Wichuda; Angkurawaranon, Chaisiri; Chockjamsai, Manoch; Deesomchok, Athavudh; Euathrongchit, Juntima

    2015-01-01

    Purpose: This study aimed to explore the associations between learning styles and high academic achievement and to ascertain whether the factors associated with high academic achievement differed between preclinical and clinical students. Methods: A survey was conducted among undergraduate medical students in Chiang Mai University, Thailand. The Index of Learning Styles questionnaire was used to assess each student’s learning style across four domains. High academic achievement was defined as a grade point average of at least 3.0. Results: Of the 1,248 eligible medical students, 1,014 (81.3%) participated. Learning styles differed between the preclinical and clinical students in the active/reflective domain. A sequential learning style was associated with high academic achievement in both preclinical and clinical students. A reflective learning style was only associated with high academic achievement among preclinical students. Conclusion: The association between learning styles and academic achievement may have differed between preclinical and clinical students due to different learning content and teaching methods. Students should be encouraged to be flexible in their own learning styles in order to engage successfully with various and changing teaching methods across the curriculum. Instructors should be also encouraged to provide a variety of teaching materials and resources to suit different learning styles. PMID:26165948

  20. Methods of cost-effectiveness analysis in the evaluation of new antipsychotics: implications for schizophrenia treatment.

    PubMed

    Neumann, P J

    1999-01-01

    Because health care payers are increasingly interested in learning whether new treatments offer value for money, there has been an abundance of research into the cost-effectiveness of pharmacologic therapies in the United States. In the past few years, a number of studies comparing the cost-effectiveness of the conventional neuroleptics with that of the atypical antipsychotics have been published. Cost-effectiveness analyses show the relationship between the resources used (costs) and the health benefits achieved (effects) for a health or medical intervention compared with an alternative strategy. Ideally, the analyses can help decision makers improve the health of the population by better allocating society's limited health care resources. However, the extent to which cost-effectiveness data are actually used in decision making is unclear. The analyses are sometimes viewed with skepticism, in part because studies differ in their methodological approaches. Recently, the U.S. Panel on Cost-Effectiveness in Health and Medicine offered recommendations for standard methodological practices, which may help improve the quality of studies and the acceptability of the approach in the future. The issue is particularly important in light of new legislation governing how the Food and Drug Administration will regulate promotional claims made by drug companies regarding health economic information. PMID:10073371

  1. Achieving the Desired Transformation: Thoughts on Next Steps for Outcomes-Based Medical Education.

    PubMed

    Holmboe, Eric S; Batalden, Paul

    2015-09-01

    Since the introduction of the outcomes-based medical education (OBME) movement, progress toward implementation has been active but challenging. Much of the angst and criticism has been directed at the approaches to assessment that are associated with outcomes-based or competency frameworks, particularly defining the outcomes. In addition, these changes to graduate medical education (GME) are concomitant with major change in health care systems--specifically, changes to increase quality and safety while reducing cost. Every sector, from medical education to health care delivery and financing, is in the midst of substantial change and disruption.The recent release of the Institute of Medicine's report on the financing and governance of GME highlights the urgent need to accelerate the transformation of medical education. One source of continued tension within the medical education community arises from the assumption that the much-needed increases in value and improvement in health care can be achieved by holding the current educational structures and architecture of learning in place while concomitantly withdrawing resources. The authors of this Perspective seek to reframe the important and necessary debate surrounding the current challenges to implementing OBME. Building on recent change and service theories (e.g., Theory U and coproduction), they propose several areas of redirection, including reexamination of curricular models and greater involvement of learners, teachers, and regulators in cocreating new training models, to help facilitate the desired transformation in medical education. PMID:26083400

  2. The Social Value Of Vaccination Programs: Beyond Cost-Effectiveness.

    PubMed

    Luyten, Jeroen; Beutels, Philippe

    2016-02-01

    In the current global environment of increased strain on health care budgets, all medical interventions have to compete for funding. Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines. In this article we also argue that socioethical contributions such as effects on health equity, sustaining the public good of herd immunity, and social integration of minority groups are neglected in cost-effectiveness analysis. Evaluations of vaccination programs require broad and multidimensional perspectives that can account for their social, ethical, and economic impact as well as their cost-effectiveness. PMID:26858372

  3. Cost-effectiveness analysis and innovation.

    PubMed

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency. PMID:18619695

  4. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    PubMed Central

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1]) through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  5. Cost-Effectiveness of a Community-Integrated Home Based Depression Intervention in Older African Americans

    PubMed Central

    Pizzi, Laura T.; Jutkowitz, Eric; Frick, Kevin D.; Suh, Dong-Churl; Prioli, Katherine M.; Gitlin, Laura N.

    2014-01-01

    Objectives To test the cost-effectiveness of a home-based depression program, Beat the Blues (BTB). Design We conducted a cost-effectiveness analysis as part of a previously reported randomized controlled trial that tested BTB versus a wait-list control group. Setting Community-dwelling older African American adults. Participants African Americans who were ≥55 years of age, English speaking, cognitively intact (MMSE ≥24), and had depressive symptoms (PHQ-9 score ≥5) (N=129). Intervention Participants randomly assigned to BTB received up to 10 home visits over a period of 4 months by licensed social workers who provided care management, referral/linkage, stress reduction, depression education, and behavioral activation to help participants achieve self-identified goals. Measurements Incremental cost effectiveness ratios (ICERs) of BTB versus wait-list controls during the 4-month study period. The primary ICER was defined as cost/quality-adjusted life year using the EQ-5D and secondarily using the HUI-3. Additional ICERs were calculated using clinical measures (cost per depression improvement, cost per depression remission). Costs included BTB intervention, depression-related healthcare visits and medications, caregiver time, and social services. Results BTB cost per participant per month was $146. Base case ICERs were $64,896 per QALY (EQ-5D) and $36,875 per QALY (HUI-3). Incremental cost per depression improvement was $2,906 and per remission was $3,507. Univariate and probabilistic sensitivity analyses yielded cost/QALY range of $20,500-$76,500. Conclusion Based on the range of cost effectiveness values resulting from this study, BTB is a cost-effective treatment for managing depressive symptoms in older African Americans that compares favorably with the cost effectiveness of previously tested approaches. PMID:25516025

  6. Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden

    PubMed Central

    Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke

    2014-01-01

    contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208

  7. Cost Effectiveness Ratio: Evaluation Tool for Comparing the Effectiveness of Similar Extension Programs

    ERIC Educational Resources Information Center

    Jayaratne, K. S. U.

    2015-01-01

    Extension educators have been challenged to be cost effective in their educational programming. The cost effectiveness ratio is a versatile evaluation indicator for Extension educators to compare the cost of achieving a unit of outcomes or educating a client in similar educational programs. This article describes the cost effectiveness ratio and…

  8. Cost effectiveness of sonic drilling

    SciTech Connect

    Masten, D.; Booth, S.R.

    1996-03-01

    Sonic drilling (combination of mechanical vibrations and rotary power) is an innovative environmental technology being developed in cooperation with DOE`s Arid-Site Volatile Organic Compounds Integrated Demonstration at Hanford and the Mixed Waste Landfill Integrated Demonstration at Sandia. This report studies the cost effectiveness of sonic drilling compared with cable-tool and mud rotary drilling. Benefit of sonic drilling is its ability to drill in all types of formations without introducing a circulating medium, thus producing little secondary waste at hazardous sites. Progress has been made in addressing the early problems of failures and downtime.

  9. The Cost-Effectiveness of Raising Teacher Quality

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2009-01-01

    Econometric studies suggest that student achievement may be improved if high-performing teachers are substituted for low-performing teachers. Drawing upon a recent study linking teacher performance on licensure exams with gains in student achievement, an analysis was conducted to determine the cost-effectiveness of requiring teacher applicants to…

  10. College Students with and without ADHD: Comparison of Self-Report of Medication Usage, Study Habits, and Academic Achievement

    ERIC Educational Resources Information Center

    Advokat, Claire; Lane, Sean M.; Luo, Chunqiao

    2011-01-01

    Objective: To examine the relationship between ADHD medications, study habits, and academic achievement of ADHD-diagnosed undergraduates. Method: A total of 92 students with a self-reported ADHD diagnosis and a current prescription for ADHD medication were compared with 143 control students in a survey of academic performance. Results: Most ADHD…

  11. The relationship between medical students’ epistemological beliefs and achievement on a clinical performance examination

    PubMed Central

    Oh, Sun-A; Chung, Eun-Kyung; Han, Eui-Ryoung; Woo, Young-Jong; Kevin, Deiter

    2016-01-01

    Purpose: This study was to explore the relationship between clinical performance examination (CPX) achievement and epistemological beliefs to investigate the potentials of epistemological beliefs in ill-structured medical problem solving tasks. Methods: We administered the epistemological beliefs questionnaire (EBQ) to fourth-year medical students and correlated the results with their CPX scores. The EBQ comprised 61 items reflecting five belief systems: certainty of knowledge, source of knowledge, rigidity of learning, ability to learn, and speed of knowledge acquisition. The CPX included scores for history taking, physical examination, and patient-physician interaction. Results: The higher epistemological beliefs group obtained significantly higher scores on the CPX with regard to history taking and patient-physician interaction. The epistemological beliefs scores on certainty of knowledge and source of knowledge were significantly positively correlated with patient-physician interaction. The epistemological beliefs scores for ability to learn were significantly positively correlated with those for history taking, physical examination, and patient-physician interaction. Conclusion: Students with more sophisticated and advanced epistemological beliefs stances used more comprehensive and varied approaches in the patient-physician interaction. Therefore, educational efforts that encourage discussions pertaining to epistemological views should be considered to improve clinical reasoning and problem-solving competence in the clinic setting. PMID:26838566

  12. Cost-effectiveness of adherence-enhancing interventions: a systematic review.

    PubMed

    Simon-Tuval, Tzahit; Neumann, Peter J; Greenberg, Dan

    2016-01-01

    Low patient adherence to health-related interventions is a major barrier to achieving healthcare goals and is associated with very high avoidable costs. Although several studies suggest that adherence-enhancing interventions can improve health outcomes, economic evaluations of these interventions are scarce. Systematic reviews published to date are limited to interventions to enhance adherence to pharmaceuticals or to specific diseases and interventions. The authors' objective was to examine the evidence regarding the cost-effectiveness of adherence-enhancing interventions in healthcare and what conclusion could be drawn about these interventions. The present systematic review included 43 original studies and assessed the current evidence regarding the cost-effectiveness of a broad array of interventions aimed at enhancing adherence to medications, medical devices, screening tests and lifestyle behaviors. The authors found that although the majority of adherence-enhancing interventions were cost-effective or cost-saving, variation exists within different intervention types. Further research on the sustainability of adherence improvements is needed in order to accurately evaluate interventions' long-term benefits. PMID:26732615

  13. Cost-effective osteopathic manipulative medicine: a literature review of cost-effectiveness analyses for osteopathic manipulative treatment.

    PubMed

    Gamber, Russell; Holland, Shane; Russo, David P; Cruser, des Anges; Hilsenrath, Peter E

    2005-08-01

    Despite the value that osteopathic manipulative medicine (OMM) may offer to healthcare consumers in a managed care, evidence-based healthcare system, very little research has been published on the cost-effectiveness of osteopathic manipulative treatment compared with other treatment modalities. The authors searched MEDLINE and OSTMED for English-language articles published between January 1966 and June 2002 using the key terms cost-effectiveness, osteopathic medicine, workers' compensation, hospital length of stay, healthcare providers, and manipulative medicine. The authors then extended their search by reviewing the reference lists provided in the articles initially identified as relevant by these databases. The purpose, methods, findings, and conclusions of each study were evaluated for how the cost-effectiveness of OMM was analyzed. The authors conclude that the osteopathic medical profession needs to conduct and publish research that is consistent with current practices in the conventional medical literature. PMID:16166390

  14. Distributional Cost-Effectiveness Analysis

    PubMed Central

    Asaria, Miqdad; Griffin, Susan; Cookson, Richard

    2015-01-01

    Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial, we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). The 2 key stages in DCEA are 1) modeling social distributions of health associated with different interventions, and 2) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgments that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modeling assumptions and social value judgments. PMID:25908564

  15. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    NASA Astrophysics Data System (ADS)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  16. Cost-effective treatment for the couple with infertility.

    PubMed

    Van Voorhis, B J; Syrop, C H

    2000-12-01

    Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated. PMID:11100309

  17. Cost-effectiveness analysis of sandhill crane habitat management

    USGS Publications Warehouse

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  18. Achievement motivation level in students of Shiraz University of Medical Sciences and its influential factors

    PubMed Central

    KAVOUSIPOUR, SOMAYEH; NOORAFSHAN, ALI; POURAHMAD, SAEEDEH; DEHGHANI-NAZHVANI, ALI

    2015-01-01

    Introduction: Many studies have investigated the relationship between motivation and educational outcomes. The present study was conducted to determine whether the students’ motivation in Shiraz University of Medical Sciences (SUMS) decreases during educational years. Methods: 770 students in SUMS were selected by multi-stage stratified random sampling from each field and entrance year. The first questionnaire contained 57 questions on the effect of economic, social, educational, geographical and personality factors on the students’ motivation. The second one was based on 50 incomplete sentences. The validity and reliability of these questionnaires were approved by the experts and Cronbach's Alpha coefficients (85% and 90%, respectively). In this cross-sectional study, ANOVA, t-test and Chi-square tests were applied for data analysis at the 0.05 significance level. Results: Six factors with the most effect on academic motivation were "family attitudes", "getting good jobs in future", "respect for themselves", " the ability to learn", "believing their role in victory and defeat" and "the tendency toward optimism about themselves". In addition, comparing professional doctorate and basic sciences’ results revealed no significant relationship between academic motivation and educational years (F=0.819, p=0.397). But comparing field by field showed that Dentistry and Hospital Management and Medical Information (HMMI) had a significant decrease in motivation score by increase in educational years (F=3.991, p=0.015). Conclusion: Achievement motivation level in SUMS students was higher than average and did not decrease during educational years. Also, the results showed that personal, social and educational related factors affected motivation level more than economic and environmental factors. PMID:25587552

  19. Hypertension education and adherence in South Africa: a cost-effectiveness analysis of community health workers

    PubMed Central

    2014-01-01

    Background To determine whether training community health workers (CHWs) about hypertension in order to improve adherence to medications is a cost-effective intervention among community members in South Africa. Methods We used an established Markov model with age-varying probabilities of cardiovascular disease (CVD) events to assess the benefits and costs of using CHW home visits to increase hypertension adherence for individuals with hypertension and aged 25–74 in South Africa. Subjects considered for CHW intervention were those with a previous diagnosis of hypertension and on medications but who had not achieved control of their blood pressure. We report our results in incremental cost-effectiveness ratios (ICERs) in US dollars per disability-adjusted life-year (DALY) averted. Results The annual cost of the CHW intervention is about $8 per patient. This would lead to over a 2% reduction in CVD events over a life-time and decrease DALY burden. Due to reductions in non-fatal CVD events, lifetime costs are only $6.56 per patient. The CHW intervention leads to an incremental cost-effectiveness ratio of $320/DALY averted. At an annual cost of $6.50 or if the blood pressure reduction is 5 mmHg or greater per patient the intervention is cost-saving. Conclusions Additional training for CHWs on hypertension management could be a cost-effective strategy for CVD in South Africa and a very good purchase according to World Health Organization (WHO) standards. The intervention could also lead to reduced visits at the health centres freeing up more time for new patients or reducing the burden of an overworked staff at many facilities. PMID:24606986

  20. Cost-effective conservation of an endangered frog under uncertainty.

    PubMed

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

  1. Implementation of the principle of as low as reasonably achievable (ALARA) for medical and dental personnel

    SciTech Connect

    Not Available

    1990-12-31

    This report is part of a series prepared under the auspices of Scientific Committee 46, Operational Radiation Safety. It provides guidance on the process of implementing the as low as reasonably achievable'' (ALARA) principle for the use of radiation by medical and dental personnel. The use of cost-benefit analysis is recommended as a basic method upon which to base ALARA decisions. Examples are provided to illustrate the ALARA principle as a process of optimization and to provide a starting point for the development of individualized ALARA programs. NCRP Report No. 91, Recommendations on Limits for Exposure to Ionizing Radiation, calls for the use of reference ranges for occupational exposures. This report recommends the use of 2 reference ranges, one based on individual dose equivalents, and the other based on collective dose equivalent. In accordance with the recommendations of NCRP Report No. 82, SI Units in Radiation Protection and Measurements, as of January 1990, only SI units are used in the text. Readers needing factors for conversion of SI to conventional units are encouraged to consult Report No. 82. 84 refs., 10 figs., 10 tabs.

  2. Screening strategies for active tuberculosis: focus on cost-effectiveness

    PubMed Central

    Dobler, Claudia Caroline

    2016-01-01

    In recent years, there has been renewed interest in screening for active tuberculosis (TB), also called active case-finding (ACF), as a possible means to achieve control of the global TB epidemic. ACF aims to increase the detection of TB, in order to diagnose and treat patients with TB earlier than if they had been diagnosed and treated only at the time when they sought health care because of symptoms. This will reduce or avoid secondary transmission of TB to other people, with the long-term goal of reducing the incidence of TB. Here, the history of screening for active TB, current screening practices, and the role of TB-diagnostic tools are summarized and the literature on cost-effectiveness of screening for active TB reviewed. Cost-effectiveness analyses indicate that community-wide ACF can be cost-effective in settings with a high incidence of TB. ACF among close TB contacts is cost-effective in settings with a low as well as a high incidence of TB. The evidence for cost-effectiveness of screening among HIV-infected persons is not as strong as for TB contacts, but the reviewed studies suggest that the intervention can be cost-effective depending on the background prevalence of TB and test volume. None of the cost-effectiveness analyses were informed by data from randomized controlled trials. As the results of randomized controlled trials evaluating different ACF strategies will become available in future, we will hopefully gain a better understanding of the role that ACF can play in achieving global TB control. PMID:27418848

  3. Smoothing out Transitions: How Pedagogy Influences Medical Students' Achievement of Self-Regulated Learning Goals

    ERIC Educational Resources Information Center

    White, Casey B.

    2007-01-01

    Medical school is an academic and developmental path toward a professional life demanding self-regulation and self-education. Thus, many medical schools include in their goals for medical student education their graduates' ability to self-assess and self-regulate their education upon graduation and throughout their professional lives. This study…

  4. The attractions of medicine: the generic motivations of medical school applicants in relation to demography, personality and achievement

    PubMed Central

    McManus, IC; Livingston, G; Katona, Cornelius

    2006-01-01

    Background The motivational and other factors used by medical students in making their career choices for specific medical specialities have been looked at in a number of studies in the literature. There are however few studies that assess the generic factors which make medicine itself of interest to medical students and to potential medical students. This study describes a novel questionnaire that assesses the interests and attractions of different aspects of medical practice in a varied range of medical scenarios, and relates them to demographic, academic, personality and learning style measures in a large group of individuals considering applying to medical school. Methods A questionnaire study was conducted among those attending Medlink, a two-day conference for individuals considering applying to medical school for a career in medicine. The main outcome measure was the Medical Situations Questionnaire, in which individuals ranked the attraction of three different aspects of medical practise in each of nine detailed, realistic medical scenarios in a wide range of medical specialities. As well as requiring clear choices, the questionnaire was also designed so that all of the possible answers were attractive and positive, thereby helping to eliminate social demand characteristics. Factor analysis of the responses found four generic motivational dimensions, which we labelled Indispensability, Helping People, Respect and Science. Background factors assessed included sex, ethnicity, class, medical parents, GCSE academic achievement, the 'Big Five' personality factors, empathy, learning styles, and a social desirability scale. Results 2867 individuals, broadly representative of applicants to medical schools, completed the questionnaire. The four generic motivational factors correlated with a range of background factors. These correlations were explored by multiple regression, and by path analysis, using LISREL to assess direct and indirect effects upon the factors

  5. Study on personality dimension negative emotionality affecting academic achievement among Malaysian medical students studying in Malaysia and overseas

    PubMed Central

    Bhagat, Vidya; Haque, Mainul; Simbak, Nordin Bin; Jaalam, Kamarudin

    2016-01-01

    Personality dimension negative emotionality is known to be associated with academic achievement. The present study focuses on the influence of negative emotionality (neuroticism) on the medical students’ academic achievements. The main objective of this study was to ascertain the negative emotionality scores among the first year Malaysian medical students studying in Malaysia and India, further to find out the association between negative emotionality and their academic achievements. The current study sample includes 60 first year Malaysian medical students from Universiti Sultan Zainal Abidin, Malaysia, and USM-KLE IMP, Belgaum, India. They were selected by convenient sampling technique. The Medico-Psychological questionnaire was used to find out the negative emotionality scores among the students and these scores were compared with academic scores. The data were analyzed using SPSS- 20. Thus, the study result goes with the prediction that there is a significant correlation between academic achievement and negative emotionality. We concluded that negative emotionality has a negative impact on medical student’s academic achievement regardless of the fact whether they study in their own country or overseas. PMID:27354836

  6. Longitudinal analysis of the effect of academic failure tolerance on academic achievement fluctuation in medical school students

    PubMed Central

    Chae, Su Jin; Kim, Miran; Chang, Ki Hong

    2016-01-01

    Purpose: Academic failure tolerance (AFT) is one of the important psychological concepts in education, but its applications in medical education are rare. Thus, the purpose of this study was to investigate the effect of academic failure tolerance on academic achievement fluctuation among medical school students using a longitudinal research design. Methods: The subjects were 43 medical students who responded to the AFT test. This study analyzed the longitudinal data of achievement scores up to the 2nd academic year (2012–2013) among students who were divided into academic achievement improvement and decline groups. Results: Comparing the improvement and decline groups’ mean academic achievement fluctuation scores demonstrated that behavior and preferred task difficulty showed high scores whereas feeling scores were lower in the improvement group (p<0.05). Conclusion: In the improvement group, despite the higher negative feeling scores during academic failure, the students favored the more difficult subjects and were more assiduous in their studies. This will form an important basis for enhancing academic achievement among medical students. PMID:26838565

  7. The essential role of medical ethics education in achieving professionalism: the Romanell Report.

    PubMed

    Carrese, Joseph A; Malek, Janet; Watson, Katie; Lehmann, Lisa Soleymani; Green, Michael J; McCullough, Laurence B; Geller, Gail; Braddock, Clarence H; Doukas, David J

    2015-06-01

    This article-the Romanell Report-offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received particular attention in recent years because of the increasing emphasis placed on professional formation by accrediting bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Yet, despite the development of standards, milestones, and competencies related to professionalism, there is no consensus about the specific goals of medical ethics education, the essential knowledge and skills expected of learners, the best pedagogical methods and processes for implementation, and optimal strategies for assessment. Moreover, the quality, extent, and focus of medical ethics instruction vary, particularly at the graduate medical education level. Although variation in methods of instruction and assessment may be appropriate, ultimately medical ethics education must address the overarching articulated expectations of the major accrediting organizations. With the aim of aiding medical ethics educators in meeting these expectations, the Romanell Report describes current practices in ethics education and offers guidance in several areas: educational goals and objectives, teaching methods, assessment strategies, and other challenges and opportunities (including course structure and faculty development). The report concludes by proposing an agenda for future research. PMID:25881647

  8. Cost-effective ultrasound PACS solution

    NASA Astrophysics Data System (ADS)

    Honeyman-Buck, Janice C.; Frost, Meryll M.; Staab, Edward V.

    1995-05-01

    Picture archiving and communication systems (PACS) have been quite successful at the University of Florida in the areas of CT, MR, and nuclear medicine. In each case, although we have not always been able to provide the optimal level of performance, we have been able to solve a problem and the systems are used extensively. Ultrasound images are required in a number of locations and the multiformat camera print capability was no longer adequate for the growing volume in the ultrasound section. Although we were certain we could successfully implement PACS for ultrasound, new forces in health care dictate that we justify our system in terms of cost. We analyzed the feasibility of a PACS solution for ultrasound and designed a system that meets our needs and is cost effective. We evaluated the ultrasound operation in terms of image acquisition patterns and throughput requirements. An inventory of existing and PACS equipment was made to determine the feasibility of interfacing the two systems. Commercial systems were evaluated for functionality and cost and a system was designed to meet our needs. The only way to achieve our goal of installing a cost effective ultrasound PACS was to eliminate film and use the cost savings to offset the cost of new equipment and development. We designed a system that could be produced using inexpensive components and existing hardware and software to meet our needs. A commercial vendor was chosen to provide the ultrasound acquisition. The Radiology Information System interface used at the University provides the necessary data to build a DICOM header, and an existing DICOM server routes the images to the appropriate workstations, archives, and printers. Additional storage is added to an existing archive to accommodate the ultrasound images and two existing workstations are evaluated for use in ultrasound.

  9. Cost-effective applications of photovoltaics

    SciTech Connect

    Thornton, J.P.

    1996-05-01

    When photovoltaic (PV) cells were first developed at Bell Laboratories in the mid-1950s, their inventors envisioned widespread terrestrial use. However, PV cells were rapidly adopted for space applications, not only because of their reliability, but because they were generally the most cost- effective power sources for satellites in spite of their high cost. Concern over oil supply and price during the 1970s once again turned people`s thoughts toward the use of PV cells and other renewable energy technologies to help meet the nation`s energy demands. A partnership was developed between the federal government and private industry to drive the cost of PV technologies down to where they could compete in commercial markets. This partnership, which continues today, has been highly successful in achieving its goal. Today`s photovoltaic modules-more efficient and reliable than ever-have dropped to about 1/100th of their 1972 prices. From $500 or more per peak watt in those early days, module prices have dropped to about $5 per peak watt. Figure 1 illustrates the expansion of PV into commercial 2 effective markets as cost (and price) decreases. Once cost only in space, military, or consumer (primarily calculators and watches) applications, PV has now penetrated into both international and domestic markets. Currently cost-effective domestic uses, which are the primary subject of this paper, include applications in the residential, municipal, remote, and utility market sectors. The price of an installed PV system now ranges from $7 per watt to as high as $15 or $20 per watt, depending on factors such as the quantity purchased, size of the unit, amount of storage, and whether output is a.c. or d.c. This translates to a life-cycle energy cost of about 25 cents to 40 cents per kilowatt hour (kWh). Even at these seemingly high prices, PV technologies are gaining significant penetration into many U.S. markets.

  10. Cost-effectiveness research in neurosurgery.

    PubMed

    Zygourakis, Corinna C; Kahn, James G

    2015-04-01

    Cost and value are increasingly important components of health care discussions. Despite a plethora of cost and cost-effectiveness analyses in many areas of medicine, there has been little of this type of research for neurosurgical procedures. This scarcity is vexing because this specialty represents one of the most expensive areas in medicine. This article discusses the general principles of cost-effectiveness analyses and reviews the cost- and cost-effectiveness-related research to date in neurosurgical subspecialties. The need for standardization of cost and cost-effectiveness measurement and reporting within neurosurgery is highlighted and a set of metrics for this purpose is defined. PMID:25771274

  11. The Impact of Interactive Whiteboard Technology on Medical Students' Achievement in ESL Essay Writing: An Early Study in Egypt

    ERIC Educational Resources Information Center

    Albaaly, Emad; Higgins, Steven

    2012-01-01

    This study investigated the impact of the interactive whiteboard on Egyptian medical students' achievement in essay writing in English as a second language (ESL). First, the writing micro-skills judged essential to help these students improve their essay writing were identified, using a questionnaire which investigated experts' views. This gave…

  12. The Effect of Mastery Learning Model with Reflective Thinking Activities on Medical Students' Academic Achievement: An Experimental Study

    ERIC Educational Resources Information Center

    Elaldi, Senel

    2016-01-01

    This study aimed to determine the effect of mastery learning model supported with reflective thinking activities on the fifth grade medical students' academic achievement. Mixed methods approach was applied in two samples (n = 64 and n = 6). Quantitative part of the study was based on a pre-test-post-test control group design with an experiment…

  13. How to Achieve Synergy between Medical Education and Cognitive Neuroscience? An Exercise on Prior Knowledge in Understanding

    ERIC Educational Resources Information Center

    Ruiter, Dirk J.; van Kesteren, Marlieke T. R.; Fernandez, Guillen

    2012-01-01

    A major challenge in contemporary research is how to connect medical education and cognitive neuroscience and achieve synergy between these domains. Based on this starting point we discuss how this may result in a common language about learning, more educationally focused scientific inquiry, and multidisciplinary research projects. As the topic of…

  14. Can Learning Style Predict Student Satisfaction with Different Instruction Methods and Academic Achievement in Medical Education?

    ERIC Educational Resources Information Center

    Gurpinar, Erol; Alimoglu, Mustafa Kemal; Mamakli, Sumer; Aktekin, Mehmet

    2010-01-01

    The curriculum of our medical school has a hybrid structure including both traditional training (lectures) and problem-based learning (PBL) applications. The purpose of this study was to determine the learning styles of our medical students and investigate the relation of learning styles with each of satisfaction with different instruction methods…

  15. WE-G-19A-01: Radiologists and Medical Physicists: Working Together to Achieve Common Goals

    SciTech Connect

    Jones, A; Ma, J; Steele, J; Choi, H

    2014-06-15

    It is vitally important that medical physicists understand the clinical questions that radiologists are trying to answer with patient images. Knowledge of the types of information the radiologist needs helps medical physicists configure imaging protocols that appropriately balance radiation dose, time, and image quality. The ability to communicate with radiologists and understand medical terminology, anatomy, and physiology is key to creating such imaging protocols. In this session, radiologists will present clinical cases and describe the information they are seeking in the clinical images. Medical physicists will then discuss how imaging protocols are configured. Learning Objectives: Understand the types of information that radiologists seek in medical images. Apply this understanding in configuring the imaging equipment to deliver this information. Develop strategies for working with physician colleagues.

  16. The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

    PubMed Central

    2013-01-01

    Background Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades. Methods Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register. Results Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on

  17. Cost-Effectiveness of Retrospective Search Systems.

    ERIC Educational Resources Information Center

    King, Donald W.; Caldwell, Nancy W.

    The purpose of the present study is to explore cost-effectiveness factors that affect the choice among alternative system designs for retrospective searching services. A cost-effectiveness model that may be used to evaluate potential systems was derived, and a statement of the general magnitude of costs that the American Psychological Association…

  18. A Departmental Cost-Effectiveness Model.

    ERIC Educational Resources Information Center

    Holleman, Thomas, Jr.

    In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…

  19. In Search of Cost-Effective Schools.

    ERIC Educational Resources Information Center

    Raywid, Mary Anne; Shaheen, Thomas A.

    1994-01-01

    Examines major cost-effectiveness proposals, describing developments that highlight concerns over making schools cost effective. The article discusses ways to blend the concerns of educational quality, equity, and costs (district consolidations, shared service and facilities arrangements, new accountability strategies, new information systems,…

  20. Cost-Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review†

    PubMed Central

    Canter, Peter H.; Coon, Joanna Thompson; Ernst, Edzard

    2006-01-01

    Objectives: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK. Data sources: Medline (via PubMed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane) and Health Technology Assessments up to October 2005. Review methods: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table. Results: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies) and acupuncture (one study) for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY) was less than £10 000. The complementary therapy represented an additional health care cost in five of the six studies. Conclusions: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies

  1. The Cost-Effectiveness of Replacing the Bottom Quartile of Novice Teachers through Value-Added Teacher Assessment

    ERIC Educational Resources Information Center

    Yeh, Stuart S.; Ritter, Joseph

    2009-01-01

    A cost-effectiveness analysis was conducted of Gordon, Kane, and Staiger's (2006) proposal to raise student achievement by identifying and replacing the bottom quartile of novice teachers, using value-added assessment of teacher performance. The cost effectiveness of this proposal was compared to the cost effectiveness of voucher programs, charter…

  2. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  3. The Cost-Effectiveness of Comprehensive School Reform and Rapid Assessment

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2008-01-01

    Analysis of the cost-effectiveness of 29 Comprehensive School Reform (CSR) models suggests that all 29 models are less cost-effective than an alternative approach for raising student achievement, involving rapid assessment systems that test students 2 to 5 times per week in math and reading and provide rapid feedback of the results to students and…

  4. Comparing the Cost-Effectiveness of Tutoring and Computer-Based Instruction.

    ERIC Educational Resources Information Center

    Niemiec, Richard P.; And Others

    1989-01-01

    Compares the effects of peer tutoring and computer-based instruction on student achievement and motivation through a meta-analysis of research. Cost effectiveness is also investigated via ratios which combine the effects of the intervention with estimates of implementation costs, and an appendix includes reviews of 10 cost-effectiveness research…

  5. Cost-Effective Stress Management Training.

    ERIC Educational Resources Information Center

    Shea, Gordon F.

    1980-01-01

    Stress management training can be a cost effective way to improve productivity and job performance. Among many relaxation techniques, the most effective in terms of teachability, participant motivation, and profitability are self-hypnosis, progressive relaxation, and transcendental meditation. (SK)

  6. How to achieve synergy between medical education and cognitive neuroscience? An exercise on prior knowledge in understanding.

    PubMed

    Ruiter, Dirk J; van Kesteren, Marlieke T R; Fernandez, Guillen

    2012-05-01

    A major challenge in contemporary research is how to connect medical education and cognitive neuroscience and achieve synergy between these domains. Based on this starting point we discuss how this may result in a common language about learning, more educationally focused scientific inquiry, and multidisciplinary research projects. As the topic of prior knowledge in understanding plays a strategic role in both medical education and cognitive neuroscience it is used as a central element in our discussion. A critical condition for the acquisition of new knowledge is the existence of prior knowledge, which can be built in a mental model or schema. Formation of schemas is a central event in student-centered active learning, by which mental models are constructed and reconstructed. These theoretical considerations from cognitive psychology foster scientific discussions that may lead to salient issues and questions for research with cognitive neuroscience. Cognitive neuroscience attempts to understand how knowledge, insight and experience are established in the brain and to clarify their neural correlates. Recently, evidence has been obtained that new information processed by the hippocampus can be consolidated into a stable, neocortical network more rapidly if this new information fits readily into a schema. Opportunities for medical education and medical education research can be created in a fruitful dialogue within an educational multidisciplinary platform. In this synergetic setting many questions can be raised by educational scholars interested in evidence-based education that may be highly relevant for integrative research and the further development of medical education. PMID:20809351

  7. Can achievement goal theory provide a useful motivational perspective for explaining psychosocial attributes of medical students?

    PubMed Central

    2012-01-01

    Background Psychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations), for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation). Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT), is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT. Methods 143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS), psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S) and Low Frustration Tolerance (LFT). Results All study variables were found reliable (Cronbach's α ranged from .66 to .90) and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S) (β = .16, p < .05) and negatively associated with low frustration tolerance (β = -.22, p < .05) while performance goal orientation was significantly associated with low frustration tolerance (β = .36, p < .001). Conclusions The results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context

  8. [Essence of scientific and technical achievements and the nature of the effect of veterinary medical research].

    PubMed

    Iliev, I; Kostadinov, I

    1980-01-01

    An attempt is made at elucidating the essence of veterinary scientific and technological achievements and the character of the effect of their implementation. On the basis of a structural analysis veterinary scientific investigations are grouped as: theoretical-fundamental, scientific-applicative and scientific-technological elaborations. Starting out from the character of the effect that is achieved through their application, the scientific works, as well as the scientific and technological achievements in the field of veterinary medicine, are categorized as follows: cognitive (New knowledge), technical and technological (medico-biological), socio-sanitary, economic and those having a mixed effect (cognitive- medico-biological, medico-biological-socio-sanitary, socio-sanitary and economic, etc. The identification of the various types of effects requires the elaboration of respective criteria, as well as a system of indexes for their characterization, a qualitative and a quantitative determination, as necessary conditions for determining the effectiveness of research veterinary works and that of research technological achievement. PMID:7233814

  9. [History of the Halle Ars medica Judaica. V. Scientific achievements and medical publications of 2 centuries].

    PubMed

    Kaiser, W; Völker, A

    1989-05-01

    A medico-scientific journalism of Jewish origin which became increasedly recognizable on the German territory in the second half of the 17th century was at first based on the activities of Spanish-Portuguese exiles. Beginning with the 18th century at first the inaugural papers, but then also the publications of renowned Jewish physicians determined the profile of this literary group. The access to academic teaching professions becoming possible in the 19th century developed concentration points of research engagement, which in this place shall be indicated at the instance of the Medical Faculty of Halle University. PMID:2662660

  10. Design of a medical and laboratory equipment management program for the new standards certification achievement in Mexico.

    PubMed

    Franco-Clark, D; Pimentel-Aguilar, A B; Rodriguez-Vera, R

    2010-01-01

    Certification for healthcare institutions in Mexico is ruled by 2009 standards homologated with the Joint Commission International criteria. Nowadays, healthcare requires of medical equipment and devices, so it has become necessary to implement guidelines for its adequate management in order to reach the highest level of quality and safety at the lowest cost. The objective of this work was to develop a Medical and Laboratory Equipment Management Program, oriented to the improvement of quality, effectiveness and efficiency of the technological resources in order to meet the certification requirements. The result of this work allows to have an auto evaluation tool that focuses the efforts of the National Institute for Respiratory Diseases to the achievement of the new requirements established for the certification. PMID:21096126

  11. Poorer verbal working memory for a second language selectively impacts academic achievement in university medical students.

    PubMed

    Mann, Collette; Canny, Benedict J; Reser, David H; Rajan, Ramesh

    2013-01-01

    Working memory (WM) is often poorer for a second language (L2). In low noise conditions, people listening to a language other than their first language (L1) may have similar auditory perception skills for that L2 as native listeners, but do worse in high noise conditions, and this has been attributed to the poorer WM for L2. Given that WM is critical for academic success in children and young adults, these speech in noise effects have implications for academic performance where the language of instruction is L2 for a student. We used a well-established Speech-in-Noise task as a verbal WM (vWM) test, and developed a model correlating vWM and measures of English proficiency and/or usage to scholastic outcomes in a multi-faceted assessment medical education program. Significant differences in Speech-Noise Ratio (SNR50) values were observed between medical undergraduates who had learned English before or after five years of age, with the latter group doing worse in the ability to extract whole connected speech in the presence of background multi-talker babble (Student-t tests, p < 0.001). Significant negative correlations were observed between the SNR50 and seven of the nine variables of English usage, learning styles, stress, and musical abilities in a questionnaire administered to the students previously. The remaining two variables, Perceived Stress Scale (PSS) and the Age of Acquisition of English (AoAoE) were significantly positively correlated with the SNR50, showing that those with a poorer capacity to discriminate simple English sentences from noise had learnt English later in life and had higher levels of stress - all characteristics of the international students. Local students exhibited significantly lower SNR50 scores and were significantly younger when they first learnt English. No significant correlation was detected between the SNR50 and the students' Visual/Verbal Learning Style (r = -0.023). Standard multiple regression was carried out to assess

  12. Poorer verbal working memory for a second language selectively impacts academic achievement in university medical students

    PubMed Central

    Canny, Benedict J.; Reser, David H.; Rajan, Ramesh

    2013-01-01

    Working memory (WM) is often poorer for a second language (L2). In low noise conditions, people listening to a language other than their first language (L1) may have similar auditory perception skills for that L2 as native listeners, but do worse in high noise conditions, and this has been attributed to the poorer WM for L2. Given that WM is critical for academic success in children and young adults, these speech in noise effects have implications for academic performance where the language of instruction is L2 for a student. We used a well-established Speech-in-Noise task as a verbal WM (vWM) test, and developed a model correlating vWM and measures of English proficiency and/or usage to scholastic outcomes in a multi-faceted assessment medical education program. Significant differences in Speech-Noise Ratio (SNR50 ) values were observed between medical undergraduates who had learned English before or after five years of age, with the latter group doing worse in the ability to extract whole connected speech in the presence of background multi-talker babble (Student-t tests, p < 0.001). Significant negative correlations were observed between the SNR50 and seven of the nine variables of English usage, learning styles, stress, and musical abilities in a questionnaire administered to the students previously. The remaining two variables, Perceived Stress Scale (PSS) and the Age of Acquisition of English (AoAoE) were significantly positively correlated with the SNR50 , showing that those with a poorer capacity to discriminate simple English sentences from noise had learnt English later in life and had higher levels of stress – all characteristics of the international students. Local students exhibited significantly lower SNR50 scores and were significantly younger when they first learnt English. No significant correlation was detected between the SNR50 and the students’ Visual/Verbal Learning Style (r = −0.023). Standard multiple regression was carried out to

  13. Medical simulation is needed in anesthesia training to achieve patient's safety

    PubMed Central

    2013-01-01

    Many medical schools and hospitals throughout the world are equipped with a simulation center for the purpose of training anesthesiologists to perform both technical and non-technical skills. Because induction, maintenance, and emergence of general anesthesia are critical to patient welfare, various simulation mannequins and tools are utilized for the purpose of training anesthesiologists for safer patient care. Traditionally, anesthesia residency training mostly consisted of didactic lectures and observations. After completion of "traditional" training, anesthesia residents were allowed to perform procedures on patients under supervision. However, simulation would be a more effective training tool for which to teach anesthesiologists the skills necessary to perform invasive procedures, such as endotracheal intubation, central venous catheter insertion, and epidural catheter insertion. Recently, non-technical skills, such as the Anesthesia Non-Technical Skills developed by anesthesiologists from Aberdeen University, have been emphasized as an important training resource. Technical skills and non-technical skills can be learned by anesthesiology residents through a standardized and organized simulation program. Such programs would be beneficial in training anesthesia residents to work efficiently as a team in the operation room. PMID:23560184

  14. Come on in, the Water is Fine: Achieving Mainstream Relevance through Integration with Primary Medical Care

    PubMed Central

    Friman, Patrick C

    2010-01-01

    Behavior analysis is a generic science, and Skinner's vision for it was that it would become a mainstream force, relevant for most if not all human concerns, major and minor. Clearly his vision has not been realized. Determining why this is the case would require a complex multifactorial analysis. One likely factor is that the majority of its basic science findings have been obtained from the study of rats and pigeons. Another likely factor, one directly addressed by this paper, is that the majority of its applied science findings have been obtained from the study of people in only one tail of the normal distribution. Regardless, those outside the field see the relevance of behavior analysis to general human affairs as very limited. Whether the path behavior analysis is on will lead to widespread perception of mainstream relevance anytime soon seems doubtful. An alternative route would involve integrating it with a field that has already made the trip successfully. A premier example involves primary medical care. This paper argues for the integration of behavior analysis with pediatric primary care, sketches a method for its accomplishment, and uses diurnal enuresis to illustrate the requirements of the method. PMID:22479124

  15. Designing to cost effectiveness - Enhancing quality

    NASA Astrophysics Data System (ADS)

    Brennan, James R.; Stracener, Jerrell T.

    The authors present a practical application of cost-effectiveness analysis techniques through the definition and solution of a representative design tradeoff study using cost-effectiveness as a figure of merit for quality. They also describe a decision process based on the results of tradeoff studies to provide a method of integrating the 'ilities' with design and manufacturing engineering to help accomplish integrated product development (IPD). While the approach is demonstrated in an aircraft application, the method is equally applicable in almost any product and any operational scenario, military or commercial.

  16. Outpatient parenteral antimicrobial therapy with ceftriaxone for acute tonsillopharyngitis: efficacy, patient satisfaction, cost effectiveness, and safety

    PubMed Central

    Al Alawi, Samah; Abdulkarim, Somaya; Elhennawy, Hazem; Al-Mansoor, Anwar; Al Ansari, Ahmed

    2015-01-01

    Background Outpatient parenteral antimicrobial therapy (OPAT) is the administration of intravenous antimicrobial therapy to patients in an outpatient setting. It may be used for patients who have infections that require parenteral treatment but who are otherwise stable enough to not require admission as inpatients. Objective We aimed to review the treatment of patients with acute tonsillopharyngitis at the OPAT health care clinic in the Bahrain Defense Force Royal Medical Services (BDF-RMS), with regard to efficacy, patient satisfaction, cost effectiveness, and safety. Methods A retrospective case notes review was conducted for all patients admitted to the OPAT clinic in the BDF-RMS with acute tonsillopharyngitis treated with ceftriaxone, between March 2012 and March 2014. Results In the period between March 2012 and March 2014, 97 patients with acute tonsillopharyngitis were treated with ceftriaxone for a minimum of 3 days at the OPAT clinic. In total, 94.8% of patients completed the prescribed course of ceftriaxone. Total cure was achieved in 89.7% of patients. Usage of the OPAT clinic led to cost savings of 10,693 BD, while total bed days saved were 301 over the 2-year period examined by this study. Participants in the program expressed high satisfaction rates, and the average (± standard deviation) score on a patient satisfaction survey was 4.41 (± 0.31) out of a total of 5. This study highlights the efficacy, patient satisfaction, cost effectiveness, and safety of the OPAT clinic service for the treatment of acute tonsillopharyngitis with ceftriaxone. We found a 45.5% drop in admission rate for acute tonsillopharyngitis after starting the OPAT service clinic and that 301 bed days were saved through this treatment. Conclusion This study showed that the management of acute tonsillopharyngitis with ceftriaxone in the OPAT clinic is safe, clinically effective, and cost effective, with low rates of complications/readmissions and high levels of patient

  17. Cost-effective strategies for rural community outreach, Hawaii, 2010-2011.

    PubMed

    Pellegrin, Karen L; Barbato, Anna; Holuby, R Scott; Ciarleglio, Anita E; Taniguchi, Ronald

    2014-01-01

    Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event. Leveraging existing community events and employers in rural areas was more cost-effective than formal advertisement for recruiting rural community members. PMID:25496555

  18. Cost-Effective Strategies for Rural Community Outreach, Hawaii, 2010–2011

    PubMed Central

    Barbato, Anna; Holuby, R. Scott; Ciarleglio, Anita E.; Taniguchi, Ronald

    2014-01-01

    Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event. Leveraging existing community events and employers in rural areas was more cost-effective than formal advertisement for recruiting rural community members. PMID:25496555

  19. The "Cost-Effectiveness" of Sim One

    ERIC Educational Resources Information Center

    Hoffman, Kaaren I.; Abrahamson, Stephen

    1975-01-01

    Sim One is a computer-controlled patient, a sophisticated simulator developed by the University of Southern California School of Medicine. This article summarizes fifteen cost-effectiveness studies conducted over a 2-year period. Savings with the use of Sim One were found to justify the cost within a short period. (JT)

  20. Cost-Effective School Nurse Practitioner Services.

    ERIC Educational Resources Information Center

    Sobolewski, Susan D.

    1981-01-01

    A broader utilization of school nurse practitioners by school districts represents a cost-effective approach in meeting educational goals. School nurse practitioners provide extended nursing services to high risk children, assist in coordinating health services between the school and the child's parents, participate in classroom presentations on…

  1. Cost-Effectiveness of Interactive Courseware.

    ERIC Educational Resources Information Center

    Fletcher, J. D.

    What is known about the cost effectiveness of interactive courseware (ICW) is reviewed, and issues that remain are summarized. Effect size is used for reporting the effectiveness of ICW programs. Two ICW media are considered: computer-based instruction and interactive videodisc instruction. Effect sizes for computer-based instruction have been…

  2. Technology Improvement Pathways to Cost-Effective Vehicle Electrification

    SciTech Connect

    Brooker, A.; Thornton, M.; Rugh, J. P.

    2010-04-01

    Electrifying transportation can reduce or eliminate dependence on foreign fuels, emission of green house gases, and emission of pollutants. One challenge is finding a pathway for vehicles that gains wide market acceptance to achieve a meaningful benefit. This paper evaluates several approaches aimed at making plug-in electric vehicles (EV) and plug-in hybrid electric vehicles (PHEVs) cost-effective including opportunity charging, replacing the battery over the vehicle life, improving battery life, reducing battery cost, and providing electric power directly to the vehicle during a portion of its travel. Many combinations of PHEV electric range and battery power are included. For each case, the model accounts for battery cycle life and the national distribution of driving distances to size the battery optimally. Using the current estimates of battery life and cost, only the dynamically plugged-in pathway was cost-effective to the consumer. Significant improvements in battery life and battery cost also made PHEVs more cost-effective than today's hybrid electric vehicles (HEVs) and conventional internal combustion engine vehicles (CVs).

  3. The cost-effectiveness of forty health interventions in Guinea.

    PubMed

    Jha, P; Bangoura, O; Ranson, K

    1998-09-01

    Addressing diseases of a high burden with the most cost-effective interventions could do much to reduce disease in the population. We conducted a cost-effectiveness analysis of 40 health interventions in Guinea, a low-income country in sub-Saharan Africa, using local data. Interventions were selected from treatment protocols at health centres, first referral hospitals and national programmes in Guinea, based upon consultation with health care providers and government plans. For each intervention, we calculated the costs (comprising labour, drugs, supplies, equipment, and overhead) in relation to years of life saved, discounted at 3%. The results show that the per capita costs and effectiveness of any intervention vary considerably. Average costs show no clear pattern by level of care, but effectiveness is generally highest for curative hospital interventions. Several interventions have a cost-effectiveness of US$100 per year of life saved (LYS) or less, and address more than 5% of total years of life lost. These include health centre interventions such as: treatment of childhood pneumonia ($3/LYS); rehydration therapy for diarrhoea ($7/LYS); integrated management of childhood pneumonia, malaria and diarrhoea ($8/LYS); short-course treatment of tuberculosis ($12/LYS); treatment of childhood malaria ($13/LYS), and childhood vaccination ($25/LYS). Outreach programmes for impregnated bed nets against malaria cost $43/LYS. Maternal and perinatal diseases, have slightly less cost-effective interventions: integrated family planning, prenatal and delivery care at health centres ($109/LYS) or outreach programmes to provide prenatal and delivery care ($283/LYS). A minimum package of health services would cost approximately $13 per capita, and would address a large proportion (69%) of major causes of premature mortality. This minimum package would cost about three times the current public spending on health, suggesting that health spending needs to rise to achieve good health

  4. Is genetic ultrasound cost-effective?

    PubMed

    DeVore, Greggory R

    2003-04-01

    During the past 10 years, investigators have reported studies examining the potential of second-trimester genetic sonography to identify fetuses at risk for trisomy 21. The consensus among most investigators is that genetic sonography offers an alternative to universal amniocentesis in high-risk women and lowers the loss rate of normal fetuses subjected to amniocentesis because of risk factors associated with advanced maternal age or abnormal maternal-serum screening. Although there is now consensus that genetic sonography may be a useful screening tool, there has been a paucity of data regarding its cost-effectiveness. In this review, 3 studies are examined and cost-effectiveness of genetic sonography evaluated. The first study compared genetic sonography and universal amniocentesis and found that genetic sonography was cost-effective if the sensitivity is 75% or higher, resulted in a savings to the healthcare system of 9%, and decreased the loss rate of normal fetuses following amniocentesis by 87%. The second study examined the use of genetic sonography in women less than 35 years of age who underwent maternal-serum triple-marker serum screening. Women who were screen negative but who were classified as moderate risk for trisomy 21 (risk 1:191 to 1:1,000) were offered genetic sonography. Amniocentesis was offered only if the genetic sonogram was abnormal. The study demonstrated that the use of genetic sonography in this group of patients increased the detection rate of trisomy 21, was cost effective, and was a safe procedure. The third study examined the use of genetic sonography in women 35 years of age and older who declined amniocentesis following second-trimester genetic counseling. Genetic sonography was offered to this group of patients followed by amniocentesis if an abnormal ultrasound finding was present. The data were analyzed for various acceptance rates of amniocentesis by the patient when informed of the ultrasound findings. Examination of the data

  5. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer☆

    PubMed Central

    Duarte, A.; Walker, J.; Walker, S.; Richardson, G.; Holm Hansen, C.; Martin, P.; Murray, G.; Sculpher, M.; Sharpe, M.

    2015-01-01

    Objectives Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. Methods Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained. Results DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses. Conclusions Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings. PMID:26652589

  6. Ensuring cost effectiveness in the TAP process

    SciTech Connect

    Trego, A.L.

    1992-06-16

    The Training Accredition Program (TAP) at the Waste Isolation Division (WID) is discussed by the general manager. Cost effectiveness in the TAP process is made possible by saving through sharing which refers to the exchange and co-development of information and technology among Westinghouse Government owned-contractor operators and with other organizations. In 1990 a comprehensive management and supervisor training (MAST) program plan was devised and a MAST certification program of 31 self-paced written moduler was developed. This program has proven to be inexpensive to develop and implement when compared to classroom training. In addition, total quality is used as a tool to continuously improve work process. Continuous improvement requires continued evaluation of work process, such as TAP analysis and development in summary to make training at DOE facilities the most cost-effective training anywhere, we need to share, challenge conventional wisdom, and seek to continuously improve.

  7. Cost-effectiveness of monitoring free flaps.

    PubMed

    Subramaniam, Shiva; Sharp, David; Jardim, Christopher; Batstone, Martin D

    2016-06-01

    Methods of free flap monitoring have become more sophisticated and expensive. This study aims to determine the cost of free flap monitoring and examine its cost effectiveness. We examined a group of patients who had had free flaps to the head and neck over a two-year period, and combined these results with costs obtained from business managers and staff. There were 132 free flaps with a success rate of 99%. The cost of monitoring was Aus $193/flap. Clinical monitoring during this time period cost Aus$25 476 and did not lead to the salvage of any free flaps. Cost equivalence is reached between monitoring and not monitoring only at a failure rate of 15.8%. This is to our knowledge the first study to calculate the cost of clinical monitoring of free flaps, and to examine its cost-effectiveness. PMID:27015730

  8. Cost effective management of space venture risks

    NASA Technical Reports Server (NTRS)

    Giuntini, Ronald E.; Storm, Richard E.

    1986-01-01

    The development of a model for the cost-effective management of space venture risks is discussed. The risk assessment and control program of insurance companies is examined. A simplified system development cycle which consists of a conceptual design phase, a preliminary design phase, a final design phase, a construction phase, and a system operations and maintenance phase is described. The model incorporates insurance safety risk methods and reliability engineering, and testing practices used in the development of large aerospace and defense systems.

  9. Theater SBI cost-effectiveness ratios

    SciTech Connect

    Canavan, G.H.

    1993-11-01

    To address M missiles spaced at intervals longer than the constillation reconstitution time t, the defense needs at the absentee ratio N{sub a} of SBIs to fill the belt plus the M SBIs needed for the intercepts; the resulting cost effectiveness scales as M/(M + N{sub a}). N{sub a} is large and CER small for small ranges and numbers of missiles. For several-hundred missile threats, CERs are greater than unity for ranges of interest.

  10. Identification and analysis of labor productivity components based on ACHIEVE model (case study: staff of Kermanshah University of Medical Sciences).

    PubMed

    Ziapour, Arash; Khatony, Alireza; Kianipour, Neda; Jafary, Faranak

    2015-01-01

    Identification and analysis of the components of labor productivity based on ACHIEVE model was performed among employees in different parts of Kermanshah University of Medical Sciences in 2014. This was a descriptive correlational study in which the population consisted of 270 working personnel in different administrative groups (contractual, fixed- term and regular) at Kermanshah University of Medical Sciences (872 people) that were selected among 872 people through stratified random sampling method based on Krejcie and Morgan sampling table. The survey tool included labor productivity questionnaire of ACHIEVE. Questionnaires were confirmed in terms of content and face validity, and their reliability was calculated using Cronbach's alpha coefficient. The data were analyzed by SPSS-18 software using descriptive and inferential statistics. The mean scores for labor productivity dimensions of the employees, including environment (environmental fit), evaluation (training and performance feedback), validity (valid and legal exercise of personnel), incentive (motivation or desire), help (organizational support), clarity (role perception or understanding), ability (knowledge and skills) variables and total labor productivity were 4.10±0.630, 3.99±0.568, 3.97±0.607, 3.76±0.701, 3.63±0.746, 3.59±0.777, 3.49±0.882 and 26.54±4.347, respectively. Also, the results indicated that the seven factors of environment, performance assessment, validity, motivation, organizational support, clarity, and ability were effective in increasing labor productivity. The analysis of the current status of university staff in the employees' viewpoint suggested that the two factors of environment and evaluation, which had the greatest impact on labor productivity in the viewpoint of the staff, were in a favorable condition and needed to be further taken into consideration by authorities. PMID:25560364

  11. Identification and Analysis of Labor Productivity Components Based on ACHIEVE Model (Case Study: Staff of Kermanshah University of Medical Sciences)

    PubMed Central

    Ziapour, Arash; Khatony, Alireza; Kianipour, Neda; Jafary, Faranak

    2015-01-01

    Identification and analysis of the components of labor productivity based on ACHIEVE model was performed among employees in different parts of Kermanshah University of Medical Sciences in 2014. This was a descriptive correlational study in which the population consisted of 270 working personnel in different administrative groups (contractual, fixed- term and regular) at Kermanshah University of Medical Sciences (872 people) that were selected among 872 people through stratified random sampling method based on Krejcie and Morgan sampling table. The survey tool included labor productivity questionnaire of ACHIEVE. Questionnaires were confirmed in terms of content and face validity, and their reliability was calculated using Cronbach’s alpha coefficient. The data were analyzed by SPSS-18 software using descriptive and inferential statistics. The mean scores for labor productivity dimensions of the employees, including environment (environmental fit), evaluation (training and performance feedback), validity (valid and legal exercise of personnel), incentive (motivation or desire), help (organizational support), clarity (role perception or understanding), ability (knowledge and skills) variables and total labor productivity were 4.10±0.630, 3.99±0.568, 3.97±0.607, 3.76±0.701, 3.63±0.746, 3.59±0.777, 3.49±0.882 and 26.54±4.347, respectively. Also, the results indicated that the seven factors of environment, performance assessment, validity, motivation, organizational support, clarity, and ability were effective in increasing labor productivity. The analysis of the current status of university staff in the employees’ viewpoint suggested that the two factors of environment and evaluation, which had the greatest impact on labor productivity in the viewpoint of the staff, were in a favorable condition and needed to be further taken into consideration by authorities. PMID:25560364

  12. Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home

    PubMed Central

    Bleser, William K.; Miller-Day, Michelle; Naughton, Dana; Bricker, Patricia L.; Cronholm, Peter F.; Gabbay, Robert A.

    2014-01-01

    PURPOSE The current model of primary care in the United States limits physicians’ ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg’s conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement. METHODS Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small- to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software. RESULTS We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment. CONCLUSION Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg’s conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process. PMID:24445102

  13. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    PubMed

    Takura, Tomoyuki; Nakanishi, Takeshi; Kawanishi, Hideki; Nitta, Kosaku; Akizawa, Tadao; Hiramatsu, Makoto; Kawasaki, Tadayuki; Kukita, Kazutaka; Soejima, Hidehisa; Hirakata, Hideki; Yoshida, Toyohiko; Miyamoto, Takashi; Takahashi, Susumu

    2015-10-01

    The cost-effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro-QOL 5-dimensions (EQ-5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost-effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ-5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P < 0.05, <65; P < 0.01, 65≤; not significant). MHD is a treatment that could improve the socioeconomic state of elderly patients with end-stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis. PMID:26387878

  14. Oral serotonin receptor agonists: a review of their cost effectiveness in migraine.

    PubMed

    Lofland, Jennifer H; Nash, David B

    2005-01-01

    Migraine headache is a highly prevalent chronic, episodic condition. The direct and indirect costs of migraine headache have a tremendous economic impact in the US. Research has shown that serotonin (5HT(1B/D)) receptor agonists reduce healthcare costs, improve health-related QOL (HR-QOL), decrease migraine disability and keep patients effective in the workplace. The purpose of this manuscript is to examine the cost effectiveness of oral 5HT(1B/D) receptor agonists for the treatment of migraine headache. In general, 5HT(1B/D) receptor agonists are associated with increases in direct healthcare costs; however, they are also associated with reductions in the indirect costs associated with migraine headache. Therefore, it appears that the relatively high acquisition cost of these medications is offset and, as a class, these medications appear to be cost effective and demonstrate net benefits from the societal perspective. Based on meta-analyses in which data on eletriptan were not available, it appears that within the class, almotriptan and rizatriptan are the most cost effective. In a prospective study comparing eletriptan with sumatriptan, it appears that the former may be more cost effective than the latter. Additional investigations are needed to further explore the application of the friction-cost approach and QALYs to cost-effectiveness analyses of this class of medication. PMID:15836007

  15. Strengthening Cost-Effectiveness Analysis for Public Health Policy.

    PubMed

    Russell, Louise B; Sinha, Anushua

    2016-05-01

    Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs. PMID:27102861

  16. Cost-effectiveness in the surgical treatments for trigeminal neuralgia.

    PubMed

    Fransen, Patrick

    2012-09-01

    Increasing costs of healthcare call for rational approaches based on cost-effectiveness of the surgical procedures. When treating trigeminal neuralgia, therapeutic options vary widely as does their cost. We have compared microvascular decompression (MVD), radiofrequency rhizotomy (RFR), percutaneous balloon compression of the Gasser ganglion (PBC) and gamma knife rhizotomy (GKR) for length of stay, cost of the stay, of the procedure, of disposable material and of specific hospital investments. This was compared to the immediate and long-term (>5 years) efficacy of the procedures. The evaluated total cost were 1,014 for PBC and RFR, 3,360 for MVD with a 2-day hospital stay, 4,560 for MVD with a 5-day hospital stay, and 3,424 for GKR. In addition, RFR requires investing in a generator (10,000 ) and GKR requires a gamma knife suite (3,000,000 ). MVD, PBC and RFR allow immediate relief of the pain, GKS having a more progressive effect. Long-term results, however, are comparable, all techniques having at least a 25% recurrence rate between 5 and 10 years postoperatively. Although all surgical techniques allow pain relief in trigeminal neuralgia, from an economical point of view, percutaneous techniques are more cost-effective than MVD and GKR. They should be considered as the first therapeutical option, keeping the more expensive procedures for percutaneous treatment failures or for medically justified indications. PMID:22684920

  17. Deregulation and Nuclear Training: Cost Effective Alternatives

    SciTech Connect

    Richard P. Coe; Patricia A. Lake

    2000-11-12

    Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies.

  18. Cost-effectiveness of febuxostat in chronic gout.

    PubMed

    Beard, Stephen M; von Scheele, Birgitta G; Nuki, George; Pearson, Isobel V

    2014-06-01

    Our objective was to evaluate data on the cost-effectiveness of febuxostat compared with standard clinical practice with allopurinol in patients with gout that was presented to the Scottish Medicines Consortium (SMC) in 2010. A Markov health-state model estimated the direct health-related costs and clinical benefits expressed as quality-adjusted life-years (QALYs). Adults with chronic gout and established hyperuricaemia received treatment sequences of daily doses of allopurinol 300 mg alone or allopurinol 300 mg followed by febuxostat 80 mg/120 mg. The proportion of patients achieving the target serum uric acid (sUA) level of less than 6 mg/dl (0.36 mmol/l) was linked to the utility per sUA level to generate an incremental cost-effectiveness ratio (ICER). Second-line therapy with febuxostat 80 mg/120 mg versus with allopurinol alone resulted in an ICER of £3,578 per QALY over a 5-year time horizon. Additional univariate analyses showed that ICER values were robust and ranged from £2,550 to £7,165 per QALY when different parameters (e.g., low- and high-dose allopurinol titrations and variations in treatment-induced flare rates) were varied. Febuxostat reduces sUA below the European League Against Rheumatism target of 0.36 mmol/l (6 mg/dl) in significantly more patients with gout than allopurinol in its most frequently prescribed dose of 300 mg per day. The SMC accepted febuxostat as cost-effective as a suitable second-line option for urate-lowering therapy for the treatment of patients with chronic hyperuricaemia in conditions where urate deposition has already occurred (including a history or presence of tophus and/or gouty arthritis) when treatment with allopurinol was inadequate, not tolerated, or contraindicated. PMID:23719971

  19. Cost-effectiveness of continuous erythropoietin receptor activator in anemia

    PubMed Central

    Schmid, Holger

    2014-01-01

    Background Erythropoiesis-stimulating agents (ESAs) are the mainstay of anemia therapy. Continuous erythropoietin receptor activator (CERA) is a highly effective, long-acting ESA developed for once-monthly dosing. A multitude of clinical studies has evaluated the safety and efficiency of this treatment option for patients with renal anemia. In times of permanent financial pressure on health care systems, the cost-effectiveness of CERA should be of particular importance for payers and clinicians. Objective To critically analyze, from the nephrologists’ point of view, the published literature focusing on the cost-effectiveness of CERA for anemia treatment. Methods The detailed literature search covered electronic databases including MEDLINE, PubMed, and Embase, as well as international conference abstract databases. Results Peer-reviewed literature analyzing the definite cost-effectiveness of CERA is scarce, and most of the available data originate from conference abstracts. Identified data are restricted to the treatment of anemia due to chronic kidney disease. Although the majority of studies suggest a considerable cost advantage for CERA, the published literature cannot easily be compared. While time and motion studies clearly indicate that a switch to CERA could minimize health care staff time in dialysis units, the results of studies comparing direct costs are more ambivalent, potentially reflecting the differences between health care systems and variability between centers. Conclusion Analyzed data are predominantly insufficient; they miss clear evidence and have to thus be interpreted with great caution. In this day and age of financial restraints, results from well-designed, head-to-head studies with clearly defined endpoints have to prove whether CERA therapy can achieve cost savings without compromising anemia management. PMID:25050070

  20. The cost effectiveness of levalbuterol versus racemic albuterol.

    PubMed

    Quinn, Campion

    2004-07-01

    Albuterol is a selective beta2-agonist that is widely used in the prevention and treatment of reactive airway disease. It is formulated as a racemic mixture containing equal parts of the R- and S-isomers. The therapeutic activity of albuterol is due entirely to the R-isomer, whereas the S-isomer may actually have detrimental effects. Because the slowly metabolized S-isomer tends to accumulate in the body, there has been concern that chronic use of racemic albuterol might lead to loss of effectiveness and clinical deterioration, with potentially serious health and cost consequences. Levalbuterol is a formulation containing only the R-isomer of albuterol, and clinical trials have demonstrated that it offers therapeutic advantages over racemic albuterol. The cost effectiveness of levalbuterol derives mainly from reduced need for acute medical care and hospitalization. PMID:15354680

  1. Modeling cost-effectiveness of pharmaceuticals in Alzheimer's disease.

    PubMed

    Oremus, Mark; Tarride, Jean-Eric

    2012-06-01

    Alzheimer's disease is a neurodegenerative disorder characterized by cognitive and behavioral deficits. Donepezil and memantine are two medications used to treat the symptoms of cognitive decline in Alzheimer's disease. A modeled cost-effectiveness analysis found that treatment with donepezil to be less costly and more effective than no treatment or treatment with memantine in Germany. However, the model drew on non-German population data and could have been more transparent with regard to 'back-end' processes. In addition, the authors would question the extent to which the differences in effectiveness between treatments would be considered clinically significant. Identifying sources of cost savings for donepezil remains an important issue for future consideration. PMID:22812550

  2. Cost-Effective Fuel Treatment Planning

    NASA Astrophysics Data System (ADS)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  3. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed Central

    Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

    2002-01-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction

  4. Distributional Cost-Effectiveness Analysis: A Tutorial.

    PubMed

    Asaria, Miqdad; Griffin, Susan; Cookson, Richard

    2016-01-01

    Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial, we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). The 2 key stages in DCEA are 1) modeling social distributions of health associated with different interventions, and 2) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgments that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modeling assumptions and social value judgments. PMID:25908564

  5. The cost-effectiveness of psychotherapy for the major psychiatric diagnoses.

    PubMed

    Lazar, Susan G

    2014-09-01

    Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need

  6. Compare the educational achievement of medical students with different circadian rhythms in difficult courses of basic sciences

    PubMed Central

    Liaghatdar, Mohammad Javad; Ashoorion, Vahid; Avizhgan, Maryam

    2016-01-01

    Background: Advantageous times for different people are different to some extent, considering the effective physiological changes during the circadian rhythm, in terms of the peak time of physiological activities. The goal of this study is to compare the educational achievement of students, with different morning–evening habits, in completing difficult and easy courses. Materials and Methods: This research is a retrospective descriptive–analytical study, which has been conducted on students of the fifth semester of General Medicine in the Faculty of Medicine, Isfahan University of Medical Sciences. The morning–evening habits of the students were determined by the Horne-Strauss 19-item questionnaire. The students were asked to determine the courses that were ’difficult’ and ’easy,’ using a researcher-made questionnaire. The students’ scores in the considered courses during the five semesters were obtained from the Education Department of the Faculty and analyzed using the descriptive t-test, analysis of variance (ANOVA), and the multivariate regression test in the SPSS software. Results: Sixty-three students (67% girls and 33% boys) participated in this study, of whom 11, 60, and 29% were morning, morning–evening, and evening students, respectively. The mean scores of the difficult courses in all five semesters were reduced in the evening pattern compared to the morning and morning–evening patterns. Reduction of the mean score in the difficult courses, in the evening group, compared with the morning–evening and morning groups was observed in all five semesters among girls, but in three semesters among boys. Conclusion: This study showed that evening students experienced academic failure in difficult courses, which required a more cognitive performance. It is recommended that difficult specialized courses be presented at hours when all student groups have a better cognitive performance PMID:27110555

  7. Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department.

    PubMed

    Ben-Assuli, Ofir; Ziv, Amitai; Sagi, Doron; Ironi, Avinoah; Leshno, Moshe

    2016-06-01

    Health care organizations have installed electronic systems to increase efficiency in health care. Empirically assessing the cost-effectiveness of technologies to the health care system is a challenging and complex task. This study examined cost-effectiveness of additional clinical information supplied via an EHR system by simulating a case of abdominal aortic aneurysm devised and acted professionally by the Israel Center of Medical Simulation. We conducted a simulation-based study on physicians who were asked to treat a simulated patient for the prevalent medical scenario of hip and leg pain that actually corresponded to an abdominal aortic aneurysm. Half of the participating physicians from the Department of Emergency Medicine at Tel-Hashomer Hospital - Israel's largest - had access to an EHR system that integrates medical data from multiple health providers (community and hospitals) in addition to the local health record, and half did not. To model medical decision making, the results of the simulation were combined with a Markov Model within a decision tree. Cost-effectiveness was analyzed by comparing the effects of the admission/discharge decision in units of quality adjusted life years (QALYs) to the estimated costs. The results showed that using EHR in the ED increases the QALY of the patient and improves medical decision-making. The expenditure per patient for one QALY unit as a result of using the EHR was $1229, which is very cost-effective according to many accepted threshold values (less than all these values). Thus, using the EHR contributes to making a cost-effective decision in this specific but prevalent case. PMID:27114352

  8. Cost-effective lightweight mirrors for aerospace and defense

    NASA Astrophysics Data System (ADS)

    Woodard, Kenneth S.; Comstock, Lovell E.; Wamboldt, Leonard; Roy, Brian P.

    2015-05-01

    The demand for high performance, lightweight mirrors was historically driven by aerospace and defense (A&D) but now we are also seeing similar requirements for commercial applications. These applications range from aerospace-like platforms such as small unmanned aircraft for agricultural, mineral and pollutant aerial mapping to an eye tracking gimbaled mirror for optometry offices. While aerospace and defense businesses can often justify the high cost of exotic, low density materials, commercial products rarely can. Also, to obtain high performance with low overall optical system weight, aspheric surfaces are often prescribed. This may drive the manufacturing process to diamond machining thus requiring the reflective side of the mirror to be a diamond machinable material. This paper summarizes the diamond machined finishing and coating of some high performance, lightweight designs using non-exotic substrates to achieve cost effective mirrors. The results indicate that these processes can meet typical aerospace and defense requirements but may also be competitive in some commercial applications.

  9. Using Cost-Effectiveness Tests to Design CHP Incentive Programs

    SciTech Connect

    Tidball, Rick

    2014-11-01

    This paper examines the structure of cost-effectiveness tests to illustrate how they can accurately reflect the costs and benefits of CHP systems. This paper begins with a general background discussion on cost-effectiveness analysis of DER and then describes how cost-effectiveness tests can be applied to CHP. Cost-effectiveness results are then calculated and analyzed for CHP projects in five states: Arkansas, Colorado, Iowa, Maryland, and North Carolina. Based on the results obtained for these five states, this paper offers four considerations to inform regulators in the application of cost-effectiveness tests in developing CHP programs.

  10. Cost-effectiveness of palliative surgery versus nonsurgical procedures in gastrointestinal cancer patients.

    PubMed

    Kim, Bradford J; Aloia, Thomas A

    2016-09-01

    Palliative care is an essential component to multidisciplinary cancer care. Improved symptom control, quality of life (QOL), and survival have resulted from its utilization. Cost-effectiveness and utility analyses are significant variables that should be considered in comparing benefits and costs of medical interventions to determine if certain treatments are economically justified. This is a review on the cost-effectiveness of palliative surgery compared to other nonsurgical palliative procedures in patients with unresectable gastrointestinal cancers. J. Surg. Oncol. 2016;114:316-322. © 2016 Wiley Periodicals, Inc. PMID:27132654

  11. Rituximab as first choice for patients with refractory rheumatoid arthritis: cost-effectiveness analysis in Iran based on a systematic review and meta-analysis.

    PubMed

    Ahmadiani, Saeed; Nikfar, Shekoufeh; Karimi, Somayeh; Jamshidi, Ahmad Reza; Akbari-Sari, Ali; Kebriaeezadeh, Abbas

    2016-09-01

    The aim of this study was to evaluate the effectiveness and cost-effectiveness of using rituximab as first line for patients with refractory rheumatoid arthritis in comparison with continuing conventional DMARDs, from a perspective of health service governors. A systematic review was implemented through searching PubMed, Scopus and Cochrane Library. Quality assessment was performed by Jadad scale. After meta-analysis of ACR index results, QALY gain was calculated through mapping ACR index to HAQ and utility index. To measure the direct and indirect medical costs, a set of interviews with patients were applied. Thirty-two patients were selected from three referral rheumatology clinics in Tehran with definite diagnosis of refractory rheumatoid arthritis in the year before and treatment regimen of either rituximab or DMARDs within last year. Incremental cost-effectiveness ratio was calculated for base case and scenario of generic rituximab. Threefold of GDP per capita was considered as threshold of cost-effectiveness. Four studies were eligible to be considered in this systematic review. Total risk differences of 0.3 for achieving ACR20 criteria, 0.21 for ACR50 and 0.1 for ACR70 were calculated. Also mean of total medical costs of patients for 24 weeks were $3985 in rituximab group and $932 for DMARDs group. Thus, the incremental cost per QALY ratio will be $45,900-$70,223 in base case and $32,386-$49,550 for generic scenario. Rituximab for treatment of patients with refractory rheumatoid arthritis is not considered as cost-effective in Iran in none of the scenarios. PMID:27136919

  12. Cost effectiveness of recycling: a systems model.

    PubMed

    Tonjes, David J; Mallikarjun, Sreekanth

    2013-11-01

    Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets. PMID:23816311

  13. Cost effectiveness of recycling: A systems model

    SciTech Connect

    Tonjes, David J.; Mallikarjun, Sreekanth

    2013-11-15

    Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.

  14. ROV's: The key is cost effectiveness

    SciTech Connect

    Saunders, E.

    1986-10-01

    Although diver-support activities will continue to be required in terms of monitoring and assistance, low-cost, remotely operated vehicles (ROV's) will have an increasing presence in the oil industry and other fields provided there is ongoing improvement in management, preparation, and execution of work. Beyond the safety aspect, the key is cost effectiveness. It is the company's intention wherever possible, and within realistic constraints, to take the man out of the water either by direct ROV replacement of the diver or by assisting him. Shell's exploration and production operations are based in three main areas: the southern, central, and northern North Sea. These developed fields, which consist of 26 various structures (interconnected), are connected to the mainland by over 1,100 km of submarine pipeline. Maintenance and underwater engineering costs in northern operations alone exceed pounds40 million/year (about $60 million/year) where typical support is an estimated 700 ROV days/year. The utilization analysis indicates a major use in ''eyeball'' vehicles for diver monitoring, and a large percentage for pipeline survey with only a limited amount on structural work and other special applications. The ''Bondi initiative'' in the late 1970s was intended to remove the diver from the water by ROV replacement, but due to lack of development, the capability in many areas has not evolved.

  15. A Systematic Review of the Cost-Effectiveness of Biologics for the Treatment of Inflammatory Bowel Diseases

    PubMed Central

    Huoponen, Saara; Blom, Marja

    2015-01-01

    Background Biologics are used for the treatment of inflammatory bowel diseases, Crohn´s disease and ulcerative colitis refractory to conventional treatment. In order to allocate healthcare spending efficiently, costly biologics for inflammatory bowel diseases are an important target for cost-effectiveness analyses. The aim of this study was to systemically review all published literature on the cost-effectiveness of biologics for inflammatory bowel diseases and to evaluate the methodological quality of cost-effectiveness analyses. Methods A literature search was performed using Medline (Ovid), Cochrane Library, and SCOPUS. All cost-utility analyses comparing biologics with conventional medical treatment, another biologic treatment, placebo, or surgery for the treatment of inflammatory bowel diseases in adults were included in this review. All costs were converted to the 2014 euro. The methodological quality of the included studies was assessed by Drummond’s, Philips’, and the Consolidated Health Economic Evaluation Reporting Standards checklist. Results Altogether, 25 studies were included in the review. Among the patients refractory to conventional medical treatment, the incremental cost-effectiveness ratio ranged from dominance to 549,335 €/Quality-Adjusted Life Year compared to the incremental cost-effectiveness ratio associated with conventional medical treatment. When comparing biologics with another biologic treatment, the incremental cost-effectiveness ratio ranged from dominance to 24,012,483 €/Quality-Adjusted Life Year. A study including both direct and indirect costs produced more favorable incremental cost-effectiveness ratios than those produced by studies including only direct costs. Conclusions With a threshold of 35,000 €/Quality-Adjusted Life Year, biologics seem to be cost-effective for the induction treatment of active and severe inflammatory bowel disease. Between biologics, the cost-effectiveness remains unclear. PMID:26675292

  16. Pharmacists' Role in Improving Diabetes Medication Management

    PubMed Central

    Smith, Marie

    2009-01-01

    Today there are significant gaps between reaching the goal of “optimal medication therapy” and the current state of medication use in the United States. Pharmacists are highly accessible and well-trained—yet often underutilized—key health care professionals who can move us closer toward achieving better medication therapy outcomes for patients. Diabetes medication management programs led by pharmacists are described. This is consistent with the “medical home” concept of care that promotes primary care providers working collaboratively to coordinate patient-centered care. Pharmacists utilize their clinical expertise in monitoring and managing diabetes medication plans to positively impact health outcomes and empower patients to actively manage their health. In addition, pharmacists can serve as a resource to other health care providers and payers to assure safe, appropriate, cost-effective diabetes medication use. PMID:20046662

  17. [The health economics of attention deficit hyperactivity disorder in Germany. Part 2: Therapeutic options and their cost-effectiveness].

    PubMed

    Schlander, M; Trott, G-E; Schwarz, O

    2010-03-01

    Attention deficit hyperactivity disorder (ADHD) has been associated with a continuous increase of health care utilization and thus expenditures. This raises the issue of cost-effectiveness of health care provided for patients with ADHD. Comparative health economic evaluations generate relevant insights and typically report incremental cost-effectiveness ratios (ICERs) of alternatives versus an established standard. Typically, results of cost-effectiveness analyses (CEAs) are reported in terms of incremental cost-effectiveness ratios (ICERs). International evaluations, as well specific adaptations to Germany, indicate an acceptable to attractive cost-effectiveness--according to currently used international benchmarks--of an intense medication management strategy based on stimulants, primarily methylphenidate, with ICERs ranging from 20,000 EUR to 37,000 EUR per quality-adjusted life year (QALY) gained. Economic modeling studies also suggest cost-effectiveness of long-acting modified-release preparations of methylphenidate, owing to improved treatment compliance associated with simplified once daily administration schemes. Atomoxetine, in contrast, appears economically inferior compared to long-acting stimulants, given its higher acquisition costs and at best equal clinical effectiveness. There are currently no data supporting the cost-effectiveness of psychotherapeutic or behavioral interventions. Economic evaluations, which have been published to date, are generally limited by time horizons of up to 1 year and by their prevailing focus on ADHD core symptom improvement only. Therefore, further research into the cost-effectiveness of ADHD treatment strategies seems warranted. PMID:19936695

  18. Cost-Effectiveness of Cetuximab for Advanced Esophageal Squamous Cell Carcinoma

    PubMed Central

    Bruno, Marco J.; Polinder, Suzanne; Lorenzen, Sylvie; Lordick, Florian; Peppelenbosch, Maikel P.; Spaander, Manon C. W.

    2016-01-01

    Background Costly biologicals in palliative oncology are emerging at a rapid pace. For example, in patients with advanced esophageal squamous cell carcinoma addition of cetuximab to a palliative chemotherapy regimen appears to improve survival. However, it simultaneously results in higher costs. We aimed to determine the incremental cost-effectiveness ratio of adding cetuximab to first-line chemotherapeutic treatment of patients with advanced esophageal squamous cell carcinoma, based on data from a randomized controlled phase II trial. Methods A cost effectiveness analysis model was applied based on individual patient data. It included only direct medical costs from the health-care perspective. Quality-adjusted life-years and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by a Monte Carlo analysis. Results Adding cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma resulted in an the incremental cost-effectiveness ratio of €252,203 per quality-adjusted life-year. Sensitivity analysis shows that there is a chance of less than 0.001 that the incremental cost-effectiveness ratio will be less than a maximum willingness to pay threshold of €40,000 per quality-adjusted life-year, which is representative for the threshold used in The Netherlands and other developed countries. Conclusions Addition of cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma is not cost-effective when appraised according to currently accepted criteria. Cost-effectiveness analyses using outcome data from early clinical trials (i.c. a phase II trial) enable pharmaceutical companies and policy makers to gain early insight into whether a new drug meets the current eligibility standards for reimbursement and thereby potential admittance for use in regular clinical practice. PMID:27100871

  19. Cost-effectiveness of a Primary Care Intervention to Treat Obesity

    PubMed Central

    Tsai, Adam G.; Wadden, Thomas A.; Volger, Sheri; Sarwer, David B.; Vetter, Marion; Kumanyika, Shiriki; Berkowitz, Robert I.; Diewald, Lisa; Perez, Joanna; Lavenberg, Jeffrey; Panigrahi, Eva R.; Glick, Henry A.

    2013-01-01

    Background Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant. Methods We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (quarterly visits with their primary care provider); Brief Lifestyle Counseling (Brief LC; quarterly provider visits plus monthly weight loss counseling visits; or Enhanced Brief Lifestyle Counseling (Enhanced Brief LC; all above interventions, plus choice of meal replacements or weight loss medication). A health care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY. Results Weight losses after 2 years were 1.7, 2.9, and 4.6 kg for Usual Care, Brief LC, and Enhanced Brief LC, respectively (p = 0.003 for comparison of Enhanced Brief LC vs. Usual Care). The incremental cost per kilogram-year lost was $292 for Enhanced Brief LC compared to Usual Care (95% CI $38 to $394). The incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short term cost per kg with published estimates of longer term cost per QALYs suggested that the intervention could be cost-effective over the long term (≥ 10 years). Conclusions A primary care intervention that included monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity. PMID:23921780

  20. Is RENP a Cost Effective Supplement to the Regular DCPS Program? RMC Report UR-330.

    ERIC Educational Resources Information Center

    Errecart, Michael T.

    This paper focuses on whether the Response to Educational Needs Project (RENP) has been demonstrated to be a cost effective way of increasing the reading and mathematical achievement scores of students in the fourth, fifth, and eighth grades of the District of Columbia Public Schools. The first section describes the RENP program and its history.…

  1. Cost effectiveness of therapies for atrial fibrillation. A review.

    PubMed

    Teng, M P; Catherwood, L E; Melby, D P

    2000-10-01

    atrial thrombus prior to pharmacological or electrical cardioversion. Further, we discuss the merits and limitations of the cost-effectiveness analyses in the context of overall treatment strategies. Finally, we identify areas that will require additional research to achieve the goal of effective and economically efficient management of atrial fibrillation. PMID:15344302

  2. A Cost Effective System Design Approach for Critical Space Systems

    NASA Technical Reports Server (NTRS)

    Abbott, Larry Wayne; Cox, Gary; Nguyen, Hai

    2000-01-01

    NASA-JSC required an avionics platform capable of serving a wide range of applications in a cost-effective manner. In part, making the avionics platform cost effective means adhering to open standards and supporting the integration of COTS products with custom products. Inherently, operation in space requires low power, mass, and volume while retaining high performance, reconfigurability, scalability, and upgradability. The Universal Mini-Controller project is based on a modified PC/104-Plus architecture while maintaining full compatibility with standard COTS PC/104 products. The architecture consists of a library of building block modules, which can be mixed and matched to meet a specific application. A set of NASA developed core building blocks, processor card, analog input/output card, and a Mil-Std-1553 card, have been constructed to meet critical functions and unique interfaces. The design for the processor card is based on the PowerPC architecture. This architecture provides an excellent balance between power consumption and performance, and has an upgrade path to the forthcoming radiation hardened PowerPC processor. The processor card, which makes extensive use of surface mount technology, has a 166 MHz PowerPC 603e processor, 32 Mbytes of error detected and corrected RAM, 8 Mbytes of Flash, and I Mbytes of EPROM, on a single PC/104-Plus card. Similar densities have been achieved with the quad channel Mil-Std-1553 card and the analog input/output cards. The power management built into the processor and its peripheral chip allows the power and performance of the system to be adjusted to meet the requirements of the application, allowing another dimension to the flexibility of the Universal Mini-Controller. Unique mechanical packaging allows the Universal Mini-Controller to accommodate standard COTS and custom oversized PC/104-Plus cards. This mechanical packaging also provides thermal management via conductive cooling of COTS boards, which are typically

  3. Cost-effectiveness analysis of antipsychotics in reducing schizophrenia relapses

    PubMed Central

    2012-01-01

    Background Schizophrenia is a severe form of mental illness which is associated with significant and long-lasting health, social and financial burdens. The aim of this project is to assess the efficiency of the antipsychotics used in Spain in reducing schizophrenia relapses under the Spanish Health System perspective. Material and methods A decision-analytic model was developed to explore the relative cost-effectiveness of five antipsychotic medications, amisulpride, aripiprazole, olanzapine, paliperidone Extended-Release (ER) and risperidone, compared to haloperidol, over a 1-year treatment period among people living in Spain with schizophrenia. The transition probabilities for assessed therapies were obtained from the systemic review and meta-analysis performed by National Institute for Health and Clinical Excellence (NICE). Results Paliperidone ER was the option that yielded more quality-adjusted life years (QALYs) gained per patient (0.7573). In addition, paliperidone ER was the least costly strategy (€3,062), followed by risperidone (€3,194), haloperidol (€3,322), olanzapine (€3,893), amisulpride (€4,247) and aripiprazole (€4,712). In the incremental cost-effectiveness (ICE) analysis of the assessed antipsychotics compared to haloperidol, paliperidone ER and risperidone were dominant options. ICE ratios for other medications were €23,621/QALY gained, €91,584/QALY gained and €94,558/QALY gained for olanzapine, amisulpride and aripiprazole, respectively. Deterministic sensitivity analysis showed that risperidone is always dominant when compared to haloperidol. Paliperidone ER is also dominant apart from the exception of the scenario with a 20% decrease in the probability of relapses. Conclusions Our findings may be of interest to clinicians and others interested in outcomes and cost of mental health services among patients with schizophrenia. Paliperidone ER and risperidone were shown to be dominant therapies compared to haloperidol in Spain

  4. Cost effectiveness of a pentavalent rotavirus vaccine in Oman

    PubMed Central

    2014-01-01

    Background Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman Methods A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives. Results A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective. Conclusions Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal

  5. Cost-effective learning aids for a variety of learning styles

    SciTech Connect

    Wyckoff, D.J.

    1993-11-01

    Some people learn easily while others find learning difficult. Trainers need to provide a variety of cost-effective learning experiences to meet the needs of all individuals. There are four techniques that can be used individually, in small groups, or in a large group to achieve the required cost effectiveness and aid the learning process. The first is flash cards, the second in a simple computer board that lights up when correct matches are made. The third technique uses popular game show format wherein objectives are used as answers and trainees come up with the questions. Demonstrating the expected learning behavior is the fourth technique, accomplished by guided practice.

  6. Japanese Cancer Association Meeting UICC International session--what is cost-effectiveness in cancer treatment?

    PubMed

    Akaza, Hideyuki; Kawahara, Norie; Roh, Jae Kyung; Inoue, Hajime; Park, Eun-Cheol; Lee, Kwang-Sig; Kim, Sukyeong; Hayre, Jasdeep; Naidoo, Bhash; Wilkinson, Thomas; Fukuda, Takashi; Jang, Woo Ick; Nogimori, Masafumi

    2014-01-01

    The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized an international session as part of the official program of the 72nd Annual Meeting of the Japanese Cancer Association to discuss the topic "What is cost-effectiveness in cancer treatment? " Healthcare economics are an international concern and a key issue for the UICC. The presenters and participants discussed the question of how limited medical resources can be best used to support life, which is a question that applies to both developing and industrialized countries, given that cancer treatment is putting medical systems under increasing strain. The emergence of advanced yet hugely expensive drugs has prompted discussion on methodologies for Health Technology Assessment (HTA) that seek to quantify cost and effect. The session benefited from the participation of various stakeholders, including representatives of industry, government and academia and three speakers from the Republic of Korea, an Asian country where discussion on HTA methodologies is already advanced. In addition, the session was joined by a representative of National Institute for Health and Care Excellence (NICE) of the United Kingdom, which has pioneered the concept of cost-effectiveness in a medical context. The aim of the session was to advance and deepen understanding of the issue of cost-effectiveness as viewed from medical care systems in different regions. PMID:24528045

  7. Cost-effectiveness of prucalopride in the treatment of chronic constipation in the Netherlands

    PubMed Central

    Nuijten, Mark J. C.; Dubois, Dominique J.; Joseph, Alain; Annemans, Lieven

    2015-01-01

    Objective: To assess the cost-effectiveness of prucalopride vs. continued laxative treatment for chronic constipation in patients in the Netherlands in whom laxatives have failed to provide adequate relief. Methods: A Markov model was developed to estimate the cost-effectiveness of prucalopride in patients with chronic constipation receiving standard laxative treatment from the perspective of Dutch payers in 2011. Data sources included published prucalopride clinical trials, published Dutch price/tariff lists, and national population statistics. The model simulated the clinical and economic outcomes associated with prucalopride vs. standard treatment and had a cycle length of 1 month and a follow-up time of 1 year. Response to treatment was defined as the proportion of patients who achieved “normal bowel function”. One-way and probabilistic sensitivity analyses were conducted to test the robustness of the base case. Results: In the base case analysis, the cost of prucalopride relative to continued laxative treatment was € 9015 per quality-adjusted life-year (QALY). Extensive sensitivity analyses and scenario analyses confirmed that the base case cost-effectiveness estimate was robust. One-way sensitivity analyses showed that the model was most sensitive in response to prucalopride; incremental cost-effectiveness ratios ranged from € 6475 to 15,380 per QALY. Probabilistic sensitivity analyses indicated that there is a greater than 80% probability that prucalopride would be cost-effective compared with continued standard treatment, assuming a willingness-to-pay threshold of € 20,000 per QALY from a Dutch societal perspective. A scenario analysis was performed for women only, which resulted in a cost-effectiveness ratio of € 7773 per QALY. Conclusion: Prucalopride was cost-effective in a Dutch patient population, as well as in a women-only subgroup, who had chronic constipation and who obtained inadequate relief from laxatives. PMID:25926794

  8. Acceptance of health technology assessment submissions with incremental cost-effectiveness ratios above the cost-effectiveness threshold

    PubMed Central

    Griffiths, Elizabeth A; Hendrich, Janek K; Stoddart, Samuel DR; Walsh, Sean CM

    2015-01-01

    Objectives In health technology assessment (HTA) agencies where cost-effectiveness plays a role in decision-making, an incremental cost-effectiveness ratio (ICER) threshold is often used to inform reimbursement decisions. The acceptance of submissions with ICERs higher than the threshold was assessed across different agencies and across indications, in order to inform future reimbursement submissions. Methods All HTA appraisals from May 2000 to May 2014 from National Institute for Health and Care Excellence (NICE), Scottish Medicines Consortium (SMC), Pharmaceutical Benefits Advisory Committee (PBAC), and Canadian Agency for Drugs and Technologies in Health (CADTH) were assessed. Multiple technology appraisals, resubmissions, vaccination programs, and requests for advice were excluded. Submissions not reporting an ICER, or for which an ICER could not be determined were also excluded. The remaining appraisals were reviewed, and the submitted ICER, recommendation, and reasoning behind the recommendation were extracted. Results NICE recommended the highest proportion of submissions with ICERs higher than the threshold (34% accepted without restrictions; 20% with restrictions), followed by PBAC (16% accepted without restrictions; 4% with restrictions), SMC (11% accepted without restrictions; 14% accepted with restrictions), and CADTH (0% accepted without restrictions; 26% with restrictions). Overall, the majority of higher-than-threshold ICER submissions were classified into the “malignant disease and immunosuppression” therapeutic category; however, there was no notable variation in acceptance rates by disease area. Reasons for accepting submissions reporting ICERs above the threshold included high clinical benefit over the standard of care, and addressing an unmet therapeutic need. Conclusion Acceptance of submissions with higher-than-threshold ICERs varied by HTA agency and was not significantly influenced by disease category. Such submissions must be

  9. Cost-effective health care: new data.

    PubMed

    Kalies, R F

    1997-06-01

    The key to health care programs that meet their goals is to integrate data, coordinate care and ensure a patient-centered not cost-centered, focus. Then the purchaser can achieve the desired decrease in cost of care, increase in quality of care, improvement in quality of life, improvement in job performance, decrease in disability and decrease in absenteeism. PMID:10168421

  10. Effectiveness and Cost-Effectiveness of Diabetes Prevention among Adherent Participants

    PubMed Central

    Herman, William H.; Edelstein, Sharon L.; Ratner, Robert E.; Montez, Maria G.; Ackermann, Ronald T.; Orchard, Trevor J.; Foulkes, Mary A.; Zhang, Ping; Saudek, Christopher D.; Brown, Morton B.

    2014-01-01

    OBJECTIVES We report the 10 year effectiveness and within-trial cost-effectiveness of the The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) interventions among participants who were adherent to the interventions. STUDY DESIGN DPP was a 3-year randomized clinical trial followed by 7-years of open-label modified intervention followup. METHODS Data on resource utilization, cost, and quality-of-life were collected prospectively. Economic analyses were performed from health system and societal perspectives. Lifestyle adherence was defined as achieving and maintaining a 5% reduction in initial body weight and metformin adherence as taking metformin at 80% of study visits. RESULTS The relative risk reduction was 49.4% among adherent lifestyle participants and 20.8% among adherent metformin participants compared to placebo. Over 10 years, the cumulative, undiscounted, per capita direct medical costs of the interventions, as implemented during the DPP, were greater for adherent lifestyle participants ($4,810) than adherent metformin participants ($2,934) or placebo ($768). Over 10 years, the cumulative, per capita non-intervention-related direct medical costs were $4,250 greater for placebo participants compared to adherent lifestyle participants and $3,251 greater compared to adherent metformin participants. The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.80) than metformin (6.74) or placebo (6.67). Without discounting, from both a modified societal perspective (excluding participant time), lifestyle cost <$5,000 per QALY-gained and metformin was cost-saving compared to placebo. CONCLUSIONS Over 10 years, lifestyle intervention and metformin were cost-saving compared to placebo. These analyses confirm that lifestyle and metformin represent a good value for money. PMID:23544761

  11. Cost Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, Philip

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous United States. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  12. Comparative effectiveness and cost-effectiveness analyses frequently agree on value.

    PubMed

    Glick, Henry A; McElligott, Sean; Pauly, Mark V; Willke, Richard J; Bergquist, Henry; Doshi, Jalpa; Fleisher, Lee A; Kinosian, Bruce; Perfetto, Eleanor; Polsky, Daniel E; Schwartz, J Sanford

    2015-05-01

    The Patient-Centered Outcomes Research Institute, known as PCORI, was established by Congress as part of the Affordable Care Act (ACA) to promote evidence-based treatment. Provisions of the ACA prohibit the use of a cost-effectiveness analysis threshold and quality-adjusted life-years (QALYs) in PCORI comparative effectiveness studies, which has been understood as a prohibition on support for PCORI's conducting conventional cost-effectiveness analyses. This constraint complicates evidence-based choices where incremental improvements in outcomes are achieved at increased costs of care. How frequently this limitation inhibits efficient cost containment, also a goal of the ACA, depends on how often more effective treatment is not cost-effective relative to less effective treatment. We examined the largest database of studies of comparisons of effectiveness and cost-effectiveness to see how often there is disagreement between the more effective treatment and the cost-effective treatment, for various thresholds that may define good value. We found that under the benchmark assumption, disagreement between the two types of analyses occurs in 19 percent of cases. Disagreement is more likely to occur if a treatment intervention is musculoskeletal and less likely to occur if it is surgical or involves secondary prevention, or if the study was funded by a pharmaceutical company. PMID:25941282

  13. Relationships between the quality of blended learning experience, self-regulated learning, and academic achievement of medical students: a path analysis

    PubMed Central

    Kassab, Salah Eldin; Al-Shafei, Ahmad I; Salem, Abdel Halim; Otoom, Sameer

    2015-01-01

    Purpose This study examined the relationships between the different aspects of students’ course experience, self-regulated learning, and academic achievement of medical students in a blended learning curriculum. Methods Perceptions of medical students (n=171) from the Royal College of Surgeons in Ireland, Medical University of Bahrain (RCSI Bahrain), on the blended learning experience were measured using the Student Course Experience Questionnaire (SCEQ), with an added e-Learning scale. In addition, self-regulated learning was measured using the Motivated Strategies for Learning Questionnaire (MSLQ). Academic achievement was measured by the scores of the students at the end of the course. A path analysis was created to test the relationships between the different study variables. Results Path analysis indicated that the perceived quality of the face-to-face component of the blended experience directly affected the motivation of students. The SCEQ scale “quality of teaching” directly affected two aspects of motivation: control of learning and intrinsic goal orientation. Furthermore, appropriate course workload directly affected the self-efficacy of students. Moreover, the e-Learning scale directly affected students’ peer learning and critical thinking but indirectly affected metacognitive regulation. The resource management regulation strategies, time and study environment, and effort regulation directly affected students’ examination scores (17% of the variance explained). However, there were no significant direct relationships between the SCEQ scales and cognitive learning strategies or examination scores. Conclusion The results of this study will have important implications for designing blended learning courses in medical schools. PMID:25610011

  14. An Assessment of the Expected Cost-Effectiveness of Quadrivalent Influenza Vaccines in Ontario, Canada Using a Static Model

    PubMed Central

    Chit, Ayman; Roiz, Julie; Aballea, Samuel

    2015-01-01

    Ontario, Canada, immunizes against influenza using a trivalent inactivated influenza vaccine (IIV3) under a Universal Influenza Immunization Program (UIIP). The UIIP offers IIV3 free-of-charge to all Ontarians over 6 months of age. A newly approved quadrivalent inactivated influenza vaccine (IIV4) offers wider protection against influenza B disease. We explored the expected cost-utility and budget impact of replacing IIV3 with IIV4, within the context of Ontario’s UIIP, using a probabilistic and static cost-utility model. Wherever possible, epidemiological and cost data were obtained from Ontario sources. Canadian or U.S. sources were used when Ontario data were not available. Vaccine efficacy for IIV3 was obtained from the literature. IIV4 efficacy was derived from meta-analysis of strain-specific vaccine efficacy. Conservatively, herd protection was not considered. In the base case, we used IIV3 and IIV4 prices of $5.5/dose and $7/dose, respectively. We conducted a sensitivity analysis on the price of IIV4, as well as standard univariate and multivariate statistical uncertainty analyses. Over a typical influenza season, relative to IIV3, IIV4 is expected to avert an additional 2,516 influenza cases, 1,683 influenza-associated medical visits, 27 influenza-associated hospitalizations, and 5 influenza-associated deaths. From a societal perspective, IIV4 would generate 76 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $4,784,112. The incremental cost effectiveness ratio for this comparison was $63,773/QALY. IIV4 remains cost-effective up to a 53% price premium over IIV3. A probabilistic sensitivity analysis showed that IIV4 was cost-effective with a probability of 65% for a threshold of $100,000/QALY gained. IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3. Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price

  15. Cost-effective alternatives for mitigating Cryptosporidium risk in drinking water and enhancing ecosystem services

    NASA Astrophysics Data System (ADS)

    Bryan, B. A.; Kandulu, J. M.

    2009-08-01

    Under the multibarrier paradigm, water quality management barriers that mitigate risk to consumers are required at multiple points from the catchment to the tap. We present a cost-effectiveness analysis of 13 catchment- and treatment-based management alternatives for mitigating Cryptosporidium risk in the Myponga water supply catchment, South Australia. A broad range of costs and benefits are identified and valued, including setup, operation and maintenance, and opportunity costs, and benefits for ecosystem services including water quality, biodiversity, carbon sequestration, and farm production services. The results suggest that the cost-effectiveness of investment in water quality management can be substantially enhanced by considering the costs of management and the benefits for ecosystem services, in addition to Cryptosporidium removal effectiveness. Cost-effectiveness of investment in management alternatives is dependent upon the desired level of Cryptosporidium removal effectiveness by both the catchment and treatment barriers. The combination of a spatially targeted 25% restriction in water course access of nondairy cattle and treatment by enhanced coagulation provides the most (net) cost-effective Cryptosporidium risk mitigation strategy. This combination may achieve 0.614 log removal at a net cost of A0.7 million and (net) cost-effectiveness of A1.14 million per log removal. Additional risk mitigation can be achieved through the addition of ultraviolet irradiation treatment, higher levels of water course access restriction for cattle, and the adoption of dung beetles in the catchment. Economic valuation of a range of costs and benefits of management priorities can support cost-effective water quality management investment decisions and inform elements of policy design such as cost-sharing arrangements and spatial targeting.

  16. Cost-effectiveness analysis of low density lipoprotein cholesterol-lowering therapy in hypertensive patients with type 2 diabetes in Korea: single-pill regimen (amlodipine/atorvastatin) versus double-pill regimen (amlodipine+atorvastatin)

    PubMed Central

    Park, Ji-Hyun; Lee, Yong-Ho; Ko, Su-Kyoung; Cha, Bong-Soo

    2015-01-01

    OBJECTIVES: Single-pill combination therapy (amlodipine/atorvastatin) might be more effective than double-pill therapy (amlodipine+atorvastatin) in patients with diabetes and concomitant hypertension requiring statin therapy. We compared the cost-effectiveness of a single-pill with that of double-pill for control of low density lipoprotein cholesterol (LDL-C) levels, with the ultimate goal of cardiovascular disease prevention, in these patients using a cost-effectiveness analysis model that considered medication adherence. METHODS: Effectiveness was defined as the percentage (%) attainment of target LDL-C levels (<100 mg/dL) based on adherence for each therapy. Adherence was defined as compliance to medication (≥80% proportion of days covered). A systematic review of the literature was conducted to determine the proportion of patients who were adherent and target goal attainment based on adherence level. The annual medication costs were based on the adherence levels for each regimen. The average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of the target LDL-C level. RESULTS: The ACER for the single-pill regimen was lower than for the double-pill regimen (4,123 vs. 6,062 Korean won per 1% achievement of target goal). Compared with the double-pill, the medication costs were approximately 32% lower with the single-pill. CONCLUSION: A single-pill for reductions in LDL-C is cost-effective compared with double-pill in hypertensive patients with type 2 diabetes. PMID:25773438

  17. Cost effective processes by using negative-tone development application

    NASA Astrophysics Data System (ADS)

    Yamamoto, Kei; Kato, Keita; Ou, Keiyu; Shirakawa, Michihiro; Kamimura, Sou

    2015-03-01

    The high volume manufacturing with extreme ultraviolet (EUV) lithography is delaying due to its light source issue. Therefore, ArF-immersion lithography has still been the most promising technology for down scaling of device pitch. As the limitation of ArF-immersion single patterning is considered to be nearly 40nm half pitch (hp), ArF-immersion lithography has necessity to be extended by combining processes to achieve sub- 20nm hp patterning. Recently, there are many reports about the extension of ArF-immersion lithography, e.g., self-aligned multiple patterning (SAMP) and litho-etch-litho-etch (LELE) process. These methods have been realized by the combination of lithography, deposition, and etching. On the other aspect, 1-D layout is adopted for leading devices, which contains additional cut or block litho and etch processes to form 2-D like layout. Thus, according to the progress of down scaling technologies, number of processes increases and the cost of ownership (CoO) can not be neglected. Especially, the number of lithography steps and etching steps has been expanded by the combination of processes, and it has come to occupy a large portion of total manufacturing cost. We have reported that negative tone development (NTD) system using organic solvent developer have enough resolution to achieve fine narrow trench or contact hole patterning, since negative tone imaging enables to apply bright mask for these pattern with significantly high optical image contrast compared to positive tone imaging, and it has contributed high throughput multiple patterning. On the other hand, NTD system is found to be useful not only for leading device node, but also for cost effective process. In this report, we propose the cost effective process using NTD application. In the viewpoint of cost down at exposure tool, we have developed KrF-NTD resist which is customized for organic solvent developer. Our KrF-NTD resist has resolution comparable with ArF positive tone development

  18. 42 CFR 457.1015 - Cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., the State must assess cost-effectiveness on a case-by-case basis. (d) Reports on family coverage. A State with a waiver under this section must include in its annual report pursuant to § 457.750, the cost... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this...

  19. Study of the Cost-Effectiveness of Retrospective Search Systems.

    ERIC Educational Resources Information Center

    King, Donald W.; Caldwell, Nancy W.

    The purpose of this study was to explore cost-effectiveness factors that affect the choice among alternative systems. A cost-effectiveness model that may be used to evaluate potential systems was derived and a statement of the general magnitude of costs that the American Psychological Association (APA) can expect in implementing and operating…

  20. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... found cost effective for a State transportation department or county to undertake a federally financed... 23 Highways 1 2010-04-01 2010-04-01 false Finding of cost effectiveness. 635.205 Section 635.205 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC...

  1. 49 CFR 639.21 - Determination of cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21 Section 639.21 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of...

  2. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Finding of cost effectiveness. 635.205 Section 635.205 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may...

  3. Cost Effectiveness for Gifted and Talented Educational Programs.

    ERIC Educational Resources Information Center

    Storms, Walt W.

    Presented is a systematic approach for analyzing cost effectiveness of gifted and talented educational programs in terms of categorizing funds, prorating expenditures, designing a data collection form, determining cost effectiveness, and considering multiple variable implications. All costs are reported to be subsumed under six major categories:…

  4. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Presuming cost-effectiveness results. 436.13 Section 436.13 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for...

  5. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Presuming cost-effectiveness results. 436.13 Section 436.13 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for...

  6. The Sunk Cost Effect in Pigeons and Humans

    ERIC Educational Resources Information Center

    Navarro, Anton D.; Fantino, Edmund

    2005-01-01

    The sunk cost effect is the increased tendency to persist in an endeavor once an investment of money, effort, or time has been made. To date, humans are the only animal in which this effect has been observed unambiguously. We developed a behavior-analytic model of the sunk cost effect to explore the potential for this behavior in pigeons as well…

  7. Flinders University School of Medicine, Northern Territory, Australia: Achieving Educational Excellence along with a Sustainable Rural Medical Workforce.

    PubMed

    Worley, Paul

    2008-10-01

    Introduction Medical schools today are being challenged to educate doctors who are willing and able to practice in areas of poverty and workforce need. In many countries, there is a shortage of doctors practicing in rural and remote communities. There is evidence that locating undergraduate medical education in rural areas increases the likelihood that graduates will choose to practice in underserved areas. Through its Parallel Rural Community Curriculum (PRCC), Flinders University School of Medicine (FUSM) now enables over 25% of its students to undertake an entire clinical year based in small rural communities supervised principally by rural family physicians. Objective The PRCC was conceived to provide a high quality educational intervention that would result in an increased number of students choosing to practice in rural and remote Australia. It was also designed to test the hypothesis that small rural and remote practices were capable of facilitating a full year of medical training at a standard comparable to that provided at a major tertiary hospital. Intervention Starting with eight students in four towns in 1997, the PRCC now places 30 students across 18 towns in rural Australia. The students simultaneously learn the disciplines of medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and family medicine. At the end of the year, all Flinders students, regardless of training location, take the same comprehensive exam. Outcomes PRCC students improved their academic performance in comparison to their tertiary trained peers. This improvement has been consistent over the ten years studied. Seventy percent of the PRCC students have chosen to practice in rural locations, compared to 18 percent of tertiary-trained students. Over twelve years, the program has proved to be sustainable in a private practice environment with a workforce shortage. Conclusions Evaluation of the PRCC indicates that a rural community-based clinical education can provide a

  8. Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey

    PubMed Central

    Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

    2016-01-01

    Objective In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. Methods A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Results Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Conclusions Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective. PMID:27322384

  9. Cost-effectiveness of pazopanib compared with sunitinib in metastatic renal cell carcinoma in Canada

    PubMed Central

    Amdahl, J.; Diaz, J.; Park, J.; Nakhaipour, H.R.; Delea, T.E.

    2016-01-01

    Background In Canada and elsewhere, pazopanib and sunitinib—tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptors—are recommended as first-line treatment for patients with metastatic renal cell carcinoma (mrcc). A large randomized noninferiority trial of pazopanib versus sunitinib (comparz) demonstrated that the two drugs have similar efficacy; however, patients randomized to pazopanib experienced better health-related quality of life (hrqol) and nominally lower rates of non-study medical resource utilization. Methods The cost-effectiveness of pazopanib compared with sunitinib for first-line treatment of mrcc from a Canadian health care system perspective was evaluated using a partitioned-survival model that incorporated data from comparz and other secondary sources. The time horizon of 5 years was based on the maximum duration of follow-up in the final analysis of overall survival from the comparz trial. Analyses were conducted first using list prices for pazopanib and sunitinib and then by assuming that the prices of sunitinib and pazopanib would be equivalent. Results Based on list prices, expected costs were CA$10,293 less with pazopanib than with sunitinib. Pazopanib was estimated to yield 0.059 more quality-adjusted life-years (qalys). Pazopanib was therefore dominant (more qalys and lower costs) compared with sunitinib in the base case. In probabilistic sensitivity analyses, pazopanib was dominant in 79% of simulations and was cost-effective in 90%–100% of simulations at a threshold cost-effectiveness ratio of CA$100,000. Assuming equivalent pricing, pazopanib yielded CA$917 in savings in the base case, was dominant in 36% of probabilistic sensitivity analysis simulations, and was cost-effective in 89% of simulations at a threshold cost-effectiveness ratio of CA$100,000. Conclusions Compared with sunitinib, pazopanib is likely to be a cost-effective option for first-line treatment of mrcc from a Canadian health care

  10. Cost-effectiveness of SHINE: A Telephone Translation of the Diabetes Prevention Program

    PubMed Central

    Hollenbeak, Christopher S.; Weinstock, Ruth S.; Cibula, Donald; Delahanty, Linda M.; Trief, Paula M.

    2016-01-01

    BACKGROUND The Support, Health Information, Nutrition, and Exercise (SHINE) trial recently showed that a telephone adaptation of the Diabetes Prevention Program (DPP) lifestyle intervention was effective in reducing weight among patients with metabolic syndrome. The aim of this study is to determine whether a conference call (CC) adaptation was cost effective relative to an individual call (IC) adaptation of the DPP lifestyle intervention in the primary care setting. METHODS We performed a stochastic cost-effectiveness analysis alongside a clinical trial comparing two telephone adaptations of the DPP lifestyle intervention. The primary outcomes were incremental cost-effectiveness ratios estimated for weight loss, body mass index (BMI), waist circumference, and quality-adjusted life years (QALYs). Costs were estimated from the perspective of society and included direct medical costs, indirect costs, and intervention costs. RESULTS After one year, participants receiving the CC intervention accumulated fewer costs ($2,831 vs. $2,933) than the IC group, lost more weight (6.2 kg vs. 5.1 kg), had greater reduction in BMI (2.1 vs. 1.9), and had greater reduction in waist circumference (6.5 cm vs. 5.9 cm). However, participants in the CC group had fewer QALYs than those in the IC group (0.635 vs. 0.646). The incremental cost-effectiveness ratio for CC vs. IC was $9,250/QALY, with a 48% probability of being cost-effective at a willingness-to-pay of $100,000/QALY. CONCLUSIONS CC delivery of the DPP was cost effective relative to IC delivery in the first year in terms of cost per clinical measure (weight lost, BMI, and waist circumference) but not in terms of cost per QALY, most likely because of the short time horizon. PMID:27429556

  11. Cost Effectiveness of Colorectal Cancer Screening Interventions with Their Effects on Health Disparity Being Considered

    PubMed Central

    Lee, Kwang-Sig; Park, Eun-Cheol

    2016-01-01

    Purpose The purpose of this study was to evaluate the cost effectiveness of colorectal cancer screening interventions with their effects on health disparity being considered. Materials and Methods Markov cohort simulation was conducted with the cycle/duration of 1/40 year(s). Data came from the results of randomized trials and others. Participants were hypothetical cohorts aged 50 years as of year 2013 in 16 Korean provinces. The interventions until the age of 80 were annual organized fecal occult blood test (FOBT) (standard screening), annual FOBT with basic reminders for provinces with higher mortalities than the national average (targeted reminder) and annual FOBT with basic/enhanced reminders for all provinces (universal reminder 1 and 2). The comparison was non-screening, the outcome was quality-adjusted life years, and only medical costs for screening and treatment were considered from a societal perspective. The Atkinson incremental cost effectiveness ratio (Atkinson ICER), the incremental cost effectiveness ratio adjusted by the Atkinson Inequality Index, was used to evaluate the cost effectiveness of the four interventions with their impacts on regional health disparity being considered. Results Health disparity was smallest (or greatest) in non-screening (or the standard screening). The targeted reminder had smaller health disparity, and smaller Atkinson ICER with respect to standard screening, than did the universal reminder 1 and 2. Conclusion The targeted reminder might be more cost effective than the universal reminders with their effects on health disparity being considered. This study helps to develop promotional effort for colorectal cancer screening with both the greatest cost effectiveness and the smallest health disparity PMID:26727714

  12. A new angle for glp-1 receptor agonist: the medical economics argument. Editorial on: Huetson P, Palmer JL, Levorsen A, et al. Cost-effectiveness of the once-daily glp-1 receptor agonist lixisenatide compared to bolus insulin both in combination with basal insulin for the treatment of patients with type 2 diabetes in Norway. J Med Econ 2015: 1-13 [Epub ahead of print].

    PubMed

    Valencia, Willy Marcos; Florez, Hermes Jose

    2015-01-01

    Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are relatively new medications for diabetes that offer a weight-loss profile that can be considered desirable for patients with both type 2 diabetes (T2D) and obesity. GLP-1 RA are effective in combination with insulin, and even slightly superior or at least equal to short-acting insulin in T2D; however, since they work in the incretin system, they may not be effective in long-standing disease. Additionally, only recently have publications reported their cardiovascular safety, and there is limited evidence for long-term effectiveness. The work presented by Huetson et al. offers a much needed perspective through a medical economic model for the long term cost-effectiveness of GLP-1 RA. The authors found benefits in quality-adjusted life years and reduced lifetime healthcare costs. While there are a few limitations, this study contributes to the understanding of these agents and their impact on the epidemics of obesity in T2D, where weight management is no longer an option, but an essential component of the diabetes plan of care. PMID:26337323

  13. Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

    PubMed Central

    2012-01-01

    Background Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China. Methods A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces. Results and discussion A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both

  14. Cost-effectiveness of levonorgestrel subdermal implants. Comparison with other contraceptive methods available in the United States.

    PubMed

    Ashraf, T; Arnold, S B; Maxfield, M

    1994-10-01

    The objective of this analysis was to evaluate and compare the cost-effectiveness of eight contraceptive methods: condoms, diaphragms, oral contraceptives, intrauterine devices, medroxyprogesterone acetate suspension, levonorgestrel subdermal implants, tubal ligation and vasectomy. Based on a comprehensive review of the literature and various additional data sources, this analysis identified, measured and compared direct costs of the methods, physician visits, treatment of adverse effects and cost of failure (i.e., mean cost for all types of deliveries or first-trimester abortion). Medical benefits (if any) resulting from each contraceptive method were calculated and considered in the analysis as cost savings. The cost of method failure proved to be the greatest influence on cost-effectiveness. Sterilization was identified as the most cost-effective method overall. Of the reversible methods, the intrauterine device was found to be the most cost-effective, followed by levonorgestrel implants. PMID:7837126

  15. Cost-Effective Hyperspectral Transmissometers for Oceanographic Applications: Performance Analysis

    PubMed Central

    Ramírez-Pérez, Marta; Röttgers, Rüdiger; Torrecilla, Elena; Piera, Jaume

    2015-01-01

    The recent development of inexpensive, compact hyperspectral transmissometers broadens the research capabilities of oceanographic applications. These developments have been achieved by incorporating technologies such as micro-spectrometers as detectors as well as light emitting diodes (LEDs) as light sources. In this study, we evaluate the performance of the new commercial LED-based hyperspectral transmissometer VIPER (TriOS GmbH, Rastede, Germany), which combines different LEDs to emulate the visible light spectrum, aiming at the determination of attenuation coefficients in coastal environments. For this purpose, experimental uncertainties related to the instrument stability, the effect of ambient light and derived temperature, and salinity correction factors are analyzed. Our results identify some issues related to the thermal management of the LEDs and the contamination of ambient light. Furthermore, the performance of VIPER is validated against other transmissometers through simultaneous field measurements. It is demonstrated that VIPER provides a compact and cost-effective alternative for beam attenuation measurements in coastal waters, but it requires the consideration of several optimizations. PMID:26343652

  16. Phycoremediation: key issues for cost-effective nutrient removal processes.

    PubMed

    Olguín, Eugenia J

    2003-12-01

    Phycoremediation applied to the removal of nutrients from animal wastewater and other high organic content wastewater is a field with a great potential and demand considering that surface and underground water bodies in several regions of the world are suffering of eutrophication. However, the development of more efficient nutrient removal algal systems requires further research in key areas. Algae growth rate controls directly and indirectly the nitrogen and phosphorus removal efficiency. Thus, maximum algae productivity is required for effective nutrient removal and must be considered as a key area of research. Likewise, low harvesting costs are also required for a cost-effective nutrient removal system. The use of filamentous microalgae with a high autoflocculation capacity and the use of immobilized cells have been investigated in this respect. Another key area of research is the use of algae strains with special attributes such as tolerance to extreme temperature, chemical composition with predominance of high added value products, a quick sedimentation behavior, or a capacity for growing mixotrophically. Finally, to combine most of the achievements from key areas and to design integrated recycling systems (IRS) should be an ultimate and rewarding goal. PMID:14623045

  17. Reliable and cost-effective serodiagnosis of rheumatoid arthritis.

    PubMed

    Meyer, Pieter W A; Ally, Mahmood M T M; Anderson, Ronald

    2016-06-01

    Early diagnosis of patients with rheumatoid arthritis (RA) optimises therapeutic benefit and the probability of achieving disease remission. Notwithstanding clinical acumen, early diagnosis is dependent on access to reliable serodiagnostic procedures, as well as on the discerning application and interpretation of these. In the case of RA, however, no disease-specific serodiagnostic procedure is available due to the multi-factorial and polygenic nature of this autoimmune disorder. This has resulted in the development of an array of serodiagnostic procedures based on the detection of autoantibodies reactive with various putative autoantigens. Other procedures based on measurement of elevations in the concentrations of systemic biomarkers of inflammation, most commonly acute phase reactants and cytokines/chemokines, are used as objective indices of disease activity. Following a brief overview of RA research in African populations, the current review is focused on those autoantibodies/biomarkers, specifically rheumatoid factor, anti-citrullinated peptide antibodies and C-reactive protein, which are currently recognised as being the most reliable and cost-effective with respect to disease prediction and diagnosis, as well as in monitoring activity and outcome. PMID:26856871

  18. Cost-Effectiveness of Intervention Thresholds for the Treatment of Osteoporosis Based on FRAX(®) in Portugal.

    PubMed

    Marques, Andréa; Lourenço, Óscar; Ortsäter, Gustaf; Borgström, Fredrik; Kanis, John A; da Silva, José António P

    2016-08-01

    Cost-effective intervention thresholds (ITs) based on FRAX(®) were determined for Portugal. Assuming a willingness to pay (WTP) of €32,000 per quality-adjusted life years (QALYs), treatment with generic alendronate is cost effective for men and women aged 50 years or more, with 10-year probabilities for major osteoporotic fractures and hip above 8.8 and 2.5 %, respectively. The aim of the present study was to identify the 10-year probabilities of a major and hip osteoporotic fracture using FRAX(®) validated for Portugal, above which pharmacologic interventions become cost effective in the Portuguese context. A previously developed and validated state transition Markov cohort model was populated with epidemiologic, economic and quality-of-life fracture data from Portugal. Cost-effectiveness of FRAX(®)-based ITs was calculated for generic alendronate and proprietary zoledronic acid, denosumab and teriparatide were compared to "no intervention", assuming a WTP of €32,000 (two times national Gross Domestic Product per capita) per QALYs. In the Portuguese epidemiological and economic context, treatment with generic alendronate was cost effective for men and women aged 50 years or more, with 10-year probabilities at or above 8.8 % for major osteoporotic fractures and 2.5 % for hip fractures. Cost-effective threshold 10-year probabilities for major osteoporotic and hip fractures were higher for zoledronic acid (20.4 and 10.1 %), denosumab (34.9 and 10.1 %) and teriparatide (77.8 and 62.6 %), respectively. A tool is provided to perform the calculation of cost-effective ITs for different medications, according to age group and diverse levels of WTP. Cost-effective ITs, for different medications, age groups and WTP, based on 10-year probabilities of major and hip fracture probabilities calculated with FRAX are provided. PMID:27016370

  19. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: The case of Mexico

    PubMed Central

    Valencia-Mendoza, Atanacio; Bertozzi, Stefano M; Gutierrez, Juan-Pablo; Itzler, Robbin

    2008-01-01

    Background In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. Methods A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Results Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. Conclusion At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be

  20. Cost-effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in children of Peru

    PubMed Central

    2013-01-01

    Background The clinical and economic burden associated with invasive and non-invasive pneumococcal and non-typeable Haemophilus influenzae (NTHi) diseases is substantial in the Latin America and Caribbean region, where pneumococcal vaccines have only been introduced to a few countries. This study analyzed the cost-effectiveness and cost utility of three different pneumococcal conjugate vaccines (PCVs) for Peru. Methods A Markov model that simulated the disease processes in a birth cohort over a lifetime, within 1,128 month cycles was used to evaluate the cost-effectiveness of 10-valent pneumococcal NTHi protein D conjugate vaccine (PHiD-CV) and 7- and 13-valent PCVs (PCV-7 and PCV-13). Expected quality-adjusted life years (QALYs), cost-savings and incremental cost-effectiveness ratios (ICERs) were calculated. Results Without vaccination, pneumonia was associated with the greatest health economic burden (90% of QALYs lost and 63% of lifetime direct medical costs); while acute otitis media (AOM) was responsible for 1% of QALYs lost and 25% of direct medical costs. All vaccines were predicted to be cost-effective for Peru, with PHiD-CV being most cost-effective. PHiD-CV was predicted to generate 50 more QALYs gained and required a reduced investment (−US$ 3.4 million) versus PCV-13 (discounted data), and was therefore dominant and cost saving. The probabilistic sensitivity analysis showed that PHiD-CV generated more QALYs gained at a reduced cost than PCV-13 in 84% of the simulations and less QALYs gains at a reduced cost in 16%. Additional scenarios using different assumptions on vaccine efficacies based on previous evidence were explored, but no significant change in the overall cost-effective results were observed. Conclusions The results of this modeling study predict that PCVs are likely to be a cost-effective strategy to help relieve the epidemiological and economic burden associated with pediatric pneumococcal and NTHi diseases for Peru. PHiD-CV is likely

  1. Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries

    PubMed Central

    Marseille, Elliot; Jiwani, Aliya; Raut, Abhishek; Verguet, Stéphane; Walson, Judd; Kahn, James G

    2014-01-01

    Objective This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases. Methods We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer's perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars. Primary and secondary outcomes The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted. Results Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness. Conclusions IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC

  2. Thresholds for the cost-effectiveness of interventions: alternative approaches.

    PubMed

    Marseille, Elliot; Larson, Bruce; Kazi, Dhruv S; Kahn, James G; Rosen, Sydney

    2015-02-01

    Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources. PMID:25883405

  3. Critical Research for Cost-Effective Photoelectrochemical Production of Hydrogen

    SciTech Connect

    Xu, Liwei; Deng, Xunming; Abken, Anka; Cao, Xinmin; Du, Wenhui; Vijh, Aarohi; Ingler, William; Chen, Changyong; Fan, Qihua; Collins, Robert; Compaan, Alvin; Yan, Yanfa; Giolando, Dean; Turner, John

    2014-10-29

    The objective of this project is to develop critical technologies required for cost-effective production of hydrogen from sunlight and water using a-Si triple junction solar cell based photo-electrodes. In this project, Midwest Optoelectronics, LLC (MWOE) and its collaborating organizations utilize triple junction a-Si thin film solar cells as the core element to fabricate photoelectrochemical (PEC) cells. Triple junction a-Si/a-SiGe/a-SiGe solar cell is an ideal material for making cost-effective PEC system which uses sun light to split water and generate hydrogen. It has the following key features: 1) It has an open circuit voltage (Voc ) of ~ 2.3V and has an operating voltage around 1.6V. This is ideal for water splitting. There is no need to add a bias voltage or to inter-connect more than one solar cell. 2) It is made by depositing a-Si/a-SiGe/aSi-Ge thin films on a conducting stainless steel substrate which can serve as an electrode. When we immerse the triple junction solar cells in an electrolyte and illuminate it under sunlight, the voltage is large enough to split the water, generating oxygen at the Si solar cell side (for SS/n-i-p/sunlight structure) and hydrogen at the back, which is stainless steel side. There is no need to use a counter electrode or to make any wire connection. 3) It is being produced in large rolls of 3ft wide and up to 5000 ft long stainless steel web in a 25MW roll-to-roll production machine. Therefore it can be produced at a very low cost. After several years of research with many different kinds of material, we have developed promising transparent, conducting and corrosion resistant (TCCR) coating material; we carried out extensive research on oxygen and hydrogen generation catalysts, developed methods to make PEC electrode from production-grade a-Si solar cells; we have designed and tested various PEC module cases and carried out extensive outdoor testing; we were able to obtain a solar to hydrogen conversion efficiency (STH

  4. Controlling Reactive Nitrogen: Attaining Cost Effectiveness and Institutional Alignment

    NASA Astrophysics Data System (ADS)

    Doering, O.

    2012-12-01

    The fact that reactive nitrogen (Nr) cascades by changing form and moving between air, land and water makes its management and control especially difficult. The cascade means that excess Nr's negative impacts may initially occur, flow through, or linger in air, land or water. The critical question becomes where and how to interdict, not only in terms of technical capacity but also in terms of cost effectiveness and institutional capacity. The nature of Nr also needs to inform the questions that need to be asked to be able to deal with Nr. For much of the world, agriculture is the major contributor to Nr.The stark trade-off often involves excess Nr that is the product of increased food production. As it is often the largest source of excess Nr, agriculture has to be a focus for Nr control and management efforts. This paper will start with the Nr balance sheet for the US and outline some of the trade-offs and opportunities for controlling Nr.The institutional responsibility and capacity to take effective action will be assessed on the basis of US institutions and their history. This will involve illustrating some of the difficulties posed by the cascading nature of Nr as it movesfrom one regulatory jurisdiction to another. Within the US agricultural sector. the history and politics of dealing with such problems will be traced as they relate to the willingness and capacity of the sector to more effectively control or manage problems like Nr. The institutional history of the sector has a strong influence onwhat can be accomplished in a cost effective way - one that is very different from the history and practice in Australia or Europe. The EPA Science Advisory Boards' suggestion that a twenty five percent reduction in excess Nr should be achievable will be traced through for agriculture and allied situations illustrating some of the possibilities and dilemmas. Finally, the issue of metrics will be addressed. As a caution to policy makers, one can obtain very different

  5. The cost-effectiveness of a school-based smoking prevention program in India.

    PubMed

    Brown, H Shelton; Stigler, Melissa; Perry, Cheryl; Dhavan, Poonam; Arora, Monika; Reddy, K Srinath

    2013-06-01

    Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50,000 for a life-year. PMID:22271928

  6. The cost-effectiveness of a school-based smoking prevention program in India

    PubMed Central

    Brown, H. Shelton; Stigler, Melissa; Perry, Cheryl; Dhavan, Poonam; Arora, Monika; Reddy, K. Srinath

    2013-01-01

    Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50 000 for a life-year. PMID:22271928

  7. Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence.

    PubMed

    Moraes, Edilaine; Campos, Geraldo M; Figlie, Neliana B; Laranjeira, Ronaldo; Ferraz, Marcos B

    2010-01-01

    The purpose of this study was to compare the cost-effectiveness of conventional outpatient treatment for alcoholic patients (CT) with this same conventional treatment plus home visits (HV), a new proposal for intervention within the Brazilian outpatient treatment system. A cost-effectiveness evaluation alongside a 12-week randomized clinical trial was performed. We identified the resources utilized by each intervention, as well as the cost according to National Health System (SUS), Brazilian Medical Association (AMB) tables of fees, and others based on 2005 data. The incremental cost-effectiveness ratio (ICER) was estimated as the main outcome measure - abstinent cases at the end of treatment. There were 51.8% abstinent cases for HV and 43.1% for CT, a clinically relevant finding. Other outcome measures, such as quality of life, also showed significant improvements that favored HV. The baseline scenario presented an ICER of USD 1,852. Sensitivity analysis showed an ICER of USD 689 (scenario favoring HV) and USD 2,334 (scenario favoring CT). The HV treatment was found to be cost-effective according to the WHO Commission on Macroeconomics and Health. PMID:20029212

  8. Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

    PubMed Central

    Beresniak, Ariel; Caruba, Thibaut; Sabatier, Brigitte; Juillière, Yves; Dubourg, Olivier; Danchin, Nicolas

    2015-01-01

    The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available. PMID:26516413

  9. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    PubMed Central

    2011-01-01

    Background Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showed inconsistent results for these vaccines because of lack of consensus on the impact. We aimed to investigate which factors had a major impact on cost-effectiveness and were primarily responsible for the large differences in previously estimated cost-effectiveness ratios. Methods Based on updated data on health outcomes and cost estimates, we re-assessed the cost-effectiveness of routine paediatric rotavirus vaccination within the National Immunization Program for the Netherlands. Two consensus meetings were organised with national and international experts in the field to achieve consensus and resolve potential controversies. Results It was estimated that rotavirus vaccination in the Netherlands could avert 34,214 cases of rotavirus gastroenteritis in children aged less than 5 years. Notably, 2,779 hospitalisations were averted of which 315 were extensions of existing hospital stays due to nosocomial rotavirus infection. With a threshold varying from 20K€ - 50K€ per QALY and according to the base-case scenario, the full vaccination costs per child leading to cost-effectiveness was €57.76 -€77.71. Results were sensitive to the inclusion of potential vaccine induced herd protection, QALY losses and number of deaths associated with rotavirus gastroenteritis. Conclusions Our economic analysis indicates that inclusion of rotavirus vaccination in the Dutch National Immunization Program might be cost-effective depending on the cost of the vaccine and the impact of rotavirus gastroenteritis on children's quality of life. PMID:21663620

  10. A cost-effective target supply for inertial fusion energy

    NASA Astrophysics Data System (ADS)

    Goodin, D. T.; Alexander, N. B.; Brown, L. C.; Frey, D. T.; Gallix, R.; Gibson, C. R.; Maxwell, J. L.; Nobile, A.; Olson, C.; Petzoldt, R. W.; Raffray, R.; Rochau, G.; Schroen, D. G.; Tillack, M.; Rickman, W. S.; Vermillion, B.

    2004-12-01

    A central feature of an inertial fusion energy (IFE) power plant is a target that has been compressed and heated to fusion conditions by the energy input of the driver. This is true whether the driver is a laser system, heavy ion beams or Z-pinch system. The IFE target fabrication, injection and tracking programmes are focusing on methods that will scale to mass production. We are working closely with target designers, and power plant systems specialists, to make specifications and material selections that will satisfy a wide range of required and desirable target characteristics. One-of-a-kind capsules produced for today's inertial confinement fusion experiments are estimated to cost about US2500 each. Design studies of cost-effective power production from laser and heavy-ion driven IFE have suggested a cost goal of about 0.25-0.30 for each injected target (corresponding to ~10% of the 'electricity value' in a target). While a four orders of magnitude cost reduction may seem at first to be nearly impossible, there are many factors that suggest this is achievable. This paper summarizes the design, specifications, requirements and proposed manufacturing processes for the future for laser fusion, heavy ion fusion and Z-pinch driven targets. These target manufacturing processes have been developed—and are proposed—based on the unique materials science and technology programmes that are ongoing for each of the target concepts. We describe the paradigm shifts in target manufacturing methodologies that will be needed to achieve orders of magnitude reductions in target costs, and summarize the results of 'nth-of-a-kind' plant layouts and cost estimates for future IFE power plant fuelling. These engineering studies estimate the cost of the target supply in a fusion economy, and show that costs are within the range of commercial feasibility for electricity production.

  11. Cost-effective suppression and eradication of invasive predators.

    PubMed

    Baxter, Peter W J; Sabo, John L; Wilcox, Chris; McCarthy, Michael A; Possingham, Hugh P

    2008-02-01

    predators can have pronounced effects on naïve prey species; thus, predator control is often essential for conservation of threatened native species. Complete eradication of the predator, although desirable, may be elusive in budget-limited situations, whereas predator suppression is more feasible and may still achieve conservation goals. We used a stochastic predator-prey model based on a Lotka-Volterra system to investigate the cost-effectiveness of predator control to achieve prey conservation. We compared five control strategies: immediate eradication, removal of a constant number of predators (fixed-number control), removal of a constant proportion of predators (fixed-rate control), removal of predators that exceed a predetermined threshold (upper-trigger harvest), and removal of predators whenever their population falls below a lower predetermined threshold (lower-trigger harvest). We looked at the performance of these strategies when managers could always remove the full number of predators targeted by each strategy, subject to budget availability. Under this assumption immediate eradication reduced the threat to the prey population the most. We then examined the effect of reduced management success in meeting removal targets, assuming removal is more difficult at low predator densities. In this case there was a pronounced reduction in performance of the immediate eradication, fixed-number, and lower-trigger strategies. Although immediate eradication still yielded the highest expected minimum prey population size, upper-trigger harvest yielded the lowest probability of prey extinction and the greatest return on investment (as measured by improvement in expected minimum population size per amount spent). Upper-trigger harvest was relatively successful because it operated when predator density was highest, which is when predator removal targets can be more easily met and the effect of predators on the prey is most damaging. This suggests that controlling

  12. [Considerations of screening and brief intervention among high-risk drinkers in Japan: from the perspectives of feasibility and cost-effectiveness].

    PubMed

    Taguchi, Yurie; Yoshimoto, Hisashi; Ikeda, Shunya

    2016-02-01

    One of the alcohol-related goals in Japan's health promotion campaign called Health Japan 21 (secondary term) is to reduce the number of high-risk drinkers (20 years old or above) who consume 40g or more pure alcohol/day in men and 20g or more in women by year 2022. To achieve this goal, a further expansion of screening and brief intervention (SBI) in the medical setting is essential. In this research, realistic and cost-effective SBI scenarios in Japan were investigated based on international systematic review and clinicians' opinions from a semi-structured interview. Several SBI scenarios were built with 2 levels of intervention based on the AUDIT scores of 8-15 (brief advice) and 16-19 (brief advice and counseling, continuous intervention), and a simulation was conducted by applying different probabilities and success rates into the scenarios. Information associated with preparation and implementation of SBI at the 2 levels was also estimated and annual costs of SBI per drinker were calculated. It was found that approximately 2,390,000 and 530,000 high-risk drinkers require brief and extensive interventions, respectively. Furthermore, incremental costs per quality-adjusted life year (QALY) gained were calculated at 723,415 yen for brief intervention and 944,762 yen for extensive intervention, suggesting cost-effectiveness of SBI in Japan. Given the limited national healthcare budget and operational challenges such as time to provide SBI especially in the primary care setting in Japan, roles of healthcare providers and wider use of information technology were discussed with some suggestions. Furthermore, lighter and more frequent interventions at various levels and not only at the medical setting but also at multiple social settings (such as workplace and among family and friends) were discussed to increase the cost-effectiveness of SBI and to keep the number of high-risk drinkers who have successfully reduced their alcohol consumption. PMID:27295821

  13. Incentives for cost-effective physician behavior.

    PubMed

    Maynard, A

    1987-04-01

    The objective of the National Health Service is to maximise improvements in the health status of patients regardless of their willingness and ability to pay. To achieve this objective it is necessary to identify those procedures which maximise improvements in health or quality adjusted life years (QALYs) and direct scarce resources to those therapies with the best cost-QALY characteristics. Unfortunately in the NHS and elsewhere cost-QALY characteristics are largely unknown and the structure of the health service and its provider remuneration systems are such that objectives are vague, behavior perverse due to the haphazard construction of incentive systems, and health status outcomes often unknown due to the failure to evaluate input-outcome relationships. To reform the NHS, in particular ensure more efficient practice by physicians, existing perverse incentives will have to be replaced by the use of buyer (NHS) power and by budgeting mechanisms which induce economizing behavior. It is not clear which type of incentive mechanism will produce outcomes consistent with NHS goals. To remedy this ignorance experimentation with careful evaluation would seem appropriate. PMID:10312074

  14. Achieving standardized medication data in clinical research studies: two approaches and applications for implementing RxNorm.

    PubMed

    Richesson, Rachel L; Smith, Susan B; Malloy, Jamie; Krischer, Jeffrey P

    2010-08-01

    The National Institutes of Health has proposed a roadmap for clinical research. Test projects of this roadmap include centralized data management for distributed research, the harmonization of clinical and research data, and the use of data standards throughout the research process. In 2003, RxNorm was named as a standard for codifying clinical drugs. Clinical researchers looking to implement RxNorm have few template implementation plans. Epidemiological studies and clinical trials (types of clinical research) have different requirements for model standards and best implementation tools. This paper highlights two different (epidemiological and intervention) clinical research projects, their unique requirements for a medication standard, the suitability of RxNorm as a standard for each, and application and process requirements for implementation. It is hoped that our experience of selecting and implementing the RxNorm standard to address varying study requirements in both domestic and international settings will be of value to other efforts. PMID:20703919

  15. Information-seeking Behavior During Residency Is Associated With Quality of Theoretical Learning, Academic Career Achievements, and Evidence-based Medical Practice

    PubMed Central

    Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

    2015-01-01

    Abstract Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3–6; range, 1–10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77–17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33–4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09–4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01–3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46–11.53); knowledge of the leading medical journals of the

  16. Orienting Nursing Students to Cost Effective Clinical Practice.

    ERIC Educational Resources Information Center

    Lessner, Muriel W.; And Others

    1994-01-01

    Describes five principles for cost-effective clinical practice: efficient use of self, efficient use of equipment and supplies, delegation of work, critical path method, and organization of the environment. (SK)

  17. Construction industry cost effectiveness; It does have an impact

    SciTech Connect

    Schappa, P.J. )

    1989-01-01

    This paper reports on the Construction Industry Cost Effectiveness (CICE) project. Northern States Power (NSP) decided to implement many suggestions proposed in the CICE report to improve labor productivity for their 800 MW project. With the project successfully completed in 1987 on time and within budget, this paper reviews the Construction Industry Cost Effectiveness strategies employed by Northern States Power and their impact on the project.

  18. Acceptance and rejection: cost-effectiveness and the working nephrologist.

    PubMed

    McFarlane, Philip A; Bayoumi, Ahmed M

    2004-11-01

    While many nephrologists have developed a sophisticated approach to appraising clinical trials, an equal comfort in critiquing cost-effectiveness literature is often lagging. Readers can wonder how new results compare to those from other cost-effectiveness trials, and whether they should accept a new intervention as cost-effective or reject it as too costly for the benefit it produces. Critical readers should first judge whether the authors have made the correct trade-off between complexity and generalizability when selecting a study perspective, and should examine the method of linkage between costs and effectiveness. The most popular method is the incremental cost-effectiveness ratio (ICER), which has limitations that have led some authors to prefer the net monetary benefit (NMB), where confidence intervals are more easily determined and which can more readily be used in regression analyses. Interpretation of the ICER and NMB require the choice of a cost-effectiveness ceiling, representing the maximum that society would be willing to pay for an incremental health benefit, and the development of a decision rule based on this maximum. Comparing cost-effectiveness studies from different disciplines requires the use of "universal" effectiveness measures, such as the quality-adjusted life-year (QALY). An understanding of study perspective, the relative strengths of different cost-effectiveness measures, the methods for measuring uncertainty in these estimates, and how to select and use cost-effectiveness ceiling ratios will help the critical reader to determine if a new intervention should be accepted or rejected. PMID:15496144

  19. Cost-effectiveness of vaccination against herpes zoster

    PubMed Central

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN. PMID:25424815

  20. Denosumab for Elderly Men with Osteoporosis: A Cost-Effectiveness Analysis from the US Payer Perspective.

    PubMed

    Silverman, Stuart; Agodoa, Irene; Kruse, Morgan; Parthan, Anju; Orwoll, Eric

    2015-01-01

    Purpose. To evaluate the cost-effectiveness of denosumab versus other osteoporotic treatments in older men with osteoporosis from a US payer perspective. Methods. A lifetime cohort Markov model previously developed for postmenopausal osteoporosis (PMO) was used. Men in the model were 78 years old, with a BMD T-score of -2.12 and a vertebral fracture prevalence of 23%. During each 6-month Markov cycle, patients could have experienced a hip, vertebral or nonhip, nonvertebral (NHNV) osteoporotic fracture, remained in a nonfracture state, remained in a postfracture state, or died. Background fracture risks, mortality rates, persistence rates, health utilities, and medical and drug costs were derived from published sources. Previous PMO studies were used for drug efficacy in reducing fracture risk. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, risedronate, ibandronate, teriparatide, and zoledronate. Results. Denosumab had an incremental cost-effectiveness ratio (ICER) of $16,888 compared to generic alendronate and dominated all other treatments. Results were most sensitive to changes in costs of denosumab and the relative risk of hip fracture. Conclusion. Despite a higher annual treatment cost compared to other medications, denosumab is cost-effective compared to other osteoporotic treatments in older osteoporotic US men. PMID:26783494

  1. Denosumab for Elderly Men with Osteoporosis: A Cost-Effectiveness Analysis from the US Payer Perspective

    PubMed Central

    Silverman, Stuart; Agodoa, Irene; Kruse, Morgan; Parthan, Anju; Orwoll, Eric

    2015-01-01

    Purpose. To evaluate the cost-effectiveness of denosumab versus other osteoporotic treatments in older men with osteoporosis from a US payer perspective. Methods. A lifetime cohort Markov model previously developed for postmenopausal osteoporosis (PMO) was used. Men in the model were 78 years old, with a BMD T-score of −2.12 and a vertebral fracture prevalence of 23%. During each 6-month Markov cycle, patients could have experienced a hip, vertebral or nonhip, nonvertebral (NHNV) osteoporotic fracture, remained in a nonfracture state, remained in a postfracture state, or died. Background fracture risks, mortality rates, persistence rates, health utilities, and medical and drug costs were derived from published sources. Previous PMO studies were used for drug efficacy in reducing fracture risk. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, risedronate, ibandronate, teriparatide, and zoledronate. Results. Denosumab had an incremental cost-effectiveness ratio (ICER) of $16,888 compared to generic alendronate and dominated all other treatments. Results were most sensitive to changes in costs of denosumab and the relative risk of hip fracture. Conclusion. Despite a higher annual treatment cost compared to other medications, denosumab is cost-effective compared to other osteoporotic treatments in older osteoporotic US men. PMID:26783494

  2. A New Cost-effective Method of NPWT in Diabetic Foot Wound.

    PubMed

    Vaidhya, Nikunj; Panchal, Arpit; Anchalia, M M

    2015-12-01

    Diabetic foot wounds present a great challenge to surgeons. They are difficult to heal and are a significant risk factor for non-traumatic foot amputation besides being a huge financial burden. NPWT systems commercially available (VAC™ system, KCI Inc., USA) are costly precluding widespread use. To determine whether negative-pressure wound therapy (NPWT) would afford quicker wound recovery as compared to saline-moistened gauze in the treatment of diabetic foot wounds. Sixty patients were randomized into either the experimental NPWT group or conventional dressing group (control). All patients were given medical therapy for diabetes and antibiotics given according to culture and sensitivity patterns. All foot ulcers were surgically debrided prior to initiation of NPWT or conventional treatment. In the NPWT group, dressings were changed every 48-72 h. In the control group, conventional dressings were applied at the time of surgical debridement and changed twice a day thereafter. End point of study was when wound was ready for either skin grafting or secondary suturing. End point was achieved in the NPWT group in 17.2(SD ± 3.55) days, compared to 34.9 (SD ± 5.96) days in the control group (p < 0.001). Number of dressing applied were 7.46(SD ± 2.25) in NPWT group versus 69.8(SD ± 11.93) in conventional dressing group (p < 0.001). Ninety percent cases were successfully treated in NPWT Group as compared to 76.6 % in conventional group. Rate of healing of ulcer is faster in NPWT group as compared to conventional group. Economically modified NPWT is more cost-effective to the patients in our setup. PMID:26730058

  3. Emission control cost-effectiveness of alternative-fuel vehicles

    SciTech Connect

    Wang, Q.; Sperling, D.; Olmstead, J.

    1993-06-14

    Although various legislation and regulations have been adopted to promote the use of alternative-fuel vehicles for curbing urban air pollution problems, there is a lack of systematic comparisons of emission control cost-effectiveness among various alternative-fuel vehicle types. In this paper, life-cycle emission reductions and life-cycle costs were estimated for passenger cars fueled with methanol, ethanol, liquefied petroleum gas, compressed natural gas, and electricity. Vehicle emission estimates included both exhaust and evaporative emissions for air pollutants of hydrocarbon, carbon monoxide, nitrogen oxides, and air-toxic pollutants of benzene, formaldehyde, 1,3-butadiene, and acetaldehyde. Vehicle life-cycle cost estimates accounted for vehicle purchase prices, vehicle life, fuel costs, and vehicle maintenance costs. Emission control cost-effectiveness presented in dollars per ton of emission reduction was calculated for each alternative-fuel vehicle types from the estimated vehicle life-cycle emission reductions and costs. Among various alternative-fuel vehicle types, compressed natural gas vehicles are the most cost-effective vehicle type in controlling vehicle emissions. Dedicated methanol vehicles are the next most cost-effective vehicle type. The cost-effectiveness of electric vehicles depends on improvements in electric vehicle battery technology. With low-cost, high-performance batteries, electric vehicles are more cost-effective than methanol, ethanol, and liquified petroleum gas vehicles.

  4. Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation.

    PubMed

    Javitz, Harold S; Zbikowski, Susan M; Deprey, Mona; McAfee, Timothy A; McClure, Jennifer B; Richards, Julie; Catz, Sheryl L; Jack, Lisa M; Swan, Gary E

    2011-03-01

    There is a lack of evidence of the relative cost-effectiveness of proactive telephone counseling (PTC) and Web-based delivery of smoking cessation services in conjunction with pharmacotherapy. We calculated the differential cost-effectiveness of three behavioral smoking cessation modalities with varenicline treatment in a randomized trial of current smokers from a large health system. Eligible participants were randomized to one of three smoking cessation interventions: Web-based counseling (n=401), PTC (n=402), or combined PTC-Web counseling (n=399). All participants received a standard 12-week course of varenicline. The primary outcome was a 7-day point prevalent nonsmoking at the 6month follow-up. The Web intervention was the least expensive followed by the PTC and PTC-Web groups. Costs per additional 6-month nonsmoker and per additional lifetime quitter were $1,278 and $2,601 for Web, $1,472 and $2,995 for PTC, and $1,617 and $3,291 for PTC-Web. Cost per life-year (LY) and quality-adjusted life-year (QALY) saved were $1,148 and $1,136 for Web, $1,320 and $1,308 for PTC, and $1,450 and $1,437 for PTC-Web. Based on the cost per LY and QALY saved, these interventions are among the most cost-effective life-saving medical treatments. Web, PTC, and combined PTC-Web treatments were all highly cost-effective, with the Web treatment being marginally more cost-effective than the PTC or combined PTC-Web treatments. PMID:21731592

  5. Cost-effective electric vehicle charging infrastructure siting for Delhi

    NASA Astrophysics Data System (ADS)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6–7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ∼10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  6. Manufactured Homes Simulated Thermal Analysis and Cost Effectiveness Report.

    SciTech Connect

    Baylon, David

    1990-05-17

    In 1988 and 1989, 150 manufactured homes were built to comply with Super Good Cents (SGC) specifications adapted from the existing specifications for site-built homes under the Residential Construction Demonstration Project (RCDP). Engineering calculations and computer simulations were used to estimate the effects of the SGC specifications on the thermal performance of the homes. These results were compared with consumer costs to establish the cost-effectiveness of individual measures. Heat loss U-factors for windows, walls, floors and ceilings were established using the standard ASHRAE parallel heat flow method. Adjustments resulted in higher U-factors for ceilings and floors than assumed at the time the homes were approved as meeting the SGC specifications. Except for those homes which included heat pumps, most of the homes did not meet the SGC compliance standards. Nonetheless these homes achieved substantial reductions in overall heat loss rate (UA) compared to UAs estimated for the same homes using the standard insulation packages provided by the manufacturers in the absence of the RCDP program. Homes with conventional electric furnaces showed a 35% reduction in total UA while homes with heat pumps had a 25% reduction. A regression analysis showed no significant relationship between climate zone, manufacturer and UA. A modified version of SUNDAY building simulation program which simulates duct and heat pump performance was used to model the thermal performance of each RCDP home as built and the same home as it would have been built without SGC specifications (base case). Standard assumptions were used for thermostat setpoint, thermal mass, internal gains and infiltration rates. 11 refs., 5 figs., 5 tabs.

  7. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

    PubMed Central

    Reddy, Vikram K.; Girish, K.; Lakshmi, Pandit; Vijendra, R.; Kumar, Ajay; Harsha, R.

    2014-01-01

    Objectives: Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods: This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient's perspective and third-party perspective. Results: The average cost-effectiveness ratio (ACER) in patient's perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03). Conclusion: Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide. PMID:25097273

  8. Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus

    PubMed Central

    Tang, Qi; Sun, Zhipeng; Zhang, Nengwei; Xu, Guangzhong; Song, Peipei; Xu, Lingzhong; Tang, Wei

    2016-01-01

    Abstract To compare the remission of type 2 diabetes mellitus (T2DM) through treatment with laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB), and to analyze the cost-effectiveness of medical treatment, LSG, and LRYGB in T2DM patients (BMI ≥ 28). A 2-group randomized controlled trial was conducted at Diabetes Surgery Centre, Beijing Shijitan Hospital in Beijing, China. Subjects were 80 patients ages 16 to 65 years with a body mass index of 28 kg/m2 or more and duration of T2DM no more than 15 years. Subjects were randomly assigned (1:1) to undergo either LSG (n = 40) or LRYGB (n = 40) between February 3, 2011 and October 31, 2013. Of those patients, 72 (90%) were available at follow-up at 2 years. These patients included 34 (85%) who underwent LSG and 38 (95%) who underwent LRYGB. This study presents the follow-up data at 2 years, which compared LSG and LRYGB in T2DM patients. Partial remission and complete remission were determined, and weight loss, BMI, changes in abdominal circumference, cholesterol, and triglycerides were measured. The cost-effectiveness of each type of bariatric surgery was analyzed with a Markov simulation model that yielded quality-adjusted life-years (QALYs) and costs. From our analysis results, LSG and LRYGB are both have taken a great effect on the reduction of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and bodyweight in patients with T2DM. The cost-effectiveness ratios of medical treatment, LSG, and LRYGB respectively are 1589.02, 1028.97, and 1197.44 dollars per QALY. Our analysis indicates that LSG appear to provide a cost-effective method of T2DM treatment for the patients. PMID:27196454

  9. Cost-Effectiveness of Proton Beam Therapy for Intraocular Melanoma

    PubMed Central

    Moriarty, James P.; Borah, Bijan J.; Foote, Robert L.; Pulido, Jose S.; Shah, Nilay D.

    2015-01-01

    Purpose Proton beam therapy is a commonly accepted treatment for intraocular melanomas, but the literature is lacking in descriptions of patient preferences of clinical outcomes and economic impact. In addition, no economic evaluations have been published regarding the incremental cost-effectiveness of proton beam therapy compared with enucleation or plaque brachytherapy, typical alternative treatments. We, therefore, conducted a cost-utility analysis of these three approaches for the treatment of intraocular melanomas. Materials and Methods A Markov model was constructed. Model parameters were identified from the published literature and publicly available data sources. Cost-effectiveness of each treatment was calculated in 2011 US Dollars per quality-adjusted life-year. Incremental cost-effectiveness ratios were calculated assuming enucleation as reference. One-way sensitivity analyses were conducted on all model parameters. A decision threshold of $50,000/quality-adjusted life-year was used to determine cost-effectiveness. Results Enucleation had the lowest costs and quality-adjusted life-years, and plaque brachytherapy had the highest costs and quality-adjusted life-years. Compared with enucleation, the base-case incremental cost-effectiveness ratios for plaque brachytherapy and proton beam therapy were $77,500/quality-adjusted life-year and $106,100/quality-adjusted life-year, respectively. Results were highly sensitive to multiple parameters. All three treatments were considered optimal, and even dominant, depending on the values used for sensitive parameters. Conclusion Base-case analysis results suggest enucleation to be optimal. However, the optimal choice was not robust to sensitivity analyses and, depending on the assumption, both plaque brachytherapy and proton beam therapy could be considered cost-effective. Future clinical studies should focus on generating further evidence with the greatest parameter uncertainty to inform future cost-effectiveness

  10. Cost-effective management alternatives for Snake river chinook salmon: A biological-economic synthesis

    USGS Publications Warehouse

    Halsing, D.L.; Moore, M.R.

    2008-01-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  11. The cost-effectiveness of primary care referral to a UK commercial weight loss programme.

    PubMed

    Meads, D M; Hulme, C T; Hall, P; Hill, A J

    2014-12-01

    Primary care referral to commercial weight loss programmes that follow best practice is included in current UK guidance on the management of adult obesity. This study investigated whether such a programme was cost-effective compared with usual care. A decision-analytical Markov model was developed to estimate the lifetime costs and benefits of the referral programme compared with usual care and enable a cost-utility analysis. The model cohort transited between body mass index classifications and type 2 diabetes, stroke and myocardial infarction (MI) with risk, cost and effect parameter values taken from published literature. The cost per incremental quality-adjusted life year (QALY) was calculated. Extensive deterministic and scenario sensitivity analyses and probabilistic sensitivity analyses (PSA) were conducted. At 12 months, the incremental cost-effectiveness ratio was £6906, indicating that programme referral was cost-effective. Over a lifetime, referral to the commercial programme was dominant as it led to a cost saving of £924 and conferred incremental benefit (0.22 QALY) over usual care. Model simulations estimated lower lifetime rates of type 2 diabetes, stroke and MI as a result of the weight loss achieved. The results were robust to extensive sensitivity analyses. The PSA indicated that programme referral had a 68% chance of being cost-effective at a willingness to pay per incremental QALY threshold of £20,000. Referral to the programme dominated usual care, being both cheaper and more effective. These results compare favourably with economic evaluations of other obesity interventions and add to a growing evidence base on the cost-effectiveness of commercial weight loss providers and practices. PMID:25826162

  12. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    PubMed

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value. PMID

  13. Cost-effective management alternatives for Snake River Chinook salmon: a biological-economic synthesis.

    PubMed

    Halsing, David L; Moore, Michael R

    2008-04-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  14. Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy.

    PubMed

    O'Connor, Alec B

    2009-01-01

    A number of different diseases or injuries can damage the central or peripheral nervous system and produce neuropathic pain (NP), which seems to be more difficult to treat than many other types of chronic pain. As a group, patients with NP have greater medical co-morbidity burden than age- and sex-adjusted controls, which makes determining the humanistic and economic burden attributable to NP challenging. Health-related quality of life (HR-QOL) is substantially impaired among patients with NP. Patients describe pain-related interference in multiple HR-QOL and functional domains, as well as reduced ability to work and reduced mobility due to their pain. In addition, the spouses of NP patients have been shown to experience adverse social consequences related to NP. In randomized controlled trials, several medications have been shown to improve various measures of HR-QOL. Changes in HR-QOL appear to be tightly linked to pain relief, but not to the development of adverse effects. However, in cross-sectional studies, many patients continue to have moderate or severe pain and markedly impaired HR-QOL, despite taking medications prescribed for NP. The quality of NP treatment appears to be poor, with few patients receiving recommended medications in efficacious dosages. The substantial costs to society of NP derive from direct medical costs, loss of the ability to work, loss of caregivers' ability to work and possibly greater need for institutionalization or other living assistance. No single study has measured all of these costs to society for chronic NP. The cost effectiveness of various interventions for the treatment or prevention of different types of NP has been assessed in several different studies. The most-studied diseases are post-herpetic neuralgia and painful diabetic neuropathy, for which tricyclic antidepressants (both amitriptyline and desipramine) have been found to be either cost effective or dominant relative to other strategies. Increasing the use of

  15. Cost-effectiveness and Pricing of Antibacterial Drugs

    PubMed Central

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of ‘value’, which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. PMID:25521641

  16. Cost effectiveness of type 2 diabetes screening: A systematic review

    PubMed Central

    Najafi, Behzad; Farzadfar, Farshad; Ghaderi, Hossein; Hadian, Mohammad

    2016-01-01

    Background: Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically. Methods: We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond’s checklist for appraising the quality of studies. Results: The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies. Conclusion: A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening. PMID:27390696

  17. Cost-Effectiveness of Antiretroviral Therapy for Prevention

    PubMed Central

    Kahn, James G; Marseille, Elliot A; Bennett, Rod; Williams, Brian G; Granich, Reuben

    2011-01-01

    Recent empirical studies and analyses have heightened interest in the use of expanded antiretroviral therapy (ART) for prevention of HIV transmission. However, ART is expensive, approximately $600 per person per year, raising issues of the cost and cost-effectiveness of ambitious ART expansion. The goal of this review is to equip the reader with the conceptual tools and substantive background needed to understand and evaluate the policy and programmatic implications of cost-effectiveness assessments of ART for prevention. We provide this review in six sections. We start by introducing and explaining basic concepts of health economics as they relate to this issue, including resources, costs, health metrics (such as Disability-Adjusted Life Years), and different types of economic analysis. We then review research on the cost and cost-effectiveness of ART as treatment, and on the cost-effectiveness of traditional HIV prevention. We describe critical issues in the epidemic impact of ART, such as suppression of transmission and the role of the acute phase of infection. We then present a conceptual model for conducting and interpreting cost-effectiveness analyses of ART as prevention, and review the existing preliminary estimates in this area. We end with a discussion of future directions for programmatic demonstrations and evaluation. PMID:21999776

  18. Cost-effectiveness and pricing of antibacterial drugs.

    PubMed

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of 'value', which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. PMID:25521641

  19. Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care.

    PubMed

    Ivbijaro, G; Patel, V; Chisholm, D; Goldberg, D; Khoja, T A M; Edwards, T M; Enum, Y; Kolkiewic, L A

    2015-07-01

    For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries. PMID:26442888

  20. The Cost Effectiveness of Fracture Stimulation in Increasing the Flow from Geothermal Wells

    SciTech Connect

    Brown, Gerald L.

    1983-12-15

    The cost effectiveness of fracture stimulation at The Geysers, the Imperial Valley, and other geothermal resource areas in the United States vas studied using GEOCOM, a computer code for analyzing the impact of completion activities on the life-cycle costs of geothermal wells. Technologies for fracturing the reservoir near the wellbore involve the creation of a pressure pulse in the wellbore by means of either hydraulic or explosive force. The cost of a single fracture stimulation job can vary from $50,000 to over $500,000, with a typical cost of around $300,000. The code shows that additional flow achieved by fracture stimulation must exceed 10,000 pounds per hour for each $100,000 invested in stimulation in order for a fracture treatment to be cost effective. In some reservoirs, this additional flow must be as great as 30,000 pounds per hour. The cost effectiveness of fracturing has not yet been demonstrated in the field. The Geothermal Well Stimulation Program achieved an overall average of about 10,000 pounds per hour for each $100,000 invested.

  1. Cost-effectiveness of losartan-based therapy in patients with hypertension and left ventricular hypertrophy: a UK-based economic evaluation of the Losartan Intervention for Endpoint reduction in hypertension (LIFE) study.

    PubMed

    McInnes, G; Burke, T A; Carides, G

    2006-01-01

    The Losartan Intervention for Endpoint reduction in hypertension (LIFE) study demonstrated the clinical benefit of losartan-based therapy in hypertensive patients with left ventricular hypertrophy (LVH), mainly due to a highly significant 25% reduction in the relative risk of stroke compared with an atenolol-based regimen, for a similar reduction in blood pressure. The aim of this economic evaluation was to estimate the cost-effectiveness of losartan compared with atenolol from a UK national health system perspective. Quality-adjusted survival and direct medical costs were modelled beyond the trial using the within-trial incidence of stroke. Survival with stroke, study medication use and quality of life by stroke status were taken directly from the LIFE trial. The LIFE data were supplemented with UK data on lifetime direct medical costs of stroke and life expectancy in individuals without stroke. No additional stroke events or use of study treatment were assumed beyond the trial. Costs and benefits were discounted using current UK Treasury rates. In the base-case analysis, the reduction in stroke-related costs (by 968 sterling pound) offset 86% of the increase in study medication costs (1128 sterling pound) among losartan-treated patients. The incremental cost-effectiveness ratio (ICER) for losartan versus atenolol in hypertensive patients with LVH was 2130 sterling pound per quality-adjusted life year (QALY) gained (3195 Euro/QALY), and this increased to 11,352 sterling pound per QALY gained (16,450 Euro/QALY) when the costs of stroke beyond the first 5 years were excluded. Thus, the clinical benefit of losartan was achieved at a cost well within reported thresholds for cost-effectiveness. PMID:16357874

  2. Direct estimation of the cost effectiveness of tornado shelters.

    PubMed

    Simmons, Kevin M; Sutter, Daniel

    2006-08-01

    This article estimates the cost effectiveness of tornado shelters using the annual probability of a tornado and new data on fatalities per building struck by a tornado. This approach differs from recent estimates of the cost effectiveness of tornado shelters in Reference 1 that use historical casualties. Historical casualties combine both tornado risk and resident action. If residents of tornado-prone states take greater precautions, observed fatalities might not be much higher than in states with lower risk. Estimation using the tornado probability avoids this potential bias. Despite the very different method used, the estimates are 68 million US dollars in permanent homes and 6.0 million US dollars in mobile homes in Oklahoma using a 3% real discount rate, within about 10% of estimates based on historical fatalities. The findings suggest that shelters provide cost-effective protection for mobile homes in the most tornado-prone states but not for permanent homes. PMID:16948687

  3. A Layered Decision Model for Cost-Effective System Security

    SciTech Connect

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

  4. Assessing the Costs and Cost-Effectiveness of Genomic Sequencing

    PubMed Central

    Christensen, Kurt D.; Dukhovny, Dmitry; Siebert, Uwe; Green, Robert C.

    2015-01-01

    Despite dramatic drops in DNA sequencing costs, concerns are great that the integration of genomic sequencing into clinical settings will drastically increase health care expenditures. This commentary presents an overview of what is known about the costs and cost-effectiveness of genomic sequencing. We discuss the cost of germline genomic sequencing, addressing factors that have facilitated the decrease in sequencing costs to date and anticipating the factors that will drive sequencing costs in the future. We then address the cost-effectiveness of diagnostic and pharmacogenomic applications of genomic sequencing, with an emphasis on the implications for secondary findings disclosure and the integration of genomic sequencing into general patient care. Throughout, we ground the discussion by describing efforts in the MedSeq Project, an ongoing randomized controlled clinical trial, to understand the costs and cost-effectiveness of integrating whole genome sequencing into cardiology and primary care settings. PMID:26690481

  5. Balancing efficiency, cost-effectiveness and patient choice in opioid selection.

    PubMed

    Davies, J; McVicar, A

    2000-01-01

    Recent UK government initiatives have stressed the importance of patient choice in health care. In relation to palliative care, this involves the achievement of the best quality of life, respect for patient autonomy and choice over treatment options. Regarding selection of analgesic, the treatment options are evaluated by considering efficacy and potency, routes of delivery, titration and conversion, adverse effects and cost effectiveness. This article explores these issues in relation to the rationale for choice of strong opioids. Morphine and diamorphine are usually considered the most effective, 'first-line' analgesics but is this necessarily the case when patient choice is put into the equation? There is a case for more flexibility in selecting the opioid depending upon individual circumstances. Opioid selection should take into account quality of life issues. However the scope for opioid selection seems likely to be restricted by considerations of cost effectiveness. The challenge is to ensure that the patient voice is heard. PMID:12271245

  6. Money Matters: Cost Effectiveness of Juvenile Drug Court with and without Evidence-Based Treatments

    PubMed Central

    Sheidow, Ashli J.; Jayawardhana, Jayani; Bradford, W. David; Henggeler, Scott W.; Shapiro, Steven B.

    2012-01-01

    The 12-month cost effectiveness of juvenile drug court and evidence-based treatments within Court were compared with traditional Family Court for 128 substance abusing/dependent juvenile offenders participating in a four-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes. PMID:22389577

  7. Money Matters: Cost Effectiveness of Juvenile Drug Court with and without Evidence-Based Treatments.

    PubMed

    Sheidow, Ashli J; Jayawardhana, Jayani; Bradford, W David; Henggeler, Scott W; Shapiro, Steven B

    2012-01-01

    The 12-month cost effectiveness of juvenile drug court and evidence-based treatments within Court were compared with traditional Family Court for 128 substance abusing/dependent juvenile offenders participating in a four-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes. PMID:22389577

  8. Cost-Effectiveness of a Physician-Pharmacist Collaboration Intervention to Improve Blood Pressure Control.

    PubMed

    Polgreen, Linnea A; Han, Jayoung; Carter, Barry L; Ardery, Gail P; Coffey, Christopher S; Chrischilles, Elizabeth A; James, Paul A

    2015-12-01

    Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability, lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now (CAPTION) trial randomized 625 patients from 32 medical offices in 15 states. Each office had an existing clinical pharmacist on staff. Pharmacists in intervention offices communicated with patients and made recommendations to physicians about changes in therapy. Demographic information, blood pressure (BP), medications, and physician visits were recorded. In addition, pharmacists tracked time spent with each patient. Costs were assigned to medications and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in BP measurements and hypertension control rates. Thirty-eight percent of patients were black, 14% were Hispanic, and 49% had annual income <$25 000. At 9 months, average systolic BP was 6.1 mm Hg lower (±3.5), diastolic was 2.9 mm Hg lower (±1.9), and the percentage of patients with controlled hypertension was 43% in the intervention group and 34% in the control group. Total costs for the intervention group were $1462.87 (±132.51) and $1259.94 (±183.30) for the control group, a difference of $202.93. The cost to lower BP by 1 mm Hg was $33.27 for systolic BP and $69.98 for diastolic BP. The cost to increase the rate of hypertension control by 1 percentage point in the study population was $22.55. Our results highlight the cost-effectiveness of a clinical pharmacy intervention for hypertension control in primary care settings. PMID:26527048

  9. COST EFFECTIVENESS OF A PHYSICIAN-PHARMACIST COLLABORATION INTERVENTION TO IMPROVE BLOOD PRESSURE CONTROL

    PubMed Central

    Polgreen, Linnea A.; Han, Jayoung; Carter, Barry L.; Ardery, Gail P.; Coffey, Christopher S.; Chrischilles, Elizabeth A.; James, Paul A.

    2015-01-01

    Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability: lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now trial randomized 625 patients from 32 medical offices in 15 states. Each office had an existing clinical pharmacist on staff. Pharmacists in intervention offices communicated with patients and made recommendations to physicians about changes in therapy. Demographic information, blood pressure, medications and physician visits were recorded. In addition, pharmacists tracked time spent with each patient. Costs were assigned to medications, and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in blood pressure measurements and hypertension-control rates. Thirty-eight percent of patients were black, 14% were Hispanic, and 49% had annual income <$25,000. At 9 months, average systolic blood pressure was 6.1 mm Hg lower (+/− 3.5), diastolic was 2.9 mm Hg lower (+/− 1.9), and the percentage of patients with controlled hypertension was 43% in the intervention group and 34% in the control group. Total costs for the intervention group were $1462.87 (+/− 132.51), and $1259.94 (+/− 183.30) for the control group, a difference of $202.93. The cost to lower blood pressure by 1 mmHg was $33.27 for systolic blood pressure and $69.98 for diastolic blood pressure. The cost to increase the rate of hypertension control by one percentage point in the study population was $22.55. Our results highlight the cost-effectiveness of a clinical pharmacy intervention for hypertension control in primary care settings. PMID:26527048

  10. Cost-effectiveness of rituximab in refractory cold agglutinin disease.

    PubMed

    Panwar, U; Mathews, C; Cullis, J O

    2008-08-01

    Cold haemagglutinin disease (CHAD) is an uncommon condition frequently associated with B-cell lymphoproliferative disorders and is refractory to conventional treatments used in autoimmune haemolytic anaemia. Rituximab has been used in this condition with favourable and lasting responses. Cost has been a major limitation to its use in such indication. We present cost-effectiveness analysis of the use of rituximab in two patients with CHAD. Rituximab successfully controlled haemolysis in both cases of CHAD and was found to be cost-effective through reducing transfusion needs. PMID:18665831

  11. Cost effective use of liquid nitrogen in cryogenic wind tunnels

    NASA Technical Reports Server (NTRS)

    Mcintosh, Glen E.; Lombard, David S.; Martindale, David L.; Dunn, Robert P.

    1987-01-01

    A method of reliquefying from 12 to 19% of the nitrogen exhaust gas from a cryogenic wind tunnel has been developed. Technical feasibility and cost effectiveness of the system depends on performance of an innovative positive displacement expander which requires scale model testing to confirm design studies. The existing cryogenic system at the 0.3-m transonic cryogenic tunnel has been surveyed and extensive upgrades proposed. Upgrades are generally cost effective and may be implemented immediately since they are based on established technology.

  12. [Haute Autorite de sante opinion on cost-effectiveness of health products : results and perspectives].

    PubMed

    Midy, Fabienne; Raimond, Véronique; Thébaut, Clémence; Sambuc, Cléa; Rumeau-Pichon, Catherine

    2015-01-01

    Since 3rd October 2013 in France, drug companies applying for reimbursement of an innovative and expensive drug or medical device are required to provide the French National Authority for Health (HAS) with a cost-effectiveness assessment of their product. After a methodological audit of the economic evaluation submitted by the drug company, the Health Economics and Public Health Committee (CEESP) issues an opinion on the expected or observed cost-effectiveness. This opinion is sent to the Pricing Committee (CEPS) which determines the price of the product. After summarizing the French reimburse'!lent and pricing system, the objective of this article is to review the first 22 months of activity, in which HAS issued 30 cost-effectiveness opinions. The process, based on exchanges between drug companies and HAS, allowed the pricing committee to document the economic criterion in the majority of applications, while characterizing the degree of uncertainty of the results. For ten applications, major methodological concerns led the CEESP to reject the drug company's assessment. PMID:26752035

  13. A new method of estimating cost effectiveness of cholesterol reduction therapy for prevention of heart disease.

    PubMed

    Kinlay, S; O'Connell, D; Evans, D; Halliday, J

    1994-03-01

    The purpose of this study was to demonstrate a new method of estimating the cost effectiveness of interventions that lower blood cholesterol levels in the prevention of coronary heart disease (CHD) at the community level. The participants in the study were 67 651 men aged 35 to 64 years in the Lower Hunter region of New South Wales, Australia. Census data, risk factor profiles and CHD event rates from community surveillance, plus costs in 1988-1989 Australian dollars, were used as inputs to a computer program that used a logistic equation. The output estimated the CHD events avoided and the cost effectiveness of an intervention that identified and treated men with cholesterol levels greater than 6.5 mmol/L with dietary modification and cholestyramine. The cost of implementation of the intervention was $A50.1 million to prevent 104 CHD events. The cost-effectiveness ratio was $A482 224 per CHD event avoided (SD = $A24 761) and the direct medical costs avoided were approximately $A500 000 over a 5-year period ($A4535.07 per CHD event avoided). Drug acquisition costs contributed substantially (88%) to the total costs of interventions that rely on screening to identify individuals with high cholesterol for intensive treatment. PMID:10146898

  14. Evaluating the cost effectiveness of national program for control of blindness in Jorhat district, India

    PubMed Central

    Laskar, Nasrin B.

    2015-01-01

    Background: We evaluated the cost of different components of the national program for control of blindness (NPCB) and assess the cost effectiveness of this program. Materials and Methods: An observational study was conducted in Jorhat District of Assam, India from July 2009 to June 2010 for assessing the cost effectiveness of the NPCB. Four broad categories of cost inputs, that is, capital costs, recurrent costs, prime/variable costs, and fixed costs were considered. The cost incurred by the provider was taken as the actual cost of delivery of different component of services to the patients, which was calculated from the costs of labor, material, and capital costs using the time utilization pattern recommended by WHO. Result: The District Blindness Control Society, Jorhat had spent 58.93% of total expense on fixed heads of which 65.86% had been spent for cataract surgery. The medical care cost was found to be Indian rupee (INR) 425 for intracapsular cataract extraction (ICCE), INR 675 for extracapsular cataract extraction + intraocular lens (ECCE + IOL) and INR 225 for refractive error correction. The patient-wise provider cost was estimated to be INR 519 for ICCE, INR 769 for ECCE + IOL implantation and INR 319 for spectacle correction of refractive error. Conclusion: National program for control of blindness is a cost effective means of controlling and treating blindness. PMID:26283841

  15. Cost-effectiveness of pazopanib in advanced soft tissue sarcoma in the United kingdom.

    PubMed

    Amdahl, Jordan; Manson, Stephanie C; Isbell, Robert; Chit, Ayman; Diaz, Jose; Lewis, Lily; Delea, Thomas E

    2014-01-01

    In the phase III PALETTE trial, pazopanib improved progression-free survival (PFS) compared with placebo in patients with advanced/metastatic soft tissue sarcomas (mSTS) who had received prior chemotherapy. We used a multistate model to estimate expected PFS, overall survival (OS), lifetime STS treatment costs, and quality-adjusted life-years (QALYs) for patients receiving pazopanib, placebo, trabectedin, ifosfamide, or gemcitabine plus docetaxel as second-line mSTS therapies. The cost-effectiveness of pazopanib was expressed as the incremental costs per QALY gained. Estimates of PFS/OS, adverse events, and utilities for pazopanib and placebo were from the PALETTE trial. Estimates of relative effectiveness of the other comparators were from an unadjusted indirect comparison versus pazopanib. Costs were from published sources. Pazopanib is estimated to increase QALYs by 0.128 and costs by £7,976 versus placebo; cost per QALY gained with pazopanib versus placebo is estimated to be £62,000. Compared with the other chemotherapies, pazopanib provides similar QALYs at a lower cost. Pazopanib may not be cost-effective versus placebo but may be cost-effective versus the most commonly used active treatments, although this conclusion is uncertain. Given the unmet need for effective treatments for mSTS, pazopanib may be an appropriate alternative to some currently used medications in the United Kingdom. PMID:25024640

  16. Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil

    PubMed Central

    Guerra, Augusto Afonso; Silva, Grazielle Dias; Andrade, Eli Iola Gurgel; Cherchiglia, Mariângela Leal; Costa, Juliana de Oliveira; Almeida, Alessandra Maciel; Acurcio, Francisco de Assis

    2015-01-01

    OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. However, regimens containing cyclosporine were more cost-effective. PMID:25741648

  17. Cost-effectiveness of measures to prevent classical swine fever introduction into The Netherlands.

    PubMed

    De Vos, C J; Saatkamp, H W; Huirne, R B M

    2005-09-12

    Recent history has demonstrated that classical swine fever (CSF) epidemics can incur high economic losses, especially for exporting countries that have densely populated pig areas and apply a strategy of non-vaccination, such as The Netherlands. Introduction of CSF virus (CSFV) remains a continuing threat to the pig production sector in The Netherlands. Reducing the annual probability of CSFV introduction (P(CSFV)) by preventive measures is therefore of utmost importance. The choice of preventive measures depends not only on the achieved reduction of the annual P(CSFV), but also on the expenditures required for implementing these measures. The objective of this study was to explore the cost-effectiveness of tactical measures aimed at the prevention of CSFV introduction into The Netherlands. For this purpose for each measure (i) model calculations were performed with a scenario tree model for CSFV introduction and (ii) its annual cost was estimated. The cost-effectiveness was then determined as the reduction of the annual P(CSFV) achieved by each preventive measure (DeltaP) divided by the annual cost of implementing that measure (DeltaC). The measures analysed reduce the P(CSFV) caused by import or export of pigs. Results showed that separation of national and international transport of pigs is the most cost-effective measure, especially when risk aversion is assumed. Although testing piglets and breeding pigs by a quick and reliable PCR also had a high cost-effectiveness ratio, this measure is not attractive due to the high cost per pig imported. Besides, implementing such a measure is not allowed under current EU law, as it is trade restrictive. PMID:15927286

  18. Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure

    PubMed Central

    Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D.

    2015-01-01

    Study objective We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. Methods We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient’s characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Results Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP’s being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. Conclusion The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. PMID:25737210

  19. A conceptual model to estimate cost effectiveness of the indoor environment improvements

    SciTech Connect

    Seppanen, Olli; Fisk, William J.

    2003-06-01

    Macroeconomic analyses indicate a high cost to society of a deteriorated indoor climate. The few example calculations performed to date indicate that measures taken to improve IEQ are highly cost-effective when health and productivity benefits are considered. We believe that cost-benefit analyses of building designs and operations should routinely incorporate health and productivity impacts. As an initial step, we developed a conceptual model that shows the links between improvements in IEQ and the financial gains from reductions in medical care and sick leave, improved work performance, lower employee turn over, and reduced maintenance due to fewer complaints.

  20. A Cost-Effective Mindfulness Stress Reduction Program: A Randomized Control Trial for Breast Cancer Survivors.

    PubMed

    Lengacher, Cecile A; Kip, Kevin E; Reich, Richard R; Craig, Benjamin M; Mogos, Mulubrhan; Ramesar, Sophia; Paterson, Carly L; Farias, Jerrica R; Pracht, Etienne

    2015-01-01

    Many breast cancer survivors continue to experience residual symptoms including anxiety, cognitive impairment, depression, fatigue, and pain. In this study, the cost-effectiveness of a Mindfulness-Based Stress Reduction intervention for breast cancer survivors was examined. The cost of the program was assessed from the societal perspective, accounting for both direct medical and patient opportunity costs. The cost per quality-adjusted life year was relatively low compared to the cost-utility findings of other published breast cancer interventions. The program appears to provide for significantly improved health-related quality of life at a comparativelv low cost. PMID:26477119

  1. Cost-Effectiveness of Rotavirus Vaccination for Under-Five Children in Iran

    PubMed Central

    Shakerian, Sareh; Moradi Lakeh, Maziar; Esteghamati, Abdoulreza; Zahraei, Mohsen; Yaghoubi, Mohsen

    2015-01-01

    Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran’s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98% coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300%, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100% and 300% for Rotarix and 300% for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested. PMID:26396704

  2. Cost-effectiveness of additional catheter-directed thrombolysis for deep vein thrombosis

    PubMed Central

    ENDEN, T.; RESCH, S.; WHITE, C.; WIK, H. S.; KLØW, N. E.; SANDSET, P. M.

    2013-01-01

    Summary Background Additional treatment with catheter-directed thrombolysis (CDT) has recently been shown to reduce post-thrombotic syndrome (PTS). Objectives To estimate the cost effectiveness of additional CDT compared with standard treatment alone. Methods Using a Markov decision model, we compared the two treatment strategies in patients with a high proximal deep vein thrombosis (DVT) and a low risk of bleeding. The model captured the development of PTS, recurrent venous thromboembolism and treatment-related adverse events within a lifetime horizon and the perspective of a third-party payer. Uncertainty was assessed with one-way and probabilistic sensitivity analyzes. Model inputs from the CaVenT study included PTS development, major bleeding from CDT and utilities for post DVT states including PTS. The remaining clinical inputs were obtained from the literature. Costs obtained from the CaVenT study, hospital accounts and the literature are expressed in US dollars ($); effects in quality adjusted life years (QALY). Results In base case analyzes, additional CDT accumulated 32.31 QALYs compared with 31.68 QALYs after standard treatment alone. Direct medical costs were $64 709 for additional CDT and $51 866 for standard treatment. The incremental cost-effectiveness ratio (ICER) was $20 429/QALY gained. One-way sensitivity analysis showed model sensitivity to the clinical efficacy of both strategies, but the ICER remained < $55 000/QALY over the full range of all parameters. The probability that CDT is cost effective was 82% at a willingness to pay threshold of $50 000/QALY gained. Conclusions Additional CDT is likely to be a cost-effective alternative to the standard treatment for patients with a high proximal DVT and a low risk of bleeding. PMID:23452204

  3. The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease

    PubMed Central

    Yarnoff, Benjamin O.; Hoerger, Thomas J.; Simpson, Siobhan A.; Pavkov, Meda E.; Burrows, Nilka R.; Shrestha, Sundar S.; Williams, Desmond E.; Zhuo, Xiaohui

    2016-01-01

    Background Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents (ESAs) for managing chronic anemia in persons with chronic kidney disease (CKD), there are differences in the recommended hemoglobin (Hb) treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3–4. Methods and Findings The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3–4 (i.e., not on dialysis) and anemia created from the 1999–2010 National Health and Nutrition Examination Survey. Incremental cost-effectiveness ratios (ICERs), computed as incremental cost divided by incremental quality adjusted life years (QALYs), were assessed for Hb targets of 10 g/dl to 13 g/dl at 0.5 g/dl increments. Targeting a Hb of 10 g/dl resulted in an ICER of $32,111 compared with no treatment and targeting a Hb of 10.5 g/dl resulted in an ICER of $32,475 compared with a Hb target of 10 g/dl. QALYs increased to 4.63 for a Hb target of 10 g/dl and to 4.75 for a target of 10.5 g/dl or 11 g/dl. Any treatment target above 11 g/dl increased medical costs and decreased QALYs. Conclusions In persons over age 30 with CKD stages 3–4, anemia treatment is most cost-effective when targeting a Hb level of 10.5 g/dl. This study provides important information for framing guidelines related to treatment of anemia in persons with CKD. PMID:27404556

  4. Biogeologic Carbon Sequestration - a Cost-Effective Proposal

    NASA Astrophysics Data System (ADS)

    Shaw, G. H.; Kuhns, R.

    2009-05-01

    Carbon sequestration has been proposed as a strategy for reducing the impact of carbon dioxide emissions from burning of fossil fuels. There are two main routes: 1) capture CO2 emissions from power plants or other large point sources followed by some form of "burial/sequestration", and 2) extraction of CO2 from the ambient atmosphere (involving substantial concentration relative to atmospheric levels) also followed by burial/sequestration. In either case the goal is to achieve significant long-term isolation of CO2 at an economically sustainable price, perhaps measured by some "market price" for CO2, such as the European carbon futures market, where the price is now (2/3/09) about 14-15/tonne of CO2. The second approach, removal of CO2 from the atmosphere, has the potential benefit of reversing the previous buildup of atmospheric CO2, and perhaps even providing a means to "adjust" terrestrial climate by regulating atmospheric CO2 concentrations. For the present, ideas of planetary "geo-engineering" are not as popular as reducing the impact of continued CO2 emissions. In fact, the energy and capital costs of extraction from a dilute atmosphere appear to make this approach uneconomical. Proposals to fertilize the open ocean suffer from concerns about long term ecosystem effects, to say nothing of a lack of verifiability. There is, however, an approach using biological systems that can not only extract significant amounts of CO2, but can do so cost-effectively. Lakes are known in which primary productivity approaches or exceeds 1gm C/cm2-yr. This equates to removal of 35,000 tonnes of CO2 per km2 per year, with a "market value" of about 500,000/yr. Such productivity only occurs under highly eutrophic conditions, and presumably requires significant nutrient additions. As such it would be unthinkable to pursue this technique on a large scale in extant lakes. If, however, it is possible to produce one or more large artificial lakes under acceptable conditions it is

  5. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 23 Highways 1 2012-04-01 2012-04-01 false Finding of cost effectiveness. 635.205 Section 635.205 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS..., crossing surfaces, and minor track and signal work. Adjustment of utility facilities shall include...

  6. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Finding of cost effectiveness. 635.205 Section 635.205 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS..., crossing surfaces, and minor track and signal work. Adjustment of utility facilities shall include...

  7. Cost-Effectiveness of Evaluating the New Technologies.

    ERIC Educational Resources Information Center

    Kastner, Theodore A.

    1997-01-01

    This commentary on a study comparing use of the brand name drug Depakene with generic valproic acid to control seizures in people with mental retardation focuses on issues of cost-effectiveness. It notes existing guidelines for pharmacoeconomic evaluation and suggests a possible model to include a threshold price (per quality-adjusted life year)…

  8. Methods for analyzing cost effectiveness data from cluster randomized trials

    PubMed Central

    Bachmann, Max O; Fairall, Lara; Clark, Allan; Mugford, Miranda

    2007-01-01

    Background Measurement of individuals' costs and outcomes in randomized trials allows uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomizing clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. Methods We used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1) joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2) joint modeling of costs and effects with Bayesian hierarchical models and 3) linear regression of net benefits at different willingness to pay levels using a) least squares regression with Huber-White robust adjustment of errors, b) a least squares hierarchical model and c) a Bayesian hierarchical model. Results All five methods produced similar results, with greater uncertainty than if cluster randomization was not accounted for. Conclusion Cost effectiveness analyses alongside cluster randomized trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software. PMID:17822546

  9. Flipping the Calculus Classroom: A Cost-Effective Approach

    ERIC Educational Resources Information Center

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  10. Estimating the Cost-Effectiveness of Coordinated DSM Programs.

    ERIC Educational Resources Information Center

    Hill, Lawrence J.; Brown, Marilyn A.

    1995-01-01

    A methodology for estimating the cost-effectiveness of coordinated programs from the standpoint of an electric or gas utility is described and illustrated. The discussion focuses on demand-side management programs cofunded by the government and utilities, but it can be applied to other types of cofunded programs. (SLD)

  11. Forecasting the Cost-Effectiveness of Educational Incentives

    ERIC Educational Resources Information Center

    Abt, Clark C.

    1974-01-01

    A look at cost-effectiveness as the major characteristic for which to develop a forecasting method, because it encompasses concerns of most educators. It indicates relative costs and relative effectiveness, and provides a rational basis for optimal resource allocation. (Author)

  12. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be... highway construction project by force account when a situation exists in which the rights or resposibilities of the community at large are so affected as to require some special course of action,...

  13. Modeling and Cost-Effectiveness in HIV Prevention.

    PubMed

    Jacobsen, Margo M; Walensky, Rochelle P

    2016-02-01

    With HIV funding plateauing and the number of people living with HIV increasing due to the rollout of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology and then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral- or community-based interventions, prevention of mother-to-child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact. PMID:26830283

  14. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    ERIC Educational Resources Information Center

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  15. Research Report: Cost-Effectiveness of Curriculum Revision.

    ERIC Educational Resources Information Center

    Mulder, M.; And Others

    1991-01-01

    Evaluation of the cost effectiveness of a revised curriculum using computer-based training (CBT) in the Dutch postal service found cost savings and satisfactory training results, implying that CBT is an effective strategy for complex work organizations training considerable numbers of employees. (SK)

  16. Final report: Compiled MPI. Cost-Effective Exascale Application Development

    SciTech Connect

    Gropp, William Douglas

    2015-12-21

    This is the final report on Compiled MPI: Cost-Effective Exascale Application Development, and summarizes the results under this project. The project investigated runtime enviroments that improve the performance of MPI (Message-Passing Interface) programs; work at Illinois in the last period of this project looked at optimizing data access optimizations expressed with MPI datatypes.

  17. Cost-Effectiveness of Case Management in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Saleh, Shadi S.; Vaughn, Thomas; Levey, Samuel; Fuortes, Laurence; Uden-Holmen, Tanya; Hall, James A.

    2006-01-01

    Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management…

  18. The Cost Effectiveness of Hepatitis Immunization for US College Students

    ERIC Educational Resources Information Center

    Jacobs, R. Jake; Saab, Sammy; Meyerhoff, Allen S.

    2003-01-01

    Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to…

  19. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2011-01-01 2011-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  20. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2013-01-01 2013-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  1. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2012-01-01 2012-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  2. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2014-01-01 2014-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  3. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2010-01-01 2010-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  4. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Technical Assistance Programs for Schools, Hospitals, Units of Local Government, and...

  5. Computers and Media Centers: Services, Satisfaction, and Cost Effectiveness.

    ERIC Educational Resources Information Center

    Givens, Patsy B.

    A survey was conducted of school media centers throughout the United States to determine: (1) how computers are being utilized by these centers, (2) the levels of satisfaction with present services, and (3) whether or not the services being provided by the computer are cost effective. Responses to survey forms returned by 20 school districts and…

  6. Cost-effectiveness of a worksite hypertension treatment program.

    PubMed

    Logan, A G; Milne, B J; Achber, C; Campbell, W P; Haynes, R B

    1981-01-01

    The cost-effectiveness of treating hypertension at the patient's place of work was compared in a randomized controlled trial with care delivered in a community. The average total cost per patient for worksite care in this 12-month study was not significantly different from that for regular care ($242.86 +/- 6.94 vs $211.34 +/- 18.66, mean +/- SEM). The worksite health system cost was significantly more expensive ($197.36 +/- 4.99 vs $129.33 +/- 13.34, p less than 0.001) but the patient cost was significantly less ($45.40 +/- 3.23 vs $82.00 +/- 6.20, p less than 0.01). The mean reduction in diastolic blood pressure (BP) at the year-end assessment was significantly greater in the worksite group (12.1 +/- 0.6 vs 6.5 +/- 0.6 mm Hg, p less than 0.001). The incremental cost-effectiveness ratio of $5.63 per mm Hg for worksite care was less than the base cost-effectiveness ratio of $32.51 per mm Hg for regular care, indicating that the worksite program was substantially more cost-effective. Our findings support health policies that favor allocating resources to work-based hypertension treatment programs for the target group identified in this study. PMID:6783519

  7. Cost-Effectiveness of Two Methods of Job Analysis.

    ERIC Educational Resources Information Center

    Hesse, Cindy G.; Nijhof, Wim J.

    A three-phase study was conducted to compare the cost-effectiveness of two methods for determining job profiles in the publishing business and book trade--the task inventory and the Developing a Curriculum (DACUM) process. In phases 1 and 2, the task inventory and DACUM approaches were used to identify future changes in the technology used in the…

  8. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  9. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  10. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  11. Utilization and cost effectiveness of retread tires. Research report

    SciTech Connect

    Fleckenstein, J.; Allen, D.L.

    1993-04-01

    This report discusses the possible utilization and cost effectiveness of using retreaded tires on state vehicles in Kentucky. Included is information obtained from a telephone survey of local companies and two state DOT agencies. Information was also obtained from a survey conducted on the AASHTO-VAN computer network. The report also contains a cost comparison of retread prices versus new tire prices.

  12. A Cost-Effectiveness Analysis of Early Literacy Interventions

    ERIC Educational Resources Information Center

    Simon, Jessica

    2011-01-01

    Success in early literacy activities is associated with improved educational outcomes, including reduced dropout risk, in-grade retention, and special education referrals. When considering programs that will work for a particular school and context; cost-effectiveness analysis may provide useful information for decision makers. The study…

  13. Cost-Effective School Alarm Systems. Security Topics Series.

    ERIC Educational Resources Information Center

    Kaufer, Steve

    This document outlines considerations in the selection of a cost-effective school-alarm system. Steps in the planning process include: conducting a district needs assessment; gathering input from all staff levels; consulting technical expertise; and selecting a security system that can be integrated with other site needs. It further describes the…

  14. Cost effectiveness studies of environmental technologies: Volume 1

    SciTech Connect

    Silva, E.M.; Booth, S.R.

    1994-02-01

    This paper examines cost effectiveness studies of environmental technologies including the following: (1) In Situ Air Stripping, (2) Surface Towed Ordinance Locator System, (3) Ditch Witch Horizontal Boring Technology, (4) Direct Sampling Ion Trap Mass Spectrometer, (5) In Situ Vitrification, (6) Site Characterization and Analysis Penetrometer System, (7) In Situ Bioremediation, and (8) SEAMIST Membrane System Technology.

  15. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY...) This paragraph applies to calculation of the simple payback period of energy conservation measures....

  16. Cost-effectiveness of colorectal cancer screening – an overview

    PubMed Central

    Lansdorp-Vogelaar, Iris; Knudsen, Amy; Brenner, Hermann

    2010-01-01

    There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests. PMID:20833348

  17. Cost Effectiveness of Current Awareness Sources in the Pharmaceutical Industry

    ERIC Educational Resources Information Center

    Ashmole, R. F.; And Others

    1973-01-01

    The cost effectiveness of several commercial data bases, journal scanning by information scientists, and the impact of private communication are compared in this study. A previously developed technique for measuring the usefulness of commercial data bases is utilized. (21 references) (Author/KE)

  18. Neural mechanisms and personality correlates of the sunk cost effect.

    PubMed

    Fujino, Junya; Fujimoto, Shinsuke; Kodaka, Fumitoshi; Camerer, Colin F; Kawada, Ryosaku; Tsurumi, Kosuke; Tei, Shisei; Isobe, Masanori; Miyata, Jun; Sugihara, Genichi; Yamada, Makiko; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2016-01-01

    The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect. PMID:27611212

  19. Neural mechanisms and personality correlates of the sunk cost effect

    PubMed Central

    Fujino, Junya; Fujimoto, Shinsuke; Kodaka, Fumitoshi; Camerer, Colin F.; Kawada, Ryosaku; Tsurumi, Kosuke; Tei, Shisei; Isobe, Masanori; Miyata, Jun; Sugihara, Genichi; Yamada, Makiko; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2016-01-01

    The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect. PMID:27611212

  20. Direct PCR of indigenous and invasive mosquito species: a time- and cost-effective technique of mosquito barcoding.

    PubMed

    Werblow, A; Flechl, E; Klimpel, S; Zittra, C; Lebl, K; Kieser, K; Laciny, A; Silbermayr, K; Melaun, C; Fuehrer, H-P

    2016-03-01

    Millions of people die each year as a result of pathogens transmitted by mosquitoes. However, the morphological identification of mosquito species can be difficult even for experts. The identification of morphologically indistinguishable species, such as members of the Anopheles maculipennis complex (Diptera: Culicidae), and possible hybrids, such as Culex pipiens pipiens/Culex pipiens molestus (Diptera: Culicidae), presents a major problem. In addition, the detection and discrimination of newly introduced species can be challenging, particularly to researchers without previous experience. Because of their medical importance, the clear identification of all relevant mosquito species is essential. Using the direct polymerase chain reaction (PCR) method described here, DNA amplification without prior DNA extraction is possible and thus species identification after sequencing can be achieved. Different amounts of tissue (leg, head; larvae or adult) as well as different storage conditions (dry, ethanol, -20 and -80 °C) and storage times were successfully applied and showed positive results after amplification and gel electrophoresis. Overall, 28 different indigenous and non-indigenous mosquito species were analysed using a gene fragment of the COX1 gene for species differentiation and identification by sequencing this 658-bp fragment. Compared with standard PCR, this method is time- and cost-effective and could thus improve existing surveillance and control programmes. PMID:26663040

  1. Intervention Costs and Cost-Effectiveness of a Successful Telephonic Intervention to Promote Diabetes Control

    PubMed Central

    Schechter, Clyde B.; Cohen, Hillel W.; Shmukler, Celia; Walker, Elizabeth A.

    2012-01-01

    OBJECTIVE To characterize the costs and cost-effectiveness of a telephonic behavioral intervention to promote glycemic control in the Improving Diabetes Outcomes study. RESEARCH DESIGN AND METHODS Using the provider perspective and a time horizon to the end of the 1-year intervention, we calculate the costs of a telephonic intervention by health educators compared with an active control (print) intervention to improve glycemic control in adults with type 2 diabetes. We calculate the cost-effectiveness ratios for a reduction of one percentage point in hemoglobin A1c (A1C), as well as for one participant to achieve an A1C <7%. Base-case and sensitivity analysis results are presented. RESULTS The intervention cost $176.61 per person randomized to the telephone group to achieve a mean 0.36 percentage point of A1C improvement. The incremental cost-effectiveness ratio was $490.58 per incremental percentage point of A1C improvement and $2,617.35 per person over a 1-year intervention in achieving the A1C goal. In probabilistic sensitivity analysis, the median (interquartile range) of per capita cost, cost per percentage point reduction in A1C, and cost per person achieving the A1C goal of <7% are $175.82 (147.32–203.56), $487.75 (356.50–718.32), and $2,312.88 (1,785.58–3,220.78), respectively. CONCLUSIONS The costs of a telephonic intervention for diabetes self-management support are moderate and commensurate to the modest associated improvement in glycemic control. PMID:22851599

  2. Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

    PubMed Central

    Kuo, Ming-Jeng; Chen, Hsiu-Hsi; Chen, Chi-Ling; Fann, Jean Ching-Yuan; Chen, Sam Li-Sheng; Chiu, Sherry Yueh-Hsia; Lin, Yu-Min; Liao, Chao-Sheng; Chang, Hung-Chuen; Lin, Yueh-Shih; Yen, Amy Ming-Fang

    2016-01-01

    AIM: To assess the cost-effectiveness of two population-based hepatocellular carcinoma (HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography (AUS). METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per life-year gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental cost-effectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening. CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval. PMID:27022228

  3. Cost effectiveness analysis of larval therapy for leg ulcers

    PubMed Central

    Iglesias, Cynthia P; Bland, J Martin; Cullum, Nicky; Dumville, Jo C; Nelson, E Andrea; Torgerson, David J; Worthy, Gill

    2009-01-01

    Objective To assess the cost effectiveness of larval therapy compared with hydrogel in the management of leg ulcers. Design Cost effectiveness and cost utility analyses carried out alongside a pragmatic multicentre, randomised, open trial with equal randomisation. Population Intention to treat population comprising 267 patients with a venous or mixed venous and arterial ulcers with at least 25% coverage of slough or necrotic tissue. Interventions Patients were randomly allocated to debridement with bagged larvae, loose larvae, or hydrogel. Main outcome measure The time horizon was 12 months and costs were estimated from the UK National Health Service perspective. Cost effectiveness outcomes are expressed in terms of incremental costs per ulcer-free day (cost effectiveness analysis) and incremental costs per quality adjusted life years (cost utility analysis). Results The larvae arms were pooled for the main analysis. Treatment with larval therapy cost, on average, £96.70 (€109.61; $140.57) more per participant per year (95% confidence interval −£491.9 to £685.8) than treatment with hydrogel. Participants treated with larval therapy healed, on average, 2.42 days before those in the hydrogel arm (95% confidence interval −0.95 to 31.91 days) and had a slightly better health related quality of life, as the annual difference in QALYs was 0.011 (95% confidence interval −0.067 to 0.071). However, none of these differences was statistically significant. The incremental cost effectiveness ratio for the base case analysis was estimated at £8826 per QALY gained and £40 per ulcer-free day. Considerable uncertainty surrounds the outcome estimates. Conclusions Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692. PMID:19304578

  4. The Cost-Effectiveness Analysis of Teleglaucoma Screening Device

    PubMed Central

    Thomas, Sera

    2015-01-01

    Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective

  5. The Cost-Effectiveness Analysis of Teleglaucoma Screening Device.

    PubMed

    Thomas, Sera; Hodge, William; Malvankar-Mehta, Monali

    2015-01-01

    Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective

  6. CB7-05: Incremental Cost-effectiveness of Preventing Depression in At-risk Adolescents

    PubMed Central

    Dickerson, John; Clarke, Greg; Beardslee, William; Weersing, V. Robin; Gladstone, Tracey; Porta, Giovanna; Brent, David; DeBar, Lynn; Garber, Judy

    2012-01-01

    Background/Aims Adolescent depression is common and leads to many negative personal, social, and economic consequences for youth and their families; unfortunately, most youth who experience major depression do not receive any treatment. Depression prevention programs can reduce these negative consequences, but they must be affordable to be widely disseminated and useful for health care systems. Decision-makers need to weigh relative costs and benefits of providing efficacious prevention programs to depressed adolescents, but little cost-effectiveness analysis exists. The Prevention of Depression trial (POD) was a brief prevention program that compared a group cognitive- behavioral preventive (CBP) intervention to usual care (UC) to reduce depression risk in at-risk youth; the intervention decreased the number of days with depression. We present an incremental cost- effectiveness analysis of the group CBP program relative to UC, from the societal perspective, for 9 months following the intervention. Methods POD was conducted in four U.S. academic and community clinics. Participants were 316 youth aged 13–17 with a past history of depression and/or current elevated, but sub-diagnostic, depressive symptoms. They were randomly assigned to the CBP group consisting of 8 weekly, 90- minute group sessions followed by 6 monthly continuation sessions or to UC alone. The main clinical outcome measures were depression-free days (DFD) and quality-adjusted life-years based on DFD (DFD-QALYs). Costs of intervention, non-protocol services, and families were included. Results CBP achieved 13 additional DFD (p=.008), 0.022 more DFD-QALYs (p=.008). CBP cost $591 (SD=286) on average. Cost per DFD was $59 (ICER = $59; 95% CI: 11–263), $35,434 per DFD-QALY (ICER=$35,434; 95% CI: 6,350 – 157,594). Cost-effectiveness acceptability curve analyses suggest a 69% probability that CBP is more cost-effective at a willingness to pay of $50,000 per QALY. CBP had a higher net benefit for

  7. Cost-Effectiveness of Payments for Ecosystem Services with Dual Goals of Environment and Poverty Alleviation

    NASA Astrophysics Data System (ADS)

    Gauvin, Crystal; Uchida, Emi; Rozelle, Scott; Xu, Jintao; Zhan, Jinyan

    2010-03-01

    The goal of this article is to understand strategies by which both the environmental and poverty alleviation objectives of PES programs can be achieved cost effectively. To meet this goal, we first create a conceptual framework to understand the implications of alternative targeting when policy makers have both environmental and poverty alleviation goals. We then use the Grain for Green program in China, the largest PES program in the developing world, as a case study. We also use a data set from a survey that we designed and implemented to evaluate the program. Using the data set we first evaluate what factors determined selection of program areas for the Grain for Green program. We then demonstrate the heterogeneity of parcels and households and examine the correlations across households and their parcels in terms of their potential environmental benefits, opportunity costs of participating, and the asset levels of households as an indicator of poverty. Finally, we compare five alternative targeting criteria and simulate their performance in terms of cost effectiveness in meeting both the environmental and poverty alleviation goals when given a fixed budget. Based on our simulations, we find that there is a substantial gain in the cost effectiveness of the program by targeting parcels based on the “gold standard,” i.e., targeting parcels with low opportunity cost and high environmental benefit managed by poorer households.

  8. Cost-effective means of reducing ammonia emissions from UK agriculture using the NARSES model

    NASA Astrophysics Data System (ADS)

    Webb, J.; Ryan, M.; Anthony, S. G.; Brewer, A.; Laws, J.; Aller, M. F.; Misselbrook, T. H.

    To comply with International agreements to improve air quality, signatory states need to reduce emissions of ammonia (NH 3). Since the majority of NH 3 emissions come from agriculture, measures may need to be implemented by the farming industry. Member states of the EU will, by 2010, require large pig and poultry production units to reduce NH 3 emissions to comply with the integrated pollution prevention and control directive (IPPC). The NARSES model uses a mass-flow method to estimate NH 3 emission from UK agriculture and to identify the most cost-effective means of reducing NH 3 emissions. Model runs were carried out to assess the likely impact of the IPPC Directive on UK NH 3 emissions and the sensitivity of model output to input data on the costs and abatement efficiencies of proposed abatement measures. The impact of the IPPC Directive is likely to be small, offering a reduction of c. 8700 t, 3.5% of total UK agricultural NH 3 emissions. Even large (30%) changes in our estimates of cost or changes of 10% in our estimates of abatement efficiency will make little difference to the ranking of abatement techniques according to cost-effectiveness. The most cost-effective reductions may be achieved by replacing urea fertilizer with ammonium nitrate, immediate incorporation of manures and slurries to tillage land by discs, storing all FYM and poultry manures before spreading to land and applying slurries to grassland by trailing shoe.

  9. Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients

    PubMed Central

    Miravitlles, Marc; Gáldiz, Juan B; Huerta, Alicia; Villacampa, Alba; Carcedo, David; Garcia-Rio, Francisco

    2016-01-01

    Purpose Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective. Methods A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed. Results UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY. Conclusion UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective. PMID:26848262

  10. A review of the methodological challenges in assessing the cost effectiveness of pharmacist interventions.

    PubMed

    Elliott, Rachel A; Putman, Koen; Davies, James; Annemans, Lieven

    2014-12-01

    Pharmacists' roles are shifting away from medicines supply and the provision of patient education involving acute medications towards consultation-type services for chronic medications. Determining the cost effectiveness of pharmacist interventions has been complicated by methodological challenges. A critique of 31 economic evaluations carried out alongside comparative studies of pharmacist interventions published between 2003 and 2013 (12 from the UK, six from the USA) found a range of disease-specific and cross-therapeutic interventions targeting both patients and prescribers in a range of settings evaluated through a variety of study designs. Only ten were full economic evaluations, five of which were based on randomized controlled trials (RCTs). The intervention was usually quite well described, but the comparator was not always clearly described, and some interventions are very context specific due to the variability in pharmacist services available in different countries and practice settings. Complex multidirectional aims of most pharmacist interventions have led to many process, intermediate and longer-term outcomes being included in any one study. Quality of resource use and cost data varied. Most incremental cost-effectiveness ratios (ICERs) were generated from process indicators such as errors and adherence, with only four studies reporting cost per quality-adjusted life-year (QALY). Very few studies examined the effect of uncertainty, and methods used were not very clear in some cases. The principal finding from our critique is that poor RCT study design or analysis precludes many studies from finding pharmacist interventions effective or cost effective. We conclude with a set of recommendations for future study design. PMID:25145799

  11. Cost effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes

    PubMed Central

    Hay, Joel W.; Katon, Wayne J.; Ell, Kathleen; Lee, Pey-Jiuan; Guterman, Jeffrey J.

    2011-01-01

    OBJECTIVE To evaluate cost effectiveness of a socio-culturally adapted collaborative depression care program among low-income Hispanics with diabetes. RESEARCH DESIGN AND METHODS A randomized controlled trial of 387 diabetes patients (96.5% Hispanic) with clinically significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program (MDDP) aimed at increasing patient exposure to evidenced-based depression psychotherapy and/or pharmacotherapy in two public safety net clinics. Patient medical care costs and utilization were captured from Los Angeles County Dept. of Health Services claims records. Patient reported outcomes included SF-12 and PHQ-9-calculated depression-free days (DFDs). RESULTS Intervention patients had significantly greater SF-12 utility improvement from baseline compared to controls over the 18 month evaluation period (4.8%; P<.001) and a corresponding significant improvement in DFDs (43.0; P<.001). Medical cost differences were not statistically significant in OLS and log-transformed cost regressions. The average costs of the MDDP study intervention were $515 per patient. The program cost effectiveness averaged $4,053/QALY per MDDP recipient and was more than 90% likely to fall below $12,000/QALY. CONCLUSIONS Socio-culturally adapted collaborative depression care improved utility and quality of life in predominantly low income Hispanic diabetes patients and was highly cost effective. PMID:22433755

  12. Cost-effectiveness of systemic treatments for moderate-to-severe psoriasis in the German health care setting.

    PubMed

    Küster, Denise; Nast, Alexander; Gerdes, Sascha; Weberschock, Tobias; Wozel, Gottfried; Gutknecht, Mandy; Schmitt, Jochen

    2016-05-01

    Systemic treatments of moderate-to-severe psoriasis differ substantially in terms of effectiveness and costs. Comprehensive economic-evaluations of all systemic treatments for psoriasis from a societal perspective are missing. The objective of our study was to compare the cost-effectiveness all systemic treatments approved for moderate-to-severe psoriasis from a societal perspective, by including all cost categories. An incremental cost-effectiveness-analysis was performed for all systemic treatments for psoriasis, currently recommended by the German S3-Guideline i.e. methotrexate, cyclosporine, fumaric acid esters, and retinoids, adalimumab, etanercept, infliximab and ustekinumab. We used a Markov model with time-dependent transition probabilities and a time horizon of 2 years to investigate incremental cost-effectiveness ratios. Both direct and indirect costs were considered to reflect the societal perspective. Effectiveness outcome was PASI-75 response. One-way and probabilistic sensitivity analyses explored the effect of treatment duration, discount rate, effectiveness, and the perspective (societal vs. healthcare system) on the findings. According to the base-case analysis a cost-effective treatment pathway for moderate-to-severe psoriasis starts with methotrexate, followed by ustekinumab 90 mg and infliximab, if methotrexate does not achieve or maintain PASI-75 response. Sensitivity analyses confirmed the general robustness of these findings with methotrexate being most cost-effective. However, from a third-party-payer perspective (without indirect cost) conventional therapies were generally more cost-effective than biologics. From a value-based healthcare perspective, methotrexate should be the systemic treatment of first choice, ustekinumab 90 mg second choice and infliximab third choice for patients with moderate-to-severe psoriasis. From a societal perspective, the other treatments are less efficient according to our model. From a third

  13. Assessing Cost-effectiveness of Green Infrastructures in response to Large Storm Events at Household Scale

    NASA Astrophysics Data System (ADS)

    Chui, T. F. M.; Liu, X.; Zhan, W.

    2015-12-01

    Green infrastructures (GI) are becoming more important for urban stormwater control worldwide. However, relatively few studies focus on researching the specific designs of GI at household scale. This study assesses the hydrological performance and cost-effectiveness of different GI designs, namely green roofs, bioretention systems and porous pavements. It aims to generate generic insights by comparing the optimal designs of each GI in 2-year and 50-year storms of Hong Kong, China and Seattle, US. EPA SWMM is first used to simulate the hydrologic performance, in particular, the peak runoff reduction of thousands of GI designs. Then, life cycle costs of the designs are computed and their effectiveness, in terms of peak runoff reduction percentage per thousand dollars, is compared. The peak runoff reduction increases almost linearly with costs for green roofs. However, for bioretention systems and porous pavements, peak runoff reduction only increases significantly with costs in the mid values. For achieving the same peak runoff reduction percentage, the optimal soil depth of green roofs increases with the design storm, while surface area does not change significantly. On the other hand, for bioretention systems and porous pavements, the optimal surface area increases with the design storm, while thickness does not change significantly. In general, the cost effectiveness of porous pavements is highest, followed by bioretention systems and then green roofs. The cost effectiveness is higher for a smaller storm, and is thus higher for 2-year storm than 50-year storm, and is also higher for Seattle when compared to Hong Kong. This study allows us to better understand the hydrological performance and cost-effectiveness of different GI designs. It facilitates the implementation of optimal choice and design of each specific GI for stormwater mitigation.

  14. Cost-Effectiveness of Interventions to Prevent Disability in Leprosy: A Systematic Review

    PubMed Central

    van Veen, Natasja H. J.; McNamee, Paul; Richardus, Jan Hendrik; Smith, W. Cairns S.

    2009-01-01

    Background Prevention of disability (POD) is one of the key objectives of leprosy programmes. Recently, coverage and access have been identified as the priority issues in POD. Assessing the cost-effectiveness of POD interventions is highly relevant to understanding the barriers and opportunities to achieving universal coverage and access with limited resources. The purpose of this study was to systematically review the quality of existing cost-effectiveness evidence and discuss implications for future research and strategies to prevent disability in leprosy and other disabling conditions. Methodology/Principal Findings We searched electronic databases (NHS EED, MEDLINE, EMBASE, and LILACS) and databases of ongoing trials (www.controlled-trials.com/mrct/, www.who.int/trialsearch). We checked reference lists and contacted experts for further relevant studies. We included studies that reported both cost and effectiveness outcomes of two or more alternative interventions to prevent disability in leprosy. We assessed the quality of the identified studies using a standard checklist for critical appraisal of economic evaluations of health care programmes. We found 66 citations to potentially relevant studies and three met our criteria. Two were randomised controlled trials (footwear, management of neuritis) and one was a generic model-based study (cost per DALY). Generally, the studies were small in size, reported inadequately all relevant costs, uncertainties in estimates, and issues of concern and were based on limited data sources. No cost-effectiveness data on self-care, which is a key strategy in POD, was found. Conclusion/Significance Evidence for cost-effectiveness of POD interventions for leprosy is scarce. High quality research is needed to identify POD interventions that offer value for money where resources are very scarce, and to develop strategies aimed at available, affordable and sustainable quality POD services for leprosy. The findings are relevant for

  15. Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?

    PubMed Central

    Losina, Elena; Daigle, Meghan E.; Reichmann, William M.; Suter, Lisa G.; Hunter, David J.; Solomon, Daniel H.; Walensky, Rochelle P.; Jordan, Joanne M.; Burbine, Sara A.; Paltiel, A. David; Katz, Jeffrey N.

    2013-01-01

    Objective Disease-modifying osteoarthritis drugs (DMOADs) are under development. Our goal was to determine efficacy, toxicity, and cost thresholds under which DMOADs would be a cost-effective knee OA treatment. Design We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare guideline-concordant care to strategies that insert DMOADs into the care sequence. The guideline-concordant care sequence included conservative pain management, corticosteroid injections, total knee replacement (TKR), and revision TKR. Base case DMOAD characteristics included: 50% chance of suspending progression in the first year (resumption rate of 10% thereafter) and 30% pain relief among those with suspended progression; 0.5%/year risk of major toxicity; and costs of $1,000/year. In sensitivity analyses, we varied suspended progression (20–100%), pain relief (10–100%), major toxicity (0.1–2%), and cost ($1,000–$7,000). Outcomes included costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs), and TKR utilization. Results Base case DMOADs added 4.00 quality-adjusted life years (QALYs) and $230,000 per 100 persons, with an ICER of $57,500/QALY. DMOADs reduced need for TKR by 15%. Cost-effectiveness was most sensitive to likelihoods of suspended progression and pain relief. DMOADs costing $3,000/year achieved ICERs below $100,000/QALY if the likelihoods of suspended progression and pain relief were 20% and 70%. At a cost of $5,000, these ICERs were attained if the likelihoods of suspended progression and pain relief were both 60%. Conclusions Cost, suspended progression, and pain relief are key drivers of value for DMOADs. Plausible combinations of these factors could reduce need for TKR and satisfy commonly cited cost-effectiveness criteria. PMID:23380251

  16. Present and future of cervical cancer prevention in Spain: a cost-effectiveness analysis.

    PubMed

    Georgalis, Leonidas; de Sanjosé, Silvia; Esnaola, Mikel; Bosch, F Xavier; Diaz, Mireia

    2016-09-01

    Human papillomavirus (HPV) vaccination within a nonorganized setting creates a poor cost-effectiveness scenario. However, framed within an organized screening including primary HPV DNA testing with lengthening intervals may provide the best health value for invested money. To compare the effectiveness and cost-effectiveness of different cervical cancer (CC) prevention strategies, including current status and new proposed screening practices, to inform health decision-makers in Spain, a Markov model was developed to simulate the natural history of HPV and CC. Outcomes included cases averted, life expectancy, reduction in the lifetime risk of CC, life years saved, quality-adjusted life years (QALYs), net health benefits, lifetime costs, and incremental cost-effectiveness ratios. The willingness-to-pay threshold is defined at 20 000&OV0556;/QALY. Both costs and health outcomes were discounted at an annual rate of 3%. A strategy of 5-year organized HPV testing has similar effectiveness, but higher efficiency than 3-year cytology. Screening alone and vaccination combined with cytology are dominated by vaccination followed by 5-year HPV testing with cytology triage (12 214&OV0556;/QALY). The optimal age for both ending screening and switching age from cytology to HPV testing in older women is 5 years later for unvaccinated than for vaccinated women. Net health benefits decrease faster with diminishing vaccination coverage than screening coverage. Primary HPV DNA testing is more effective and cost-effective than current cytological screening. Vaccination uptake improvements and a gradual change toward an organized screening practice are critical components for achieving higher effectiveness and efficiency in the prevention of CC in Spain. PMID:26375246

  17. Cost-effectiveness analysis of a state funded programme for control of severe asthma

    PubMed Central

    Franco, Rosana; Santos, Andreia C; do Nascimento, Harrison F; Souza-Machado, Carolina; Ponte, Eduardo; Souza-Machado, Adelmir; Loureiro, Sebastião; Barreto, Maurício L; Rodrigues, Laura C; Cruz, Alvaro A

    2007-01-01

    Background Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce. Methods 81 patients with severe asthma (12–75 years) joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted. Results 64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387 per patient. Family annual income increased US$512, and family costs were reduced by US$733. Conclusion A programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families. PMID:17509137

  18. Examining the cost-effectiveness of cancer screening promotion.

    PubMed

    Andersen, M Robyn; Urban, Nicole; Ramsey, Scott; Briss, Peter A

    2004-09-01

    Cost-effectiveness analyses (CEAs) can help to quantify the contribution of the promotion of a screening program to increased participation in screening. The cost-effectiveness (C/E) of screening promotion depends in large part on the endpoints of interest. At the most fundamental level, the C/E of a strategy for promoting screening would focus on the attendance rate, or cost per person screened, and the C/E would be influenced by the costs of promotion, as well as by the size and responsiveness of the target population. In addition, the costs of screening promotion (measured as the cost per additional participant in screening) can be included in a CEA estimate of the screening technology. In this case, depending on the efficacy of the screening test and the costs and influence of the promotion, the C/E of screening may improve or become poorer. In the current study, the authors reviewed the literature on the C/E of cancer screening promotion. The following lessons were learned regarding the C/E of screening and its promotion: 1) high-quality information on the C/E of screening is increasingly available; 2) cost-effective promotion of screening is dependent on cost-effective screening strategies; 3) quality-of-life effects may be important in assessing the overall C/E of screening programs; 4) research efforts aimed at identifying cost-effective approaches to screening promotion are useful but sparse; 5) C/E studies should be better incorporated into well designed effectiveness research efforts; 6) variations in C/E according to intervention characteristics, population characteristics, and context should be evaluated in greater depth; 7) the long-term effects of screening promotion are critical to assessing C/E; 8) the effects of promotion on costs of screening must be better understood; and 9) CEA must be interpreted in light of other information. The authors showed that CEA can be a valuable tool for understanding the merits of health promotion interventions and

  19. Cost-Effectiveness of Norovirus Vaccination in Children in Peru

    PubMed Central

    Mirelman, Andrew; Ballard, Sarah-Blythe; Saito, Mayuko; Kosek, Margaret; Gilman, Robert H.

    2015-01-01

    Background With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. Methods We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru’s routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Results Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. Conclusions The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence

  20. Different strategies and cost-effectiveness in the treatment of primary open angle glaucoma

    PubMed Central

    Ting, Naomi SJ; Li Yim, James FT; Ng, Jia Y

    2014-01-01

    Glaucoma is the second highest cause of blindness worldwide with an estimated half of the glaucoma population unaware of their disease. To date, intraocular pressure is the most important modifiable risk factor and lowering it has been proven to reduce progression of visual field loss associated with glaucoma. Different strategies are available to lower intraocular pressure and include medical, laser, or surgical treatment in the form of topical or systemic medications, argon or selective laser trabeculoplasty, and glaucoma drainage surgery such as trabeculectomy, deep sclerectomy, or other drainage devices. The effectiveness of these treatments has been well documented however their cost-effectiveness between the developed world and third world remains unclear. PMID:25506233

  1. The Cost-Effectiveness of Supplementary Immunization Activities for Measles: A Stochastic Model for Uganda

    PubMed Central

    Johns, Benjamin; Nair, Divya; Nabyonga-Orem, Juliet; Fiona-Makmot, Braka; Simons, Emily; Dabbagh, Alya

    2011-01-01

    Supplemental Immunization Activities (SIAs) have become an important adjunct to measles control efforts in countries that endeavor to achieve higher levels of population immunity than can be achieved in a growing routine immunization system. Because SIAs are often supported with funds that have alternative uses, decision makers need to know how cost-effective they are compared with other options. This study integrated a dynamic stochastic model of measles transmission in Uganda (2010–2050) with a cost model to compare a strategy of maintaining Uganda's current (2008) levels of the first dose of routine measles-containing vaccine (MCV1) coverage at 68% with SIAs with a strategy using the same levels of MCV1 coverage without SIAs. The stochastic model was fitted with parameters drawn from district-level measles case reports from Uganda, and the cost model was fitted to administrative data from the Ugandan Expanded Program on Immunization and from the literature. A discount rate of 0.03, time horizon of 2010–2050, and a societal perspective on costs were assumed. Costs expressed in US dollars (2010) included vaccination costs, disease treatment costs including lost productivity of mothers, as well as costs of outbreaks and surveillance. The model estimated that adding on triennial SIAs that covered 95% of children aged 12–59 months to a system that achieved routine coverage rates of 68% would have an incremental cost-effectiveness ratio (ICER) of $1.50 ($US 2010) per disability-adjusted life year averted. The ICER was somewhat higher if the discount rate was set at either 0 or 0.06. The addition of SIAs was found to make outbreaks less frequent and lower in magnitude. The benefit was reduced if routine coverage rates were higher. This cost-effectiveness ratio compares favorably to that of other commonly accepted public health interventions in sub-Saharan Africa. PMID:21666151

  2. Cost-Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, P.; Parker, D.

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous U.S. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are as follows: to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  3. Simvastatin: a pharmacoeconomic evaluation of its cost-effectiveness in hypercholesterolaemia and prevention of coronary heart disease.

    PubMed

    Chrisp, P; Lewis, N J; Milne, R J

    1992-02-01

    Epidemiological and intervention study results support reduction of coronary heart disease (CHD) risk, and hence direct and indirect costs, by lowering plasma lipids. Cost-effectiveness of a lipid-lowering strategy thus depends significantly on the extent of plasma lipid decrease achieved. The 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor simvastatin is a well tolerated and highly effective antihyperlipidaemic agent. Despite a current lack of direct evidence that simvastatin reduces CHD incidence, the cost-effectiveness of the drug {in terms of years of life saved (YOLS)} has been studied, based on findings of epidemiological trials. Simvastatin 20 mg/day is more cost-effective than cholestyramine 4g 3 times daily, particularly in men and in those with a higher pretreatment cholesterol level ( greater than 8 mmol/L) and other risk factors. Cost-effectiveness is also enhanced if treatment is started at a younger age (35 to 45 years) and maintained for a defined period rather than lifelong. Thus, while additional direct comparative studies are needed to confirm this finding, present evidence suggests simvastatin is a cost-effective intervention in appropriately selected patients. PMID:10146941

  4. Cost-effectiveness analysis of malaria chemoprophylaxis for travellers to West-Africa

    PubMed Central

    2010-01-01

    Background The importation of malaria to non-endemic countries remains a major cause of travel-related morbidity and a leading cause of travel-related hospitalizations. Currently they are three priority medications for malaria prophylaxis to West Africa: mefloquine, atovaquone/proguanil and doxycycline. We investigate the cost effectiveness of a partial reimbursement of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers to high risk areas of malaria transmission compared with the current situation of no reimbursement. Methods This study is a cost-effectiveness analysis based on malaria cases imported from West Africa to Switzerland from the perspective of the Swiss health system. We used a decision tree model and made a literature research on the components of travel related malaria. The main outcome measure was the cost effectiveness of malaria chemoprophylaxis reimbursement based on malaria and deaths averted. Results Using a program where travellers would be reimbursed for 80% of the cost of the cheapest malaria chemoprophylaxis is dominant (i.e. cost saving and more effective than the current situation) using the assumption that currently 68.7% of travellers to West Africa use malaria chemoprophylaxis. If the current usage of malaria chemoprophylaxis would be higher, 82.4%, the incremental cost per malaria case averted is € 2'302. The incremental cost of malaria death averted is € 191'833. The most important factors influencing the model were: the proportion of travellers using malaria chemoprophylaxis, the probability of contracting malaria without malaria chemoprophylaxis, the cost of the mefloquine regimen, the decrease in the number of travellers without malaria chemoprophylaxis in the reimbursement strategy. Conclusions This study suggests that a reimbursement of 80% of the cost of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers from Switzerland to West Africa is highly effective in terms of malaria

  5. The Cost-Effectiveness of Surgical Treatment of Medial Unicompartmental Knee Osteoarthritis in Younger Patients

    PubMed Central

    Konopka, Joseph F.; Gomoll, Andreas H.; Thornhill, Thomas S.; Katz, Jeffrey N.; Losina, Elena

    2015-01-01

    Background: Surgical options for the management of medial compartment osteoarthritis of the varus knee include high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty. We sought to determine the cost-effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty as alternatives to total knee arthroplasty for patients fifty to sixty years of age. Methods: We built a probabilistic state-transition computer model with health states defined by pain, postoperative complications, and subsequent surgical procedures. We estimated transition probabilities from published literature. Costs were determined from Medicare reimbursement schedules. Health outcomes were measured in quality-adjusted life-years (QALYs). We conducted analyses over patients’ lifetimes from the societal perspective, with health and cost outcomes discounted by 3% annually. We used probabilistic sensitivity analyses to account for uncertainty in data inputs. Results: The estimated discounted QALYs were 14.62, 14.63, and 14.64 for high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty, respectively. Discounted total direct medical costs were $20,436 for high tibial osteotomy, $24,637 for unicompartmental knee arthroplasty, and $24,761 for total knee arthroplasty (in 2012 U.S. dollars). The incremental cost-effectiveness ratio (ICER) was $231,900 per QALY for total knee arthroplasty and $420,100 per QALY for unicompartmental knee arthroplasty. Probabilistic sensitivity analyses showed that, at a willingness-to-pay (WTP) threshold of $50,000 per QALY, high tibial osteotomy was cost-effective 57% of the time; total knee arthroplasty, 24%; and unicompartmental knee arthroplasty, 19%. At a WTP threshold of $100,000 per QALY, high tibial osteotomy was cost-effective 43% of time; total knee arthroplasty, 31%; and unicompartmental knee arthroplasty, 26%. Conclusions: In fifty to sixty-year-old patients with medial unicompartmental knee

  6. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa

    PubMed Central

    Hamza, Muhammad; Idris, Maryam A.; Maiyaki, Musa B.; Lamorde, Mohammed; Chippaux, Jean-Philippe; Warrell, David A.; Kuznik, Andreas; Habib, Abdulrazaq G.

    2016-01-01

    Background Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa. Methods We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs. Results The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition

  7. A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control

    PubMed Central

    Tamagnan, Jules A.; Medlock, Jan; Ndeffo-Mbah, Martial L.; Fish, Durland; Ávila-Agüero, María L.; Marín, Rodrigo; Ko, Albert I.; Galvani, Alison P.

    2016-01-01

    Background As Zika virus continues to spread, decisions regarding resource allocations to control the outbreak underscore the need for a tool to weigh policies according to their cost and the health burden they could avert. For example, to combat the current Zika outbreak the US President requested the allocation of $1.8 billion from Congress in February 2016. Methodology/Principal Findings Illustrated through an interactive tool, we evaluated how the number of Zika cases averted, the period during pregnancy in which Zika infection poses a risk of microcephaly, and probabilities of microcephaly and Guillain-Barré Syndrome (GBS) impact the cost at which an intervention is cost-effective. From Northeast Brazilian microcephaly incidence data, we estimated the probability of microcephaly in infants born to Zika-infected women (0.49% to 2.10%). We also estimated the probability of GBS arising from Zika infections in Brazil (0.02% to 0.06%) and Colombia (0.08%). We calculated that each microcephaly and GBS case incurs the loss of 29.95 DALYs and 1.25 DALYs per case, as well as direct medical costs for Latin America and the Caribbean of $91,102 and $28,818, respectively. We demonstrated the utility of our cost-effectiveness tool with examples evaluating funding commitments by Costa Rica and Brazil, the US presidential proposal, and the novel approach of genetically modified mosquitoes. Our analyses indicate that the commitments and the proposal are likely to be cost-effective, whereas the cost-effectiveness of genetically modified mosquitoes depends on the country of implementation. Conclusions/Significance Current estimates from our tool suggest that the health burden from microcephaly and GBS warrants substantial expenditures focused on Zika virus control. Our results justify the funding committed in Costa Rica and Brazil and many aspects of the budget outlined in the US president’s proposal. As data continue to be collected, new parameter estimates can be customized

  8. Structural and parameter uncertainty in Bayesian cost-effectiveness models

    PubMed Central

    Jackson, Christopher H; Sharples, Linda D; Thompson, Simon G

    2010-01-01

    Health economic decision models are subject to various forms of uncertainty, including uncertainty about the parameters of the model and about the model structure. These uncertainties can be handled within a Bayesian framework, which also allows evidence from previous studies to be combined with the data. As an example, we consider a Markov model for assessing the cost-effectiveness of implantable cardioverter defibrillators. Using Markov chain Monte Carlo posterior simulation, uncertainty about the parameters of the model is formally incorporated in the estimates of expected cost and effectiveness. We extend these methods to include uncertainty about the choice between plausible model structures. This is accounted for by averaging the posterior distributions from the competing models using weights that are derived from the pseudo-marginal-likelihood and the deviance information criterion, which are measures of expected predictive utility. We also show how these cost-effectiveness calculations can be performed efficiently in the widely used software WinBUGS. PMID:20383261

  9. Selecting cost-effective areas for restoration of ecosystem services.

    PubMed

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services. PMID:25199996

  10. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    SciTech Connect

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

  11. Cost-Effective TiAl based Materials

    NASA Technical Reports Server (NTRS)

    Moxson, V. S.; Sun, Fusheng; Draper, Susan L.; Froes, F. H.; Duz, V.

    2003-01-01

    Because of their inherent low ductility, TiAl-based materials are difficult to fabricate, especially thin gage titanium gamma aluminide (TiAl) sheet and foil. In this paper, an innovative powder metallurgy approach for producing cost-effective thin gage TiAl sheets (with 356 mm long and 235 mm wide, and a thickness of 0.74, 1.09, 1.55, and 2.34 mm, respectively) is presented. The microstructures and tensile properties at room and elevated temperatures of the thin gage TiAl are studied. Results show that these TiAl sheets have a relatively homogenous chemistry, uniform microstructure, and acceptable mechanical properties. This work demonstrates a cost-effective method for producing both flat products (sheet/foil) and complex chunky parts of TiAl for various advanced applications including aerospace and automotive industries.

  12. Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities.

    PubMed

    Pasquel, Francisco J; Hendrick, Andrew M; Ryan, Martha; Cason, Emily; Ali, Mohammed K; Narayan, K M Venkat

    2016-03-01

    Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs. PMID:26719134

  13. Cost-effectiveness analysis and the selection of blood products.

    PubMed

    Pereira, A

    2000-11-01

    A new generation of blood components and transfusion modalities aimed at further reducing real or hypothetical risks threatening the blood supply is available. Since the risk of infection with transfusion-transmitted viruses is already very low, many of these new interventions provide a minimal health benefit at a very high cost. It is even possible that risks inherent to the new technologies themselves could surpass the current risk of transfusion-transmitted viruses. For some of the new blood components, such as leukoreduced products, the poor cost-effectiveness projections may be substantially improved if the purported health benefits are eventually proved in appropriate randomized, controlled clinical trials. Meanwhile, cost-effectiveness analyses show that allocating more resources to improve the safety of donated blood may actually decrease the overall transfusion safety by subtracting resources from other areas of the health care system, so a realignment of costs with health benefits seems necessary. PMID:11055518

  14. Development and Manufacture of Cost Effective Composite Drill Pipe

    SciTech Connect

    James C. Leslie; James C. Leslie, II; Lee Truong; James T. Heard

    2006-09-29

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2005 through September 30, 2006 and contains the following discussions: Qualification Testing; Prototype Development and Testing of ''Smart Design'' Configuration; Field Test Demonstration; Development of Ultra-Short Radius Composite Drill Pipe (USR-CDP); and Development of Smart USR-CDP.

  15. A Cost-Effective Model for Digital Forensic Investigations

    NASA Astrophysics Data System (ADS)

    Overill, Richard; Kwan, Michael; Chow, Kam-Pui; Lai, Pierre; Law, Frank

    Because of the way computers operate, every discrete event potentially leaves a digital trace. These digital traces must be retrieved during a digital forensic investigation to prove or refute an alleged crime. Given resource constraints, it is not always feasible (or necessary) for law enforcement to retrieve all the related digital traces and to conduct comprehensive investigations. This paper attempts to address the issue by proposing a model for conducting swift, practical and cost-effective digital forensic investigations.

  16. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    SciTech Connect

    Dr. James C. Leslie; Mr. Jeffrey R. Jean; Hans Neubert; Lee Truong

    2000-10-30

    This annual, technical report will discuss the engineering research and data accomplishments that have transpired in support of the development of Cost Effective Composite Drill Pipe (CDP). The report discusses and illustrates the first iteration design of the tube and the tool joint interface. The report discusses standards and specifications to which the CDP design will be tailored and tested, and discusses conclusions of the first iteration design for future design enhancements.

  17. The cost effectiveness of rotavirus vaccination in Iran.

    PubMed

    Mousavi Jarrahi, Yasaman; Zahraei, Seyed Mohsen; Sadigh, Nader; Esmaeelpoor Langeroudy, Keyhan; Khodadost, Mahmoud; Ranjbaran, Mehdi; Sanjari Moghaddam, Ali; Besharat, Mehdi; Mosavi Jarrahi, Alireza

    2016-03-01

    Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. Effective vaccines have recently been approved and successful vaccination program implemented. The aim of this study was to evaluate the cost effectiveness of mass rotavirus vaccination program in Iran. We developed a Markov model that reflects key features of rotavirus natural history. Parameters of the model were assessed by field study or developed through literature search and published data. We applied the model to the 2009 Iranian birth cohort and evaluated the cost-effectiveness of including the rotavirus vaccine (Rotarix®) into Iranian expanded immunization program (EPI). With an estimated hospitalization rate of 0.05 and outpatient rate of 0.23 cases per person-year, vaccinating cohort of 1231735 infants in Iran with 2 doses of (Rotarix®), would prevent 32092 hospitalizations, 158750 outpatient visits, and 1591 deaths during 5 y of follow-up. Under base-case assumption of $10 cost per course of vaccine, the vaccination would incur an extra cost of $1,019,192 from health care perspective and would avert 54680 DALYs. From societal perspective, there would be $15,192,568 saving for the society with the same averted DALYs. The incremental cost effectiveness ratio showed a cost of $19 US dollars per averted DALY from health care perspective and a saving of $278 US dollars for each averted DALY from societal perspective. Introducing rotavirus vaccine into EPI program would be highly cost-effective public health intervention in Iran. PMID:26360331

  18. A Cost-Effectiveness Analysis Model for Evaluating and Planning Secondary Vocational Programs

    ERIC Educational Resources Information Center

    Kim, Jin Eun

    1977-01-01

    This paper conceptualizes a cost-effectiveness analysis and describes a cost-effectiveness analysis model for secondary vocational programs. It generates three kinds of cost-effectiveness measures: program effectiveness, cost efficiency, and cost-effectiveness and/or performance ratio. (Author)

  19. Health promotion in nursing and cost-effectiveness.

    PubMed

    Jadelhack, Raja

    2012-01-01

    Close examination of the different healthcare systems and the present economic crisis worldwide suggests that all health organizations should re-evaluate the concept of health promotion and its relationship to cost-effectiveness. When choosing the most efficient and cost-effective system, each nation's healthcare system must seriously start to implement strategies for the change. Health professions, including nursing, must change their vision of education both in academic and practice settings, to focus on health promotion and illness prevention. The key principle underlying this paper is to illustrate the importance of health promotion and cost-effectiveness being adopted by all health organizations worldwide, as well as to observe the experiences of selected counties in developing a health policy related to education in primary healthcare. The paper will include a plan adopted by the General Nursing Directorate (GND) in the Kingdom of Saudi Arabia (SA), which contains a health promotion policy for the nursing administrations in all governmental primary healthcare centers in Saudi Arabia. PMID:22924205

  20. Cost-effectiveness of assisted conception for male subfertility.

    PubMed

    Moolenaar, Lobke M; Cissen, Maarje; de Bruin, Jan Peter; Hompes, Peter G A; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J

    2015-06-01

    Intrauterine insemination (IUI), with or without ovarian stimulation, IVF and intracytoplasmatic sperm injection (ICSI) are frequently used treatments for couples with male subfertility. No consensus has been reached on specific cut-off values for semen parameters, at which IVF would be advocated over IUI and ICSI over IVF. The aim of this study was to evaluate the cost-effectiveness of interventions for male subfertility according to total motile sperm count (TMSC). A computer-simulated cohort of subfertile women aged 30 years with a partner was analysed with a pre-wash TMSC of 0 to 10 million. Three treatments were evaluated: IUI with and without controlled ovarian stimulation; IVF; and ICSI. Main outcome was expected live birth; secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. The choice of IVF over IUI with ovarian stimulation and ICSI over IVF depends on the willingness to pay for an extra live birth. If only cost per live birth is considered for each treatment, above a pre-wash TMSC of 3 million, IUI is less costly than IVF and, below a pre-wash, TMSC of 3 million ICSI is less costly. Effectiveness needs to be confirmed in a large randomized controlled trial. PMID:25900905

  1. Cost-effectiveness of hepatitis A vaccination in Indonesia

    PubMed Central

    Suwantika, Auliya A; Beutels, Philippe; Postma, Maarten J

    2014-01-01

    Objective This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. Methods An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the model, we made a comparison on the use of two-dose and one-dose vaccines. The model involved a 70-year time horizon with 1-month cycles for children less than 2 years old and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of the hepatitis A vaccination. Results Vaccination would save US$ 3 795 148 and US$ 2 892 920 from the societal perspective, for the two-dose and one-dose vaccine schedules, respectively, in the context of hepatitis A treatment. It also would save 8917 and 6614 discounted quality-adjusted-life-years (QALYs), respectively. With the vaccine price of US$ 3.21 per dose, the implementation of single dose vaccine would yield an incremental cost-effectiveness ratio (ICER) of US$ 4933 per QALY gained versus no vaccination, whereas the two-dose versus one-dose schedule would cost US$ 14 568 per QALY gained. Considering the 2012 gross-domestic-product (GDP) per capita in Indonesia of US$ 3557, the results indicate that hepatitis A vaccination would be a cost-effective intervention, both for the two-dose and one-dose vaccine schedules in isolation, but two-dose vaccination would no longer be cost-effective if one-dose vaccination is a feasible option. Vaccination would be 100% affordable at budgets of US$ 71 408 000 and US$ 37 690 000 for the implementation of the two-dose and one-dose vaccine schedules, respectively. Conclusions The implementation of hepatitis A vaccination in Indonesia would be a cost-effective health intervention under the market vaccine price. Given the budget limitations, the use of a one-dose-vaccine schedule would be more realistic to be applied than a two

  2. The Cost-effectiveness of Pre-Exposure Prophylaxis for HIV Infection in South African Women

    PubMed Central

    Walensky, Rochelle P.; Park, Ji-Eun; Wood, Robin; Freedberg, Kenneth A.; Scott, Callie A.; Bekker, Linda-Gail; Losina, Elena; Mayer, Kenneth H.; Seage, George R.; Paltiel, A. David

    2012-01-01

    Background. Recent trials report the short-term efficacy of tenofovir-based pre-exposure prophylaxis (PrEP) for prevention of human immunodeficiency virus (HIV) infection. PrEP’s long-term impact on patient outcomes, population-level transmission, and cost-effectiveness remains unknown. Methods. We linked data from recent trials to a computer model of HIV acquisition, screening, and care to project lifetime HIV risk, life expectancy (LE), costs, and cost-effectiveness, using 2 PrEP-related strategies among heterosexual South African women: (1) women receiving no PrEP and (2) women not receiving PrEP (a tenofovir-based vaginal microbicide). We used a South African clinical cohort and published data to estimate population demographic characteristics, age-adjusted incidence of HIV infection, and HIV natural history and treatment parameters. Baseline PrEP efficacy (percentage reduction in HIV transmission) was 39% at a monthly cost of $5 per woman. Alternative parameter values were examined in sensitivity analyses. Results. Among South African women, PrEP reduced mean lifetime HIV risk from 40% to 27% and increased population discounted (undiscounted) LE from 22.51 (41.66) to 23.48 (44.48) years. Lifetime costs of care increased from $7280 to $9890 per woman, resulting in an incremental cost-effectiveness ratio of $2700/year of life saved, and may, under optimistic assumptions, achieve cost savings. Under baseline HIV infection incidence assumptions, PrEP was not cost saving, even assuming an efficacy >60% and a cost <$1. At an HIV infection incidence of 9.1%/year, PrEP achieved cost savings at efficacies ≥50%. Conclusions. PrEP in South African women is very cost-effective by South African standards, conferring excellent value under virtually all plausible data scenarios. Although optimistic assumptions would be required to achieve cost savings, these represent important benchmarks for future PrEP study design. PMID:22474224

  3. The need for cost-effectiveness analyses of antimicrobial stewardship programmes: A structured review.

    PubMed

    Coulter, Sonali; Merollini, Katharina; Roberts, Jason A; Graves, Nicholas; Halton, Kate

    2015-08-01

    The cost effectiveness of antimicrobial stewardship (AMS) programmes was reviewed in hospital settings of Organisation for Economic Co-operation and Development (OECD) countries, and limited to adult patient populations. In each of the 36 studies, the type of AMS strategy and the clinical and cost outcomes were evaluated. The main AMS strategy implemented was prospective audit with intervention and feedback (PAIF), followed by the use of rapid technology, including rapid polymerase chain reaction (PCR)-based methods and matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) technology, for the treatment of bloodstream infections. All but one of the 36 studies reported that AMS resulted in a reduction in pharmacy expenditure. Among 27 studies measuring changes to health outcomes, either no change was reported post-AMS, or the additional benefits achieved from these outcomes were not quantified. Only two studies performed a full economic evaluation: one on a PAIF-based AMS intervention; and the other on use of rapid technology for the selection of appropriate treatment for serious Staphylococcus aureus infections. Both studies found the interventions to be cost effective. AMS programmes achieved a reduction in pharmacy expenditure, but there was a lack of consistency in the reported cost outcomes making it difficult to compare between interventions. A failure to capture complete costs in terms of resource use makes it difficult to determine the true cost of these interventions. There is an urgent need for full economic evaluations that compare relative changes both in clinical and cost outcomes to enable identification of the most cost-effective AMS strategies in hospitals. PMID:26058776

  4. The cost-effectiveness of improving malaria home management: shopkeeper training in rural Kenya.

    PubMed

    Goodman, C A; Mutemi, W M; Baya, E K; Willetts, A; Marsh, V

    2006-07-01

    Home management is a very common approach to the treatment of illnesses such as malaria, acute respiratory infections, tuberculosis, diarrhoea and sexually transmitted infections, frequently through over-the-counter purchase of drugs from shops. Inappropriate drugs and doses are often obtained, but interventions to improve treatment quality are rare. An educational programme for general shopkeepers and communities in Kilifi District, rural Kenya was associated with major improvements in the use of over-the-counter anti-malarial drugs for childhood fevers. The two main components were workshop training for drug retailers and community information activities, with impact maintained through on-going refresher training, monitoring and community mobilization. This paper presents the cost and cost-effectiveness of the programme in terms of additional appropriately treated cases, evaluating both its measured cost-effectiveness in the first area of implementation (early implementation phase) and the estimated cost-effectiveness of the programme recommended for district-level implementation (recommended district programme). The proportion of shop-treated childhood fevers receiving an adequate amount of a recommended antimalarial rose from 2% to 15% in the early implementation phase, at an economic cost of 4.00 US dollars per additional appropriately treated case (2000 US dollars). If the same impact were achieved through the recommended district programme, the economic cost per additional appropriately treated case would be 0.84 US dollars, varying between 0.37 US dollars and 1.36 US dollars in the sensitivity analysis. As with most educational approaches, the programme carries a relatively high initial financial cost, of 11,477 US dollars (0.02 per capita US dollars) for the development phase and 81,450 US dollars (0.17 per capita US dollars) for the set up year, which would be particularly suitable for donor funding, while the annual costs of 18,129 US dollars (0.04 per

  5. A participatory approach for selecting cost-effective measures in the WFD context: the Mar Menor (SE Spain).

    PubMed

    Perni, Angel; Martínez-Paz, José M

    2013-08-01

    Achieving a good ecological status in water bodies by 2015 is one of the objectives established in the European Water Framework Directive. Cost-effective analysis (CEA) has been applied for selecting measures to achieve this goal, but this appraisal technique requires technical and economic information that is not always available. In addition, there are often local insights that can only be identified by engaging multiple stakeholders in a participatory process. This paper proposes to combine CEA with the active involvement of stakeholders for selecting cost-effective measures. This approach has been applied to the case study of one of the main coastal lagoons in the European Mediterranean Sea, the Mar Menor, which presents eutrophication problems. Firstly, face-to-face interviews were conducted to estimate relative effectiveness and relative impacts of a set of measures by means of the pairwise comparison technique. Secondly, relative effectiveness was used to estimate cost-effectiveness ratios. The most cost-effective measures were the restoration of watercourses that drain into the lagoon and the treatment of polluted groundwater. Although in general the stakeholders approved the former, most of them stated that the latter involved some uncertainties, which must be addressed before implementing it. Stakeholders pointed out that the PoM would have a positive impact not only on water quality, but also on fishing, agriculture and tourism in the area. This approach can be useful to evaluate other programmes, plans or projects related to other European environmental strategies. PMID:23669576

  6. Cost-effective selection of fire fighter recruits.

    PubMed

    Brownlie, L; Brown, S; Diewert, G; Good, P; Holman, G; Laue, G; Banister, E

    1985-12-01

    To discriminate suitable fire fighters from recurring large groups of applicants, an objective test battery was developed which screened applicants on the basis of physical, psychomotor, and mental abilities. The physical and psychomotor selection procedures first involved fundamental tests of general aerobic endurance, upper body strength, and anaerobic endurance. Successful candidates progressed to more specific tests. Measurements were made of height, weight, hamstring flexibility, balance, strength, upper body flexibility, hand-eye coordination, and the ability to negotiate a fire fighting simulation course. Results of these tests were weighted, allocating 25% to physical tests, 20% to psychomotor tests, and 39% to the simulation course. These scores were then combined with scores of several knowledge tests weighted to be 16% of the whole. This provided a computer-generated ability profile of the top applicants which was considered at their interview before a final selection board of fire service officers. Selected candidates were then required to pass a medical examination. Pearson correlation coefficient analysis of 1984 test results demonstrated general independence of the tests (R = -0.34 to R = 0.52), with the exception of bilateral grip strength (R = 0.77). The first four trials of the selection procedure screened 3,172 applicants, 16.4% of whom were finally selected for interview. City officials estimated that based on a comparison of new and previously used selection procedures, cost savings of +92,500 were being achieved by 1984. PMID:3935900

  7. Medication reviews.

    PubMed

    Blenkinsopp, Alison; Bond, Christine; Raynor, David K

    2012-10-01

    Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinician conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When 'harder' outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped. PMID:22607195

  8. Is Taurolidine-citrate an effective and cost-effective hemodialysis catheter lock solution? A systematic review and cost- effectiveness analysis

    PubMed Central

    Kavosi, Zahra; Sarikhani Khorrami, Maryam; Keshavarz, Khosro; Jafari, Abdosaleh; Hashemi Meshkini, Amir; Safaei, Hamid Reza; Nikfar, Shekoufeh

    2016-01-01

    Background: Prevention of catheter-related infection is of prime importance,. However, because of the risks caused by the leakage of circulating antibiotics and development of resistance to antibiotics, they are replaced by lock solutions. The aim of this study was to evaluate the efficacy and cost- effectiveness of taurolidine-citrate as a hemodialysis catheter lock solution compared to other common alternatives in Iran. Methods: To evaluate the efficacy of taurolidine-citrate, a systematic review was conducted by searching electronic databases. The outcomes of interest for cost-effectiveness analysis were as follows: "Catheter-related bacteremia episodes"; "catheter-related bacteremia-free survival"; "catheter thrombosis rate" for efficacy evaluation and "reduction of catheter-related infection". For evidence synthesis, a meta-analysis was conducted on the extracted efficacy data. To evaluate the cost of treatments, direct medical costs were included, and the incremental cost-effectiveness ratio was calculated for each comparison. The payers’ (patients and insurance companies) perspectives were used for cost analysis. Results: After carrying out the systematic process, three articles were included in the analysis. Considering 95% confidence interval, the relative difference was -0.16 (-0.25 to -0.07) for catheterrelated bacteremia episode, indicating that the rate of catheter-related infections in hemodialysis patients who used taurolidine-citrate was 16% less than in those hemodialysis patients who received heparin. Considering 95% confidence interval, the relative difference was 0.13 (-0.06 0.32) for catheter thrombosis, showing that the rate of catheter-related thrombosis in hemodialysis patients who used taurolidine-citrate was 13% more than in hemodialysis patients who received heparin. The results of this analysis indicated that taurolidine-citrate, compared to heparin, was more effective in preventing catheter-related infection; therefore, it could be

  9. Cost-effectiveness of Pharmaceutical Interventions to Prevent Osteoporotic Fractures in Postmenopausal Women with Osteopenia

    PubMed Central

    Kwon, Jin-Won; Park, Hae-Young; Kim, Ye Jee; Moon, Seong-Hwan

    2016-01-01

    Background To assess the cost-effectiveness of drug therapy to prevent osteoporotic fractures in postmenopausal women with osteopenia in Korea. Methods A Markov cohort simulation was conducted for lifetime with a hypothetical cohort of postmenopausal women with osteopenia and without prior fractures. They were assumed to receive calcium/vitamin D supplements only or drug therapy (i.e., raloxifene or risedronate) along with calcium/vitamin D for 5 years. The Markov model includes fracture-specific and non-fracture specific health states (i.e. breast cancer and venous thromboembolism), and all-cause death. Published literature was used to determine the model parameters. Local data were used to estimate the baseline incidence rates of fracture in those with osteopenia and the costs associated with each health state. Results From a societal perspective, the estimated incremental cost-effectiveness ratios (ICERs) for the base cases that had T-scores between -2.0 and -2.4 and began drug therapy at the age of 55, 60, or 65 years were $16,472, $6,741, and -$13,982 per quality-adjusted life year (QALY) gained, respectively. Sensitivity analyses for medication compliance, risk of death following vertebral fracture, and relaxing definition of osteopenia resulted in ICERs reached to $24,227 per QALY gained. Conclusions ICERs for the base case and sensitivity analyses remained within the World Health Organization's willingness-to-pay threshold, which is less than per-capita gross domestic product in Korea (about $25,700). Thus, we conclude that drug therapy for osteopenia would be a cost-effective intervention, and we recommend that the Korean National Health Insurance expand its coverage to include drug therapy for osteopenia. PMID:27294078

  10. Cost-effectiveness analysis of universal influenza vaccination with quadrivalent inactivated vaccine in the United States

    PubMed Central

    Clements, Karen M; Meier, Genevieve; McGarry, Lisa J; Pruttivarasin, Narin; Misurski, Derek A

    2014-01-01

    To address influenza B lineage mismatch and co-circulation, several quadrivalent inactivated influenza vaccines (IIV4s) containing two type A strains and both type B lineages have recently been approved in the United States. Currently available trivalent inactivated vaccines (IIV3s) or trivalent live attenuated influenza vaccines (LAIV3s) comprise two influenza A strains and one of the two influenza B lineages that have co-circulated in the United States since 2001. The objective of this analysis was to evaluate the cost-effectiveness of a policy of universal vaccination with IIV4 vs. IIV3/LAIV3 during 1 year in the United States. On average per influenza season, IIV4 was predicted to result in 30 251 fewer influenza cases, 3512 fewer hospitalizations, 722 fewer deaths, 4812 fewer life-years lost, and 3596 fewer quality-adjusted life-years (QALYs) lost vs. IIV3/LAIV3. Using the Fluarix QuadrivalentTM (GlaxoSmithKline) prices and the weighted average IIV3/LAIV3 prices, the model predicts that the vaccination program costs would increase by $452.2 million, while direct medical and indirect costs would decrease by $111.6 million and $218.7 million, respectively, with IIV4. The incremental cost-effectiveness ratio (ICER) comparing IIV4 to IIV3/LAIV3 is predicted to be $90 301/QALY gained. Deterministic sensitivity analyses found that influenza B vaccine-matched and mismatched efficacies among adults aged ≥65 years had the greatest impact on the ICER. Probabilistic sensitivity analysis showed that the cost per QALY remained below $100 000 for 61% of iterations. In conclusion, vaccination with IIV4 in the US is predicted to reduce morbidity and mortality. This strategy is also predicted to be cost-effective vs. IIV3/LAIV3 at conventional willingness-to-pay thresholds. PMID:24609063

  11. Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion

    PubMed Central

    GARIEPY, Aileen M.; DUFFY, Jennifer Y.; XU, Xiao

    2015-01-01

    Objective To evaluate the cost-effectiveness of immediate versus delayed (6 weeks) postpartum etonogestrel implant insertion in preventing future unintended pregnancy. Methods We constructed a decision-analytic model to examine a hypothetical population of women who request a contraceptive implant after giving birth. The timeframe for analysis was from the time of childbirth to one year postpartum. Model inputs were derived from a comprehensive literature review. We compared immediate (before discharge from the childbirth hospital stay) versus delayed (at first postpartum office visit) postpartum placement of the contraceptive implant from a health care system’s perspective. Implant insertion and removal, loss to follow-up at postpartum visit, use of alternative contraceptive methods, and contraceptive failure were incorporated into the model. We calculated the incremental cost of immediate insertion for each pregnancy prevented during the first postpartum year and cost savings associated with pregnancies prevented. One-way sensitivity analyses were also performed. Cost estimates are reported in 2014 U.S. dollars. Results Immediate postpartum implant insertion is associated with higher expected cost than delayed insertion ($1,091 per patient versus $650 per patient), but is more effective in preventing pregnancies (expected pregnancy rate: 2.4% and 21.6%, respectively). This results in an incremental cost-effectiveness ratio of $2,304 per pregnancy prevented. When taking into consideration medical costs of the resulting unintended pregnancies that could be avoided, immediate implant insertion is expected to save $1,263 per patient. Conclusions Immediate postpartum provision of the contraceptive implant is cost-effective in preventing unintended pregnancies, and should be provided to women requesting this form of contraception. PMID:26241255

  12. Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis

    PubMed Central

    2013-01-01

    Background The aim of this study was to assess the cost-effectiveness of administering magnesium sulphate to patients in whom preterm birth at < 32+0 weeks gestation is either imminent or threatened for the purpose of fetal neuroprotection. Methods Multiple decision tree models and probabilistic sensitivity analyses were used to compare the administration of magnesium sulphate with the alternative of no treatment. Two separate cost perspectives were utilized in this series of analyses: a health system and a societal perspective. In addition, two separate measures of effectiveness were utilized: cases of cerebral palsy (CP) averted and quality-adjusted life years (QALYs). Results From a health system and a societal perspective, respectively, a savings of $2,242 and $112,602 is obtained for each QALY gained and a savings of $30,942 and $1,554,198 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is imminent. From a health system perspective and a societal perspective, respectively, a cost of $2,083 is incurred and a savings of $108,277 is obtained for each QALY gained and a cost of $28,755 is incurred and a savings of $1,494,500 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is threatened. Conclusions Administration of magnesium sulphate to patients in whom preterm birth is imminent is a dominant (i.e. cost-effective) strategy, no matter what cost perspective or measure of effectiveness is used. Administration of magnesium sulphate to patients in whom preterm birth is threatened is a dominant strategy from a societal perspective and is very likely to be cost-effective from a health system perspective. PMID:24350635

  13. Cost-Effectiveness of Pharmacotherapy to Reduce Obesity

    PubMed Central

    Veerman, J. Lennert; Barendregt, Jan J.; Forster, Megan; Vos, Theo

    2011-01-01

    Aims Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. Methods We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money. Results The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000–180 000) for sibutramine and A$230 000/DALY (170 000–340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. Conclusions Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden. PMID:22046255

  14. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    PubMed Central

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

  15. Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening

    PubMed Central

    Shankaran, Veena; Luu, Thanh Ha; Nonzee, Narissa; Richey, Elizabeth; McKoy, June M.; Graff Zivin, Joshua; Ashford, Alfred; Lantigua, Rafael; Frucht, Harold; Scoppettone, Marc; Bennett, Charles L.; Sheinfeld Gorin, Sherri

    2009-01-01

    Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention. Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates. Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates. Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective. PMID:19826133

  16. A Cost-Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat

    PubMed Central

    Donaldson, Elisabeth A; Waters, Hugh R; Arora, Monika; Varghese, Beena; Dave, Paresh; Modi, Bhavesh

    2011-01-01

    Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India’s Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat. PMID:21655118

  17. Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program.

    PubMed

    Rosenheck, Robert; Leslie, Douglas; Sint, Kyaw; Lin, Haiqun; Robinson, Delbert G; Schooler, Nina R; Mueser, Kim T; Penn, David L; Addington, Jean; Brunette, Mary F; Correll, Christoph U; Estroff, Sue E; Marcy, Patricia; Robinson, James; Severe, Joanne; Rupp, Agnes; Schoenbaum, Michael; Kane, John M

    2016-07-01

    This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at $40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices. PMID:26834024

  18. Using patient-centered endpoints to determine the cost-effectiveness of triptans for acute migraine therapy.

    PubMed

    Kelman, Leslie; Von Seggern, Randal L

    2006-01-01

    The objective of this study was to use the patient-centered efficacy measurements of sustained pain free and sustained pain free with no adverse events to compare the relative cost-effectiveness of 6 oral triptans in the treatment of acute migraine. Adverse event and sustained pain-free rates were obtained from a comprehensive meta-analysis of 53 clinical trials of oral triptans. Efficacy and tolerability were assumed to be independent. Average wholesale prices were in US dollars as of May 10, 2004. The meta-analysis of oral triptans reported that almotriptan 12.5 mg (Axert) exhibited the highest sustained pain-free rate (25.9%), with the lowest rate associated with eletriptan 20 mg (Relpax) (10.6%). In addition, almotriptan 12.5 mg possessed the lowest overall absolute adverse event rate (14.2%), with the highest adverse event rate exhibited by eletriptan 80 mg (53.9%). To attain 100 sustained pain-free patients, almotriptan 12.5 mg and rizatriptan 10 mg (Maxalt) proved to be the most cost-effective triptans, costing $7120 and $7427, respectively; the least cost-effective were naratriptan 2.5 mg (Amerge) ($13,736) and eletriptan 20 mg ($16,104). To attain 100 sustained pain-free with no adverse events patients, almotriptan 12.5 mg was the most cost-effective triptan ($8298) and the least cost-effective were eletriptan 20 mg ($25,521) and eletriptan 80 mg ($29,614). At average wholesale prices as of May 10, 2004, almotriptan 12.5 mg achieved the highest level of cost-effectiveness using either sustained pain free or sustained pain free with no adverse events as endpoints. PMID:16988536

  19. Cost-Effectiveness of Early Versus Standard Antiretroviral Therapy in HIV-Infected Adults in Haiti

    PubMed Central

    Koenig, Serena P.; Bang, Heejung; Severe, Patrice; Jean Juste, Marc Antoine; Ambroise, Alex; Edwards, Alison; Hippolyte, Jessica; Fitzgerald, Daniel W.; McGreevy, Jolion; Riviere, Cynthia; Marcelin, Serge; Secours, Rode; Johnson, Warren D.; Pape, Jean W.; Schackman, Bruce R.

    2011-01-01

    Background In a randomized clinical trial of early versus standard antiretroviral therapy (ART) in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm3 in Haiti, early ART decreased mortality by 75%. We assessed the cost-effectiveness of early versus standard ART in this trial. Methods and Findings Trial data included use of ART and other medications, laboratory tests, outpatient visits, radiographic studies, procedures, and hospital services. Medication, laboratory, radiograph, labor, and overhead costs were from the study clinic, and hospital and procedure costs were from local providers. We evaluated cost per year of life saved (YLS), including patient and caregiver costs, with a median of 21 months and maximum of 36 months of follow-up, and with costs and life expectancy discounted at 3% per annum. Between 2005 and 2008, 816 participants were enrolled and followed for a median of 21 months. Mean total costs per patient during the trial were US$1,381 for early ART and US$1,033 for standard ART. After excluding research-related laboratory tests without clinical benefit, costs were US$1,158 (early ART) and US$979 (standard ART). Early ART patients had higher mean costs for ART (US$398 versus US$81) but lower costs for non-ART medications, CD4 cell counts, clinically indicated tests, and radiographs (US$275 versus US$384). The cost-effectiveness ratio after a maximum of 3 years for early versus standard ART was US$3,975/YLS (95% CI US$2,129/YLS–US$9,979/YLS) including research-related tests, and US$2,050/YLS excluding research-related tests (95% CI US$722/YLS–US$5,537/YLS). Conclusions Initiating ART in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm3 in Haiti, consistent with World Health Organization advice, was cost-effective (US$/YLS <3 times gross domestic product per capita) after a maximum of 3 years, after excluding research-related laboratory tests. Trial registration ClinicalTrials.gov NCT00120510 Please see

  20. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    SciTech Connect

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Peter Manekas

    2005-03-18

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2003 through September 30, 2004 and contains the following discussions: (1) Direct Electrical Connection for Rotary Shoulder Tool Joints; (2) Conductors for inclusion in the pipe wall (ER/DW-CDP); (3) Qualify fibers from Zoltek; (4) Qualify resin from Bakelite; (5) First commercial order for SR-CDP from Integrated Directional Resources (SR-CDP); and (6) Preparation of papers for publication and conference presentations.

  1. Cost-effective ceramics program in the United States

    SciTech Connect

    Schulz, R.B.; Johnson, D.R.

    1994-10-01

    The 5-year Cost-Effective Ceramics for Heat Engines program began in 1993. This effort reflects the realization that the problems with reliability of structural ceramics have been largely overcome, but the high cost of structural ceramics is limited their use in commercial applications. The technical causes of high cost were identified, and a technical plan developed. The work elements in the program include the following: economic cost modeling, ceramic machining, powder synthesis, alternative forming and densification processes, yield improvement, standards development, and low-expansion ceramics.

  2. Cost-Effectiveness of Osteoporosis Screening Strategies for Men.

    PubMed

    Nayak, Smita; Greenspan, Susan L

    2016-06-01

    Osteoporosis affects many men, with significant morbidity and mortality. However, the best osteoporosis screening strategies for men are unknown. We developed an individual-level state-transition cost-effectiveness model with a lifetime time horizon to identify the cost-effectiveness of different osteoporosis screening strategies for US men involving various screening tests (dual-energy X-ray absorptiometry [DXA]; the Osteoporosis Self-Assessment Tool [OST]; or a fracture risk assessment strategy using age, femoral neck bone mineral density [BMD], and Vertebral Fracture Assessment [VFA]); screening initiation ages (50, 60, 70, or 80 years); and repeat screening intervals (5 years or 10 years). In base-case analysis, no screening was a less effective option than all other strategies evaluated; furthermore, no screening was more expensive than all strategies that involved screening with DXA or the OST risk assessment instrument, and thus no screening was "dominated" by screening with DXA or OST at all evaluated screening initiation ages and repeat screening intervals. Screening strategies that most frequently appeared as most cost-effective in base-case analyses and one-way sensitivity analyses when assuming willingness-to-pay of $50,000/quality-adjusted life-year (QALY) or $100,000/QALY included screening initiation at age 50 years with the fracture risk assessment strategy and repeat screening every 10 years; screening initiation at age 50 years with fracture risk assessment and repeat screening every 5 years; and screening initiation at age 50 years with DXA and repeat screening every 5 years. In conclusion, expansion of osteoporosis screening for US men to initiate routine screening at age 50 or 60 years would be expected to be effective and of good value for improving health outcomes. A fracture risk assessment strategy using variables of age, femoral neck BMD, and VFA is likely to be the most effective of the evaluated strategies within accepted cost-effectiveness

  3. Invisible Cost Effective Mechanics for Anterior Space Closure.

    PubMed

    Jumle, Aatish Vinod; Bagrecha, Saurabh; Gharat, Ninad; Misal, Abhijit; Toshniwal, N G

    2015-01-01

    The shifting paradigm towards invisible orthodontic treatment and also awareness in patients has allured their focus towards the most esthetic treatment approach. Also the lingual treatment is proved successful and is very well accepted by the patients. The problem that persist is its high expenses, which is not affordable by all patients. This article is a effort to treat a simple Class I malocclusion with anterior spacing using a simple, esthetic, Cost effective approach with acceptable results when esthetics plays a priority role. PMID:26349282

  4. Key aspects of cost effective collector and solar field design

    NASA Astrophysics Data System (ADS)

    von Reeken, Finn; Nicodemo, Dario; Keck, Thomas; Weinrebe, Gerhard; Balz, Markus

    2016-05-01

    A study has been performed where different key parameters influencing solar field cost are varied. By using levelised cost of energy as figure of merit it is shown that parameters like GoToStow wind speed, heliostat stiffness or tower height should be adapted to respective site conditions from an economical point of view. The benchmark site Redstone (Northern Cape Province, South Africa) has been compared to an alternate site close to Phoenix (AZ, USA) regarding site conditions and their effect on cost-effective collector and solar field design.

  5. Cost effective tools for soil organic carbon monitoring

    NASA Astrophysics Data System (ADS)

    Shepherd, Keith; Aynekulu, Ermias

    2013-04-01

    There is increasing demand for data on soil properties at fine spatial resolution to support management and planning decisions. Measurement of soil organic carbon has attracted much interest because (i) soil organic carbon is widely cited as a useful indicator of soil condition and (ii) of the importance of soil carbon in the global carbon cycle and climate mitigation strategies. However in considering soil measurement designs there has been insufficient attention given to careful analysis of the specific decisions that the measurements are meant to support and on what measurements have high information value for decision-making. As a result, much measurement effort may be wasted or focused on the wrong variables. A cost-effective measurement is one that reduces risk in decisions and does not cost more than the societal returns to additional evidence. A key uncertainty in measuring soil carbon as a soil condition indicator is what constitutes a good or bad level of carbon on a given soil. A measure of soil organic carbon concentration may have limited value for informing management decisions without the additional information required to interpret it, and so expending further efforts on improving measurements to increase precision may then have no value to improving the decision. Measuring soil carbon stock changes for carbon trading purposes requires high levels of measurement precision but there is still large uncertainty on whether the costs of measurement exceed the benefits. Since the largest cost component in soil monitoring is often travel to the field and physically sampling soils, it is generally cost-effective to meet multiple objectives by analysing a number of properties on a soil sample. Diffuse reflectance infrared spectroscopy is playing a key role in allowing multiple soil properties to be determined rapidly and at low cost. The method provides estimation of multiple soil properties (e.g. soil carbon, texture and mineralogy) in one measurement

  6. A cost effective data management subsystem for the LST

    NASA Technical Reports Server (NTRS)

    Dougherty, J. A.; Patterson, T. D.; Cole, A. E.

    1975-01-01

    The paper outlines the approach used in developing DMS (Data Management Subsystem) alternatives for the LST (Large Space Telescope) and in selecting the concept considered to be the most cost effective means of implementing the LST DMS requirements. Two candidate DMS concepts are discussed: a functionally integrated and a functionally separated one. For the single vehicle LST program, separation of the DMS functions best provides high reliability, operations flexibility, minimal interface complexity, and the least complex software development and verification task. The use of available hardware and NASA standard components is stressed.

  7. Facilitating Sound, Cost-Effective Federal Energy Management (Fact Sheet)

    SciTech Connect

    Not Available

    2012-03-01

    This fact sheet is an overview of the U.S. Department of Energy's Federal Energy Management Program (FEMP). The Federal Government, as the nation's largest energy consumer, has a tremendous opportunity and acknowledged responsibility to lead by example. The U.S. Department of Energy's (DOE's) Federal Energy Management Program (FEMP) plays a critical role in this effort. FEMP facilitates the Federal Government's implementation of sound, cost-effective energy management and investment practices to enhance the nation's energy security and environmental stewardship. FEMP does this by focusing on the needs of its Federal customers, delivering an array of services across a variety of program areas.

  8. High-Energy-Density Cost-Effective Graphene Supercapacitors

    NASA Astrophysics Data System (ADS)

    Samuilov, Vladimir; Ying Mu, Ying; Hedayat, Nader; Solovyov, Vyacheslav; Sensor CAT at Stony Brook Team

    We introduce a cost-effective graphene platelet composite material as a replacement of an expensive reduced graphene oxide for electrodes in high energy density supercapacitors. We have tested a low size supercapacitor prototypes with the graphene platelets electrodes and newly developed polymer-gel Li + ion electrolyte. We discuss the ways how to increase the capacitance and the energy densities of the supercapacitor significantly. A working prototype for testing the concept of the high voltage supercapacitor has been developed as well. The first test done up to 10 V showed excellent performance of the multy-cell multi-layer high voltage test assembly.

  9. Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study

    PubMed Central

    Binagwaho, Agnes; Pegurri, Elisabetta; Muita, Jane; Bertozzi, Stefano

    2010-01-01

    ratio is negative), even though savings from infant circumcision will be realized later in time. The cost per infection averted is US$3,932 for adolescent MC and US$4,949 for adult MC. Results for infant MC appear robust. Infant MC remains highly cost-effective across a reasonable range of variation in the base case scenario. Adolescent MC is highly cost-effective for the base case scenario but this high cost-effectiveness is not robust to small changes in the input variables. Adult MC is neither cost-saving nor highly cost-effective when considering only the direct benefit for the circumcised man. Conclusions The study suggests that Rwanda should be simultaneously scaling up circumcision across a broad range of age groups, with high priority to the very young. Infant MC can be integrated into existing health services (i.e., neonatal visits and vaccination sessions) and over time has better potential than adolescent and adult circumcision to achieve the very high coverage of the population required for maximal reduction of HIV incidence. In the presence of infant MC, adolescent and adult MC would evolve into a “catch-up” campaign that would be needed at the start of the program but would eventually become superfluous. Please see later in the article for the Editors' Summary PMID:20098721

  10. Superior cost-effectiveness in flue gas desulfurization via high-volume, high value byproduct generation

    SciTech Connect

    Ellison, W.

    1998-07-01

    Current worldwide advancements in application and commercial operation of ammonia-base flue gas desulfurization, (FGD), in electric utility service, motivated in part by significant revenues from ammonium sulfate output, are detailed. This new direction in FGD process selection and in the design of flue gas cleaning installations achieves major performance advancements herein reviewed. Attractive cost effectiveness, achieved in the face of substantial capital cost, is quantified. Favorable process economics, superior to that of all available alternatives for high-capacity, high-sulfur, powerplant service, is made possible through substantial value added in conversion of ammonia reagent consumed to agglomerated byproduct, principally ammonium sulfate. This low-nitrogen-content compound, the poor man's fertilizer of times past, is now in great and growing demand for use as sulfur blending stock in worldwide, commercial NPKS, (nitrogen/phosphorus/ potassium/sulfur), chemical fertilizer manufacture.

  11. Environmental cost-effectiveness analysis in intertemporal natural resource policy: evaluation of selective fishing gear.

    PubMed

    Kronbak, Lone Grønbæk; Vestergaard, Niels

    2013-12-15

    In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included. PMID:24184529

  12. Cost-effectiveness of pre-participation screening of athletes with ECG in Europe and Algeria.

    PubMed

    Assanelli, Deodato; Levaggi, Rosella; Carré, François; Sharma, Sanjay; Deligiannis, Asterios; Mellwig, Klaus Peter; Tahmi, Mohamed; Vinetti, Giovanni; Aliverti, Paola

    2015-03-01

    The aim of this study is to evaluate the cost-effectiveness of ECG in combination with family and personal history and physical examination in order to detect cardiovascular diseases that might cause sudden death in athletes. The study was conducted on a cohort of 6,634, mainly young professional and recreational athletes, 1,071 from Algeria and 5,563 from Europe (France, Germany and Greece). Each athlete underwent medical history, physical examination, and resting 12-lead ECG. 293 athletes (4.4 %), 149 in Europe (2.7 %) and 144 in Algeria (13.4 %) required further tests, and 56 were diagnosed with cardiovascular disease and thus disqualified. The cost-effectiveness ratio (CER) was calculated as the ratio between the cost of screening and the number of statistical life-years saved by the intervention. The estimated reduced risk of death deriving from treatment or disqualification resulted in the saving of 79.1 statistical life-years in Europe and 136.3 in Algeria. CER of screening was 4,071 purchasing-power-parity-adjusted US dollars ($PPP) in Europe and 582 $PPP in Algeria. The results of this study strongly support the utilisation of 12-lead ECG in the pre-participation screening of young athletes, especially in countries where secondary preventive care is not highly developed. PMID:25164412

  13. Clinical Evaluation and Cost-Effectiveness Analysis of Serum Tumor Markers in Lung Cancer

    PubMed Central

    Wang, Rong; Wang, Guoqing; Zhang, Nan; Li, Xue; Liu, Yunde

    2013-01-01

    The detection of serum tumor markers is valuable for the early diagnosis of lung cancer. Tumor markers are frequently used for the management of cancer patients. However, single markers are less efficient but marker combinations increase the cost, which is troublesome for clinics. To find an optimal serum marker combination panel that benefits the patients and the medical management system as well, four routine lung cancer serum markers (SCCA, NSE, CEA, and CYFRA21-1) were evaluated individually and in combination. Meanwhile, the costs and effects of these markers in clinical practice in China were assessed by cost-effectiveness analysis. As expected, combinations of these tumor markers improved their sensitivity for lung cancer and different combination panels had their own usefulness. NSE + CEA + CYFRA21-1 was the optimal combination panel with highest Youden's index (0.64), higher sensitivity (75.76%), and specificity (88.57%), which can aid the clinical diagnosis of lung cancer. Nevertheless, the most cost-effective combination was SCCA + CEA, which can be used to screen the high-risk group. PMID:24167812

  14. A strategic plan for integrating cost-effectiveness analysis into the US healthcare system.

    PubMed

    Neumann, Peter J; Palmer, Jennifer A; Daniels, Norman; Quigley, Karen; Gold, Marthe R; Chao, Schumarry

    2008-04-01

    The Panel on Integrating Cost-Effectiveness Considerations into Health Policy Decisions, composed of medical and pharmacy directors at public and private health plans, was convened to (1) explore the views of health plan purchasers about cost-effectiveness analysis (CEA) and (2) to develop a strategic plan for policymakers to address obstacles and to integrate CEA into health policy decisions, drawing on stakeholders as part of the solution. Panelists expressed strong support for a greater role for CEA in US health policy decisions, although they also highlighted barriers in the current system and challenges involved in moving forward. The strategic plan involves a series of activities to advance the use of CEA in the United States, including research and demonstration projects to illustrate potential gains from using the technique and ongoing consensus- building steps (eg, workshops, conferences, town meetings) involving a broad coalition of stakeholders. Funding and leadership from policymakers and nonprofit foundations will be needed, as well as the active engagement of legislators and business and consumer groups. Panelists emphasized the importance of the Medicare program taking a lead role, and the need for new "infrastructure," in the form of either a new institute for conducting research or increased funding for existing institutions. PMID:18402510

  15. The cost-effectiveness of health checkups--an illustrative study.

    PubMed

    Collen, M F

    1984-12-01

    An economic analysis of personal health maintenance is complicated by the great variability in the health care process, the large amount of missing data and the great range in analytic results. Accordingly, this study should be considered more illustrative than conclusive. Data are available on middle-aged adults that periodic health checkups can be effective in significantly lowering mortality from potentially postponable disease. Using these data, a net-cost analysis has been attempted for periodic health checkups. The findings suggest that their costs and effects on health depend on how they are provided, how often and to whom. Yet, periodic health checkups can reduce lost earnings capability of examinees and can be cost-effective by using efficient health examination methods. If policy decision makers require health checkups for the lowest income people to be cost-effective, then these checkups probably will continue to be limited to case finding by physicians as an expense already included in current medical practice. PMID:6441347

  16. Comparative and Cost Effectiveness of Telemedicine Versus Telephone Counseling for Smoking Cessation

    PubMed Central

    Shireman, Theresa I; Ellerbeck, Edward F; Cupertino, A Paula; Catley, Delwyn; Cox, Lisa Sanderson; Preacher, Kristopher J; Spaulding, Ryan; Mussulman, Laura M; Nazir, Niaman; Hunt, Jamie J; Lambart, Leah

    2015-01-01

    Background In rural America, cigarette smoking is prevalent and health care providers lack the time and resources to help smokers quit. Telephone quitlines are important avenues for cessation services in rural areas, but they are poorly integrated with local health care resources. Objective The intent of the study was to assess the comparative effectiveness and cost effectiveness of two models for delivering expert tobacco treatment at a distance: telemedicine counseling that was integrated into smokers’ primary care clinics (Integrated Telemedicine—ITM) versus telephone counseling, similar to telephone quitline counseling, delivered to smokers in their homes (Phone). Methods Smokers (n=566) were recruited offline from 20 primary care and safety net clinics across Kansas. They were randomly assigned to receive 4 sessions of ITM or 4 sessions of Phone counseling. Patients in ITM received real-time video counseling, similar to Skype, delivered by computer/webcams in clinic exam rooms. Three full-time equivalent trained counselors delivered the counseling. The counseling duration and content was the same in both groups and was available in Spanish or English. Both groups also received identical materials and assistance in selecting and obtaining cessation medications. The primary outcome was verified 7-day point prevalence smoking abstinence at month 12, using an intent-to-treat analysis. Results There were no significant baseline differences between groups, and the trial achieved 88% follow-up at 12 months. Verified abstinence at 12 months did not significantly differ between ITM or Phone (9.8%, 27/280 vs 12%, 34/286; P=.406). Phone participants completed somewhat more counseling sessions than ITM (mean 2.6, SD 1.5 vs mean 2.4, SD 1.5; P=.0837); however, participants in ITM were significantly more likely to use cessation medications than participants in Phone (55.9%, 128/280 vs 46.1%, 107/286; P=.03). Compared to Phone participants, ITM participants were

  17. Cost effectiveness of the stream-gaging program in Nevada

    USGS Publications Warehouse

    Arteaga, F.E.

    1990-01-01

    The stream-gaging network in Nevada was evaluated as part of a nationwide effort by the U.S. Geological Survey to define and document the most cost-effective means of furnishing streamflow information. Specifically, the study dealt with 79 streamflow gages and 2 canal-flow gages that were under the direct operation of Nevada personnel as of 1983. Cost-effective allocations of resources, including budget and operational criteria, were studied using statistical procedures known as Kalman-filtering techniques. The possibility of developing streamflow data at ungaged sites was evaluated using flow-routing and statistical regression analyses. Neither of these methods provided sufficiently accurate results to warrant their use in place of stream gaging. The 81 gaging stations were being operated in 1983 with a budget of $465,500. As a result of this study, all existing stations were determined to be necessary components of the program for the foreseeable future. At the 1983 funding level, the average standard error of streamflow records was nearly 28%. This same overall level of accuracy could have been maintained with a budget of approximately $445,000 if the funds were redistributed more equitably among the gages. The maximum budget analyzed, $1,164 ,000 would have resulted in an average standard error of 11%. The study indicates that a major source of error is lost data. If perfectly operating equipment were available, the standard error for the 1983 program and budget could have been reduced to 21%. (Thacker-USGS, WRD)

  18. The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis

    PubMed Central

    Manca, Andrea; Claxton, Karl; Sculpher, Mark J.

    2014-01-01

    This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. PMID:24944196

  19. Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan.

    PubMed

    Freiesleben de Blasio, Birgitte; Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children <5 years of age. Indirect protection accounted for 40% and 60% reduction in severe and mild rotavirus gastroenteritis, respectively. Cost per life year gained was US $18,044 from a societal perspective and US $23,892 from a health care perspective. Comparing the 2 key parameters of cost-effectiveness, mortality rates and vaccine cost at

  20. Cost effectiveness of the stream-gaging program in Pennsylvania

    USGS Publications Warehouse

    Flippo, H.N.; Behrendt, T.E.

    1985-01-01

    This report documents a cost-effectiveness study of the stream-gaging program in Pennsylvania. Data uses and funding were identified for 223 continuous-record stream gages operated in 1983; four are planned for discontinuance at the close of water-year 1985; two are suggested for conversion, at the beginning of the 1985 water year, for the collection of only continuous stage records. Two of 11 special-purpose short-term gages are recommended for continuation when the supporting project ends; eight of these gages are to be discontinued and the other will be converted to a partial-record type. Current operation costs for the 212 stations recommended for continued operation is $1,199,000 per year in 1983. The average standard error of estimation for instantaneous streamflow is 15.2%. An overall average standard error of 9.8% could be attained on a budget of $1,271,000, which is 6% greater than the 1983 budget, by adopted cost-effective stream-gaging operations. (USGS)

  1. Staging of lung cancer. A cost-effectiveness analysis

    SciTech Connect

    Houston, G.A.; Sanders, J.A.; Little, D.D.; Griffith, J.E.; Clericuzio, C.; Balducci, L.

    1985-06-01

    Previous reports found the WXGa scan highly accurate in staging lung cancer. In the present study the cost-effectiveness of the WXGa scan was measured and compared with that of routine tests (radionuclide liver and bone scans, brain CT scan) used to stage lung cancer. In 160 patients, the WXGa scan had a lower sensitivity, specificity, and negative predictive value than the combination of routine tests in detecting metastatic disease. The WXGa scan was less accurate than the appropriate routine test in establishing the presence of liver, bone, and brain metastases. In the mediastinum the WXGa scan was not more accurate than the chest radiograph. The average cost to accurately stage a patient by WXGa scan was $812.12 and by routine tests was $737.60. The cost for metastatic disease was $1,417.70 by WXGa scan and $1,287.70 by routine tests. It is concluded that at our institution the use of WXGa scan to stage lung cancer is not cost-effective.

  2. Cost-effectiveness of simvastatin versus cholestyramine: results for Sweden.

    PubMed

    Hjalte, K; Lindgren, B; Persson, U

    1992-03-01

    Cost-effectiveness ratios were estimated for each of 2 plasma cholesterol-lowering drug therapies, the HMG-CoA reductase inhibitor simvastatin and the well established cholestyramine, in comparison with a nonpreventive drug treatment alternative. The study was confined to Swedish men (aged 37 to 64 years at start of therapy) with total serum cholesterol levels above 6.2 mmol/L who were free of coronary artery disease (CAD). Costs included expected direct costs of plasma cholesterol-lowering treatment less expected savings resulting from preventing CAD. Effects were defined as changes in life expectancy. A discount rate of 5% and Swedish kronor (SEK) 1988 prices were used. The impact on CAD risks was calculated using multivariate logistic risk estimates from the Framingham Heart Study; Swedish estimates were used to calculate intervention costs and changes in healthcare costs. Over the range of cholesterol levels examined (6.2 to 9.8 mmol/L), simvastatin was consistently more cost-effective than cholestyramine. PMID:10147032

  3. Can Aging in Place Be Cost Effective? A Systematic Review

    PubMed Central

    Graybill, Erin M.; McMeekin, Peter; Wildman, John

    2014-01-01

    Purpose of the Study To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to ‘age in place’ and highlight what further research is needed to inform decisions regarding aging in place. Design People aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement. Methods Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style. Results Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered. Implications The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn. PMID:25058505

  4. Cost effectiveness of the 1993 Model Energy Code in Colorado

    SciTech Connect

    Lucas, R.G.

    1995-06-01

    This report documents an analysis of the cost effectiveness of the Council of American Building Officials` 1993 Model Energy Code (MEC) building thermal-envelope requirements for single-family homes in Colorado. The goal of this analysis was to compare the cost effectiveness of the 1993 MEC to current construction practice in Colorado based on an objective methodology that determined the total life-cycle cost associated with complying with the 1993 MEC. This analysis was performed for the range of Colorado climates. The costs and benefits of complying with the 1993 NIEC were estimated from the consumer`s perspective. The time when the homeowner realizes net cash savings (net positive cash flow) for homes built in accordance with the 1993 MEC was estimated to vary from 0.9 year in Steamboat Springs to 2.4 years in Denver. Compliance with the 1993 MEC was estimated to increase first costs by $1190 to $2274, resulting in an incremental down payment increase of $119 to $227 (at 10% down). The net present value of all costs and benefits to the home buyer, accounting for the mortgage and taxes, varied from a savings of $1772 in Springfield to a savings of $6614 in Steamboat Springs. The ratio of benefits to costs ranged from 2.3 in Denver to 3.8 in Steamboat Springs.

  5. Cost-effectiveness of growth monitoring and promotion.

    PubMed

    Dixon, R A

    1993-08-01

    50 million children/year are in growth monitoring and promotion (GMP) programs in developing countries and 30 million growth charts are printed annually in India alone. GMP is a simple technology of weighing and charting, but it must be properly implemented under conditions that are conducive to program success. Critics of GMP argue that its effectiveness remains to be proved. If GMP programs lead to improved growth, health, and nutritional status, will it work when expanded to the national level and is it cost-effective? A community intervention trial in South India considered the cost-effectiveness component of these concerns, but yielded only mixed results and the recommendation that replicate studies be conducted in other countries. An observational study of 179 health workers in 100 rural health facilities in 9 developing countries found deficiencies so severe in weighing, plotting, and interpreting that GMP activities simply consumed time and resources which could have been better allocated elsewhere within the health system. GMP is unlikely to succeed in the absence of training and supervision for assessment, analysis, and action. Community involvement in and ownership of GMP are also recommended. PMID:8101577

  6. Development and Manufacture of Cost Effective Composite Drill Pipe

    SciTech Connect

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Steve Loya

    2006-02-20

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2004 through September 30, 2005 and contains the following discussions: (1) Qualification Testing; (2) Prototype Development and Testing of ''Smart Design'' Configuration; (3) Field Test Demonstration; and (4) Commercial order for SR-CDP from Torch International. The objective of this contract is to develop and demonstrate ''cost effective'' Composite Drill Pipe. It is projected that this drill pipe will weigh less than half of its steel counter part. The resultant weight reduction will provide enabling technology that will increase the lateral distance that can be reached from an offshore drilling platform and the depth of water in which drilling and production operations can be carried out. Further, composite drill pipe has the capability to carry real time signal and power transmission within the pipe walls. CDP can also accommodate much shorter drilling radius than is possible with metal drill pipe. As secondary benefits, the lighter weight drill pipe can increase the storage capability of floating off shore drilling platforms and provide substantial operational cost savings.

  7. The cost-effectiveness challenge: is it worth it?

    PubMed

    Knapp, Martin

    2015-01-01

    Scarcity of resources means that difficult choices have to be made about how to use them. Cost-effectiveness evidence provides a way to help decision-makers get 'best value' from their resources when choosing between two or more clinical or other interventions. Often it is found that one intervention has better outcomes than another, but also costs more. In these circumstances there is a need for the decision-maker to reach a view as to whether those better outcomes are 'worth' the higher costs, necessitating difficult trade-offs. Illustrations from the dementia field are given to illustrate how these trade-offs might be made. For strategic decisions it has often proved helpful to use a generic outcome measure such as the quality-adjusted life year. The fundamental aim of a healthcare system is not to save money, but to save and improve lives. Cost-effectiveness and similar analyses can help by showing how to get the most out of available resources. PMID:27391601

  8. Cost effectiveness and delivery study for future HIV vaccines.

    PubMed

    Barth-Jones, D C; Cheng, H; Kang, L Y; Kenya, Patrick R; Odera, D; Mosqueira, N R; Mendoza, W; Portela, M C; Brito, C; Tangcharoensathien, V; Akaleephan, C; Supantamart, S; Patcharanarumol, W; de Macedo Brigido, L F; Fonseca, M G P; Sanchez, M; Chang, M-L; Osmanov, S; Avrett, S; Esparza, J; Griffiths, U

    2005-09-01

    Research teams from five countries, Brazil, China, Kenya, Peru and Thailand, have initiated a policy-maker survey on vaccine delivery, cost studies for future HIV vaccination programmes, and associated simulation modeling exercises analysing the relative cost-effectiveness of potential HIV vaccination strategies. The survey assesses challenges and opportunities for future country-level HIV vaccination strategies, providing data on the vaccine characteristics (e.g. vaccine efficacies for susceptibility, infectiousness and disease progression) and vaccination programme strategies to be considered in the cost-effectiveness modeling analyses. The study will provide decision-makers with modeling data on vaccination policy considerations that will assist in developing country-level capacities for future HIV vaccine policy adoption and effective delivery systems, and will help delineate the long-term financial requirements for sustainable HIV vaccination programmes. The WHO-UNAIDS HIV Vaccine Initiative and the collaborating researchers welcome comments or questions from policy makers, health professionals and other stakeholders in the public and private sectors about this effort to help advance policy and capacity related to future potential HIV vaccines. PMID:16103763

  9. Cost effectiveness of the 1995 model energy code in Massachusetts

    SciTech Connect

    Lucas, R.G.

    1996-02-01

    This report documents an analysis of the cost effectiveness of the Council of American Building Officials` 1995 Model Energy Code (MEC) building thermal-envelope requirements for single-family houses and multifamily housing units in Massachusetts. The goal was to compare the cost effectiveness of the 1995 MEC to the energy conservation requirements of the Massachusetts State Building Code-based on a comparison of the costs and benefits associated with complying with each.. This comparison was performed for three cities representing three geographical regions of Massachusetts--Boston, Worcester, and Pittsfield. The analysis was done for two different scenarios: a ``move-up`` home buyer purchasing a single-family house and a ``first-time`` financially limited home buyer purchasing a multifamily condominium unit. Natural gas, oil, and electric resistance heating were examined. The Massachusetts state code has much more stringent requirements if electric resistance heating is used rather than other heating fuels and/or equipment types. The MEC requirements do not vary by fuel type. For single-family homes, the 1995 MEC has requirements that are more energy-efficient than the non-electric resistance requirements of the current state code. For multifamily housing, the 1995 MEC has requirements that are approximately equally energy-efficient to the non-electric resistance requirements of the current state code. The 1995 MEC is generally not more stringent than the electric resistance requirements of the state code, in fact; for multifamily buildings the 1995 MEC is much less stringent.

  10. Fuels for urban transit buses: a cost-effectiveness analysis.

    PubMed

    Cohen, Joshua T; Hammitt, James K; Levy, Jonathan I

    2003-04-15

    Public transit agencies have begun to adopt alternative propulsion technologies to reduce urban transit bus emissions associated with conventional diesel (CD) engines. Among the most popular alternatives are emission controlled diesel buses (ECD), defined here to be buses with continuously regenerating diesel particle filters burning low-sulfur diesel fuel, and buses burning compressed natural gas (CNG). This study uses a series of simplifying assumptions to arrive at first-order estimates for the incremental cost-effectiveness (CE) of ECD and CNG relative to CD. The CE ratio numerator reflects acquisition and operating costs. The denominator reflects health losses (mortality and morbidity) due to primary particulate matter (PM), secondary PM, and ozone exposure, measured as quality adjusted life years (QALYs). We find that CNG provides larger health benefits than does ECD (nine vs six QALYs annually per 1000 buses) but that ECD is more cost-effective than CNG (dollar 270 000 per QALY for ECD vs dollar 1.7 million to dollar 2.4 million for CNG). These estimates are subject to much uncertainty. We identify assumptions that contribute most to this uncertainty and propose potential research directions to refine our estimates. PMID:12731827

  11. Efficacy and cost-effectiveness of environmental management for malaria control.

    PubMed

    Utzinger, J; Tozan, Y; Singer, B H

    2001-09-01

    Roll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement efficacious and cost-effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3-5 years, malaria-related mortality, morbidity and incidence rates were reduced by 70-95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161,205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3-5 years start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524-591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower: US$ 22-92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management--integrated with pharmacological, insecticidal and bednet interventions

  12. The value of hygiene promotion: cost-effectiveness analysis of interventions in developing countries.

    PubMed

    Sijbesma, Christine; Christoffers, Trea

    2009-11-01

    Hygiene promotion can greatly improve the benefits of water and sanitation programmes in developing countries at relatively limited costs. There are, however, few studies with hard data on the costs and effectiveness of individual programmes and even fewer have compared the cost-effectiveness of different promotional approaches. This article argues that objectively measured reductions of key sanitation and hygiene risks are better than DALYs for evaluating hygiene and sanitation promotion programmes. It presents a framework for the cost-effectiveness analysis of such programmes, which is used to analyse six field programmes. At costs ranging from US dollar 1.05 to US dollar 1.74 per person per year in 1999 US dollar values, they achieved (almost) complete abandonment of open defecation and considerable improvements in keeping toilets free from faecal soiling, safe disposal of child faeces, and/or washing hands with soap after defecation, before eating and after cleaning children's bottoms. However, only two studies used a quasi-experimental design (before and after studies in the intervention and - matched - control area) and only two measured costs and the degree to which results were sustained after the programme had ended. If the promotion of good sanitation and hygiene is to receive the political and managerial support it deserves, every water, sanitation and/or hygiene programme should give data on inputs, costs, processes and effects over time. More and better research that reflects the here-presented model is also needed to compare the cost-effectiveness of different promotional approaches. PMID:19703917

  13. Magnetic dipolar coupling and collective effects for binary information codification in cost-effective logic devices

    NASA Astrophysics Data System (ADS)

    Chiolerio, Alessandro; Allia, Paolo; Graziano, Mariagrazia

    2012-09-01

    Physical limitations foreshadow the eventual end to traditional Complementary Metal Oxide Semiconductor (CMOS) scaling. Therefore, interest has turned to various materials and technologies aimed to succeed to traditional CMOS. Magnetic Quantum dot Cellular Automata (MQCA) are one of these technologies. Working MQCA arrays require very complex techniques and an excellent control on the geometry of the nanomagnets and on the quality of the magnetic thin film, thus limiting the possibility for MQCA of representing a definite solution to cost-effective, high density and low power consumption device demand. Counter-intuitively, moving towards bigger sizes and lighter technologies it is still possible to develop multi-state logic devices, as we demonstrated, whose main advantage is cost-effectiveness. Applications may be seen in low cost logic devices where integration and computational power are not the main issue, eventually using flexible substrates and taking advantage of the intrinsic mechanical toughness of systems where long range interactions do not need wirings. We realized cobalt micrometric MQCA arrays by means of Electron Beam Lithography, exploiting cost-effective processes such as lift-off and RF sputtering that usually are avoided due to their low control on array geometry and film roughness. Information relative to the magnetic configuration of MQCA elements including their eventual magnetic interactions was obtained from Magnetic Force Microscope (MFM) images, enhanced by means of a numerical procedure and presented in differential maps. We report the existence of bi-stable magnetic patterns, as detected by MFM while sampling the z-component of magnetic induction field, arising from dipolar inter-element magnetostatic coupling, able to store and propagate binary information. This is achieved despite the array quality and element magnetic state, which are low and multi-domain, respectively. We discuss in detail shape, inter-element spacing and dot profile

  14. The Impact of Outliers on Net-Benefit Regression Model in Cost-Effectiveness Analysis.

    PubMed

    Wen, Yu-Wen; Tsai, Yi-Wen; Wu, David Bin-Chia; Chen, Pei-Fen

    2013-01-01

    Ordinary least square (OLS) in regression has been widely used to analyze patient-level data in cost-effectiveness analysis (CEA). However, the estimates, inference and decision making in the economic evaluation based on OLS estimation may be biased by the presence of outliers. Instead, robust estimation can remain unaffected and provide result which is resistant to outliers. The objective of this study is to explore the impact of outliers on net-benefit regression (NBR) in CEA using OLS and to propose a potential solution by using robust estimations, i.e. Huber M-estimation, Hampel M-estimation, Tukey's bisquare M-estimation, MM-estimation and least trimming square estimation. Simulations under different outlier-generating scenarios and an empirical example were used to obtain the regression estimates of NBR by OLS and five robust estimations. Empirical size and empirical power of both OLS and robust estimations were then compared in the context of hypothesis testing. Simulations showed that the five robust approaches compared with OLS estimation led to lower empirical sizes and achieved higher empirical powers in testing cost-effectiveness. Using real example of antiplatelet therapy, the estimated incremental net-benefit by OLS estimation was lower than those by robust approaches because of outliers in cost data. Robust estimations demonstrated higher probability of cost-effectiveness compared to OLS estimation. The presence of outliers can bias the results of NBR and its interpretations. It is recommended that the use of robust estimation in NBR can be an appropriate method to avoid such biased decision making. PMID:23840378

  15. Cost-effectiveness of next-generation vaccines: The case of pertussis.

    PubMed

    Fitzpatrick, Meagan C; Wenzel, Natasha S; Scarpino, Samuel V; Althouse, Benjamin M; Atkins, Katherine E; Galvani, Alison P; Townsend, Jeffrey P

    2016-06-17

    Despite steady vaccination coverage rates, pertussis incidence in the United States has continued to rise. This public health challenge has motivated calls for the development of a new vaccine with greater efficacy and duration of protection. Any next-generation vaccine would likely come at a higher cost, and must provide sufficient health benefits beyond those provided by the current vaccine in order to be deemed cost-effective. Using an age-structured transmission model of pertussis, we quantified the health and economic benefits of a next-generation vaccine that would enhance either the efficacy or duration of protection of the childhood series, the duration of the adult booster, or a combination. We developed a metric, the maximum cost-effective price increase (MCPI), to compare the potential value of such improvements. The MCPI estimates the per-dose price increase that would maintain the cost-effectiveness of pertussis vaccination. We evaluated the MCPI across a range of potential single and combined improvements to the pertussis vaccine. As an upper bound, we found that a next-generation vaccine which could achieve perfect efficacy for the childhood series would permit an MCPI of $18 per dose (95% CI: $12-$31). Pertussis vaccine improvements that extend the duration of protection to an average of 75 years would allow for an MCPI of $22 per dose for the childhood series (CI: $10-$33) or $12 for the adult booster (CI: $4-$18). Despite the short duration of the adult booster, improvements to the childhood series could be more valuable than improvements to the adult booster. Combining improvements in both efficacy and duration, a childhood series with perfect efficacy and average duration of 75 years would permit an MCPI of $39 per dose, the highest of any scenario evaluated. Our results highlight the utility of the MCPI metric in evaluating potential vaccines or other interventions when prices are unknown. PMID:27087151

  16. Cost - effectiveness analysis of the antiplatelet treatment administered on ischemic stroke patients using goal programming approach

    NASA Astrophysics Data System (ADS)

    Rajendran, Rasvini; Zainuddin, Zaitul Marlizawati; Idris, Badrisyah

    2014-09-01

    There are numerous ways to prevent or treat ischemic stroke and each of these competing alternatives is associated with a different effectiveness and a cost. In circumstances where health funds are budgeted and thus fixed, cost-effectiveness analysis (CEA) can provide information on how to comprehend the largest health gains with that limited fund as CEA is used to compare different strategies for preventing or treating a single disease. The most common medications for ischemic stroke are the anti-platelet drugs. While some drugs are more effective than others, they are also more expensive. This paper will thus assess the CEA of anti-platelet drug available for ischemic stroke patients using goal programming (GP) approach subject to in-patients days and patients' quality-of-life. GP presents a way of striving towards several objectives simultaneously whereby in this case we will consider minimizing the cost and maximizing the effectiveness.

  17. Clinical technology assessment, cost-effective adoption, and quality management by hospitals in the 1990s.

    PubMed

    Veluchamy, S; Saver, C L

    1990-06-01

    Technology assessment in the 1990s must become an integral part of a hospital's strategic priority goals, with active participation of physicians and top management. Technology assessment should involve a wide range of criteria and health care consumer expectations, so that the appropriateness, effectiveness, cost-effectiveness, and quality improvement aspects of new technologies are all considered. Mount Carmel Health's Advanced Treatment and Bionics Institute (ATBI), established in 1986, monitors significant developments in new technologies and performs technology and outcomes assessments. ATBI activities, which have facilitated adoption of 35 treatment-based projects, are integrated into the existing QA structure of Mount Carmel hospitals. Through resolution of identified problems, quality care can be promoted, while providing patients innovative medical treatments. PMID:2120659

  18. Fast and cost-effective fabrication of large-area plasmonic transparent biosensor array.

    PubMed

    Intartaglia, R; Beke, S; Moretti, M; De Angelis, F; Diaspro, A

    2015-03-01

    Surface enhanced Raman-based sensors are widely used for chemical and biological species analysis; but to date the high cost, long production time, hazardous, and toxic content as well as small sensing area and opacity are limiting their capabilities for widespread applications in the medical and environmental fields. We present a novel cost-effective method for fast laser-based fabrication of affordable large-area and transparent periodic arrays of ligand-free metallic nanoparticles, offering a maximum possibility for the adsorption/immobilization of molecules and labeling. Further, we demonstrate a remarkable detection limit in the picomolar range by means of Raman scattering, thus evidencing a superior signal-to-noise ratio compared to other sensor substrates. The high sensitivity performance along with a fast and cheap fabrication procedure of reusable large-area transparent plasmonic devices opens the route for direct, in situ multimodal optical analysis with broad applications in the biomedical/analytical fields. PMID:25591078

  19. The Cost-Effectiveness of New York City’s Safe Routes to School Program

    PubMed Central

    Epstein, Michael; DiMaggio, Charles

    2014-01-01

    Objective. We evaluated the cost-effectiveness of a package of roadway modifications in New York City funded under the Safe Routes to School (SRTS) program. Methods. We used a Markov model to estimate long-term impacts of SRTS on injury reduction and the associated savings in medical costs, lifelong disability, and death. Model inputs included societal costs (in 2013 US dollars) and observed spatiotemporal changes in injury rates associated with New York City’s implementation of SRTS relative to control intersections. Structural changes to roadways were assumed to last 50 years before further investment is required. Therefore, costs were discounted over 50 consecutive cohorts of modified roadway users under SRTS. Results. SRTS was associated with an overall net societal benefit of $230 million and 2055 quality-adjusted life years gained in New York City. Conclusions. SRTS reduces injuries and saves money over the long run. PMID:24832430

  20. When is Cancer Care Cost-Effective? A Systematic Overview of Cost–Utility Analyses in Oncology

    PubMed Central

    Greenberg, Dan; Earle, Craig; Fang, Chi-Hui; Eldar-Lissai, Adi

    2010-01-01

    New cancer treatments pose a substantial financial burden on health-care systems, insurers, patients, and society. Cost–utility analyses (CUAs) of cancer-related interventions have received increased attention in the medical literature and are being used to inform reimbursement decisions in many health-care systems. We identified and reviewed 242 cancer-related CUAs published through 2007 and included in the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org). Leading cancer types studied were breast (36% of studies), colorectal (12%), and hematologic cancers (10%). Studies have examined interventions for tertiary prevention (73% of studies), secondary prevention (19%), and primary prevention (8%). We present league tables by disease categories that consist of a description of the intervention, its comparator, the target population, and the incremental cost-effectiveness ratio. The median reported incremental cost-effectiveness ratios (in 2008 US $) were $27 000 for breast cancer, $22 000 for colorectal cancer, $34 500 for prostate cancer, $32 000 for lung cancer, and $48 000 for hematologic cancers. The results highlight the many opportunities for efficient investment in cancer care across different cancer types and interventions and the many investments that are inefficient. Because we found only modest improvement in the quality of studies, we suggest that journals provide specific guidance for reporting CUA and assure that authors adhere to guidelines for conducting and reporting economic evaluations. PMID:20056956

  1. Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs.

    PubMed

    Bhatt, Nikhilesh; Turakhia, Mintu; Fogarty, Thomas J

    2016-01-01

    In the United States (U.S.), atrial fibrillation (AF) is the second-most common cardiovascular condition after hypertension, affecting four million Americans each year. Individuals with AF are three times more likely to be hospitalized over the span of a year when compared to medically matched control groups. The considerably large clinical population of individuals with AF mandates that the cost-effectiveness and efficacy of current treatment regimens for AF have egregious implications for health care spending and public health. Unfortunately, catheter ablation for AF treatment has been shown to make only modest gains in quality-adjusted life years, has yet to demonstrate cost-utility advantages over conventional therapies for AF, and has a reported rate of recurrence for AF that is notably high. Thus, there is a major unmet clinical need for a therapeutic option to treat AF that produces more consistent and efficacious results that are cost-effective. Cardiac radiosurgery as a therapy for AF has the potential to be remarkably cost-effective and produce robust patient outcomes. CyberHeart Inc. has developed the world's first-ever cardiac radiosurgery (CRS) system designed to ablate the heart non-invasively. Procedures that ablate the heart utilizing the Cyberheart CRS system are anticipated to allow higher efficacy and more consistent results than current techniques such as catheter ablation. The aim of this study is to present the current healthcare utilization and expenditures in AF treatment, report the cost-effectiveness of catheter ablation for AF, and project the potential cost-effectiveness of cardiac radiosurgery for the treatment of AF. PMID:27625906

  2. Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs

    PubMed Central

    Turakhia, Mintu; Fogarty, Thomas J.

    2016-01-01

    In the United States (U.S.), atrial fibrillation (AF) is the second-most common cardiovascular condition after hypertension, affecting four million Americans each year. Individuals with AF are three times more likely to be hospitalized over the span of a year when compared to medically matched control groups. The considerably large clinical population of individuals with AF mandates that the cost-effectiveness and efficacy of current treatment regimens for AF have egregious implications for health care spending and public health. Unfortunately, catheter ablation for AF treatment has been shown to make only modest gains in quality-adjusted life years, has yet to demonstrate cost-utility advantages over conventional therapies for AF, and has a reported rate of recurrence for AF that is notably high. Thus, there is a major unmet clinical need for a therapeutic option to treat AF that produces more consistent and efficacious results that are cost-effective. Cardiac radiosurgery as a therapy for AF has the potential to be remarkably cost-effective and produce robust patient outcomes. CyberHeart Inc. has developed the world’s first-ever cardiac radiosurgery (CRS) system designed to ablate the heart non-invasively. Procedures that ablate the heart utilizing the Cyberheart CRS system are anticipated to allow higher efficacy and more consistent results than current techniques such as catheter ablation. The aim of this study is to present the current healthcare utilization and expenditures in AF treatment, report the cost-effectiveness of catheter ablation for AF, and project the potential cost-effectiveness of cardiac radiosurgery for the treatment of AF. PMID:27625906

  3. The STAIRRS project, work package 1: a cost-effectiveness analysis of railway noise reduction on a European scale

    NASA Astrophysics Data System (ADS)

    Oertli, J.

    2003-10-01

    Noise control is a major economic factor for the railways as national and European Union environmental legislation is being enacted. In an effort to determine optimal strategies on a European level, the EU fifth framework programme has co-financed the Strategies and Tools to Assess and Implement noise Reducing measures for Railway Systems (STAIRRS) project. Work package 1 developed the necessary software to undertake large-scale cost-effectiveness analyses. The acoustically relevant geographic, traffic and track data were collected for 11 000 km of lines in seven European countries. Standard cost-benefit methodologies were adapted to fit the requirements of the project. An extrapolation mechanism allowed studies on Europe as a whole and, in an approximate manner, also on individual countries. Major conclusions are that the highest cost-effectiveness can be achieved by combining measures; freight rolling stock has a high cost-effectiveness on its own as well as in combination with other measures, especially when combined with track measures; noise barriers, in particular high ones, have a low cost-effectiveness. The conclusions for Europe as a whole are also true for individual countries. The STAIRRS project co-ordinator is the European Rail Research Institute, the work package leader is the Swiss Federal Railways with the participation of AEAT Technology (NL), German Railways, French Railways, PSI-Akustik (A), the Swiss Federal Institute of Technology and the Free University of Brussels.

  4. Cost effectiveness of stream-gaging program in Michigan

    USGS Publications Warehouse

    Holtschlag, D.J.

    1985-01-01

    Data uses and funding sources were identified for the 129 continuous gaging stations being operated in Michigan as of 1984. One gaging station was identified as having insufficient reason to continue its operation. Several stations were identified for reactivation, should funds become available, because of insufficiencies in the data network. Alternative methods of developing streamflow information based on routing and regression analyses were investigated for 10 stations. However, no station records were reproduced with sufficient accuracy to replace conventional gaging practices. A cost-effectiveness analysis of the data collection procedure for the ice-free season was conducted using a Kalman-filter analysis. To define missing record characteristics, cross-correlation coefficients and coefficients of variation were computed at stations on the basis of daily mean discharge. Discharge measurement data were used to describe the gage/discharge rating stability at each station. The results of the cost-effectiveness analysis for a 9-month ice-free season show that the current policy of visiting most stations on a fixed servicing schedule once every 6 weeks results in an average standard error of 12.1% for the current $718,100 budget. By adopting a flexible servicing schedule, the average standard error could be reduced to 11.1%. Alternatively, the budget could be reduced to $700,200 while maintaining the current level of accuracy. A minimum budget of $680,200 is needed to operate the 129-gaging-station program; a budget less than this would not permit proper service and maintenance of stations. At the minimum budget, the average standard error would be 14.4%. A budget of $789,900 (the maximum analyzed) would result in a decrease in the average standard error to 9.07%. Owing to continual changes in the composition of the network and the changes in the uncertainties of streamflow accuracy at individual stations, the cost-effectiveness analysis will need to be updated

  5. Cost-Effective Icy Bodies Exploration using Small Satellite Missions

    NASA Technical Reports Server (NTRS)

    Jonsson, Jonas; Mauro, David; Stupl, Jan; Nayak, Michael; Aziz, Jonathan; Cohen, Aaron; Colaprete, Anthony; Dono-Perez, Andres; Frost, Chad; Klamm, Benjamin; McCafferty, Julian; McKay, Chris; Sears, Derek; Soulage, Michael; Swenson, Jason; Weston, Sasha; Yang Yang, Fan

    2015-01-01

    It has long been known that Saturn's moon Enceladus is expelling water-rich plumes into space, providing passing spacecraft with a window into what is hidden underneath its frozen crust. Recent discoveries indicate that similar events could also occur on other bodies in the solar system, such as Jupiter's moon Europa and the dwarf planet Ceres in the asteroid belt. These plumes provide a possible giant leap forward in the search for organics and assessing habitability beyond Earth, stepping stones toward the long-term goal of finding extraterrestrial life. The United States Congress recently requested mission designs to Europa, to fit within a cost cap of $1B, much less than previous mission designs' estimates. Here, innovative cost-effective small spacecraft designs for the deep-space exploration of these icy worlds, using new and emerging enabling technologies, and how to explore the outer solar system on a budget below the cost horizon of a flagship mission, are investigated. Science requirements, instruments selection, rendezvous trajectories, and spacecraft designs are some topics detailed. The mission concepts revolve around a comparably small-sized and low-cost Plume Chaser spacecraft, instrumented to characterize the vapor constituents encountered on its trajectory. In the event that a plume is not encountered, an ejecta plume can be artificially created by a companion spacecraft, the Plume Maker, on the target body at a location timed with the passage of the Plume Chaser spacecraft. Especially in the case of Ceres, such a mission could be a great complimentary mission to Dawn, as well as a possible future Europa Clipper mission. The comparably small volume of the spacecraft enables a launch to GTO as a secondary payload, providing multiple launch opportunities per year. Plume Maker's design is nearly identical to the Plume Chaser, and fits within the constraints for a secondary payload launch. The cost-effectiveness of small spacecraft missions enables the

  6. Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria

    PubMed Central

    Habib, Abdulrazaq G.; Lamorde, Mohammed; Dalhat, Mahmood M.; Habib, Zaiyad G.; Kuznik, Andreas

    2015-01-01

    Background Snakebite envenoming is a major public health problem throughout the rural tropics. Antivenom is effective in reducing mortality and remains the mainstay of therapy. This study aimed to determine the cost-effectiveness of using effective antivenoms for Snakebite envenoming in Nigeria. Methodology Economic analysis was conducted from a public healthcare system perspective. Estimates of model inputs were obtained from the literature. Incremental Cost Effectiveness Ratios (ICERs) were quantified as deaths and Disability-Adjusted-Life-Years (DALY) averted from antivenom therapy. A decision analytic model was developed and analyzed with the following model base-case parameter estimates: type of snakes causing bites, antivenom effectiveness to prevent death, untreated mortality, risk of Early Adverse Reactions (EAR), mortality risk from EAR, mean age at bite and remaining life expectancy, and disability risk (amputation). End-user costs applied included: costs of diagnosing and monitoring envenoming, antivenom drug cost, supportive care, shipping/freezing antivenom, transportation to-and-from hospital and feeding costs while on admission, management of antivenom EAR and free alternative snakebite care for ineffective antivenom. Principal Findings We calculated a cost/death averted of ($2330.16) and cost/DALY averted of $99.61 discounted and $56.88 undiscounted. Varying antivenom effectiveness through the 95% confidence interval from 55% to 86% yield a cost/DALY averted of $137.02 to $86.61 respectively. Similarly, varying the prevalence of envenoming caused by carpet viper from 0% to 96% yield a cost/DALY averted of $254.18 to $78.25 respectively. More effective antivenoms and carpet viper envenoming rather than non-carpet viper envenoming were associated with lower cost/DALY averted. Conclusions/Significance Treatment of snakebite envenoming in Nigeria is cost-effective with a cost/death averted of $2330.16 and cost/DALY averted of $99.61 discounted, lower

  7. Machine learning-based method for personalized and cost-effective detection of Alzheimer's disease.

    PubMed

    Escudero, Javier; Ifeachor, Emmanuel; Zajicek, John P; Green, Colin; Shearer, James; Pearson, Stephen

    2013-01-01

    Diagnosis of Alzheimer's disease (AD) is often difficult, especially early in the disease process at the stage of mild cognitive impairment (MCI). Yet, it is at this stage that treatment is most likely to be effective, so there would be great advantages in improving the diagnosis process. We describe and test a machine learning approach for personalized and cost-effective diagnosis of AD. It uses locally weighted learning to tailor a classifier model to each patient and computes the sequence of biomarkers most informative or cost-effective to diagnose patients. Using ADNI data, we classified AD versus controls and MCI patients who progressed to AD within a year, against those who did not. The approach performed similarly to considering all data at once, while significantly reducing the number (and cost) of the biomarkers needed to achieve a confident diagnosis for each patient. Thus, it may contribute to a personalized and effective detection of AD, and may prove useful in clinical settings. PMID:22893371

  8. Film-free efficiency systems: a new cost-effective approach.

    PubMed

    Reicher, M A

    1998-01-01

    Pressure is on healthcare providers to make their services more affordable. Streamlining operations to improve efficiency is one means of achieving that goal. PACS has been touted as the technology to improve radiologic services. Sold as a way to eliminate lost records and lower operations costs, in reality, PACS has raised costs and slowed work flow in many cases. Perhaps PACS that raise operations costs are more properly named digital overhead generating systems (DOGS). There is an alternative solution--film-free efficiency systems (FFES), defined as the technological tools required to lower radiologic costs and improve services. A new type of image and information management technology and distinct from traditional PACS in a number of ways, film-free efficiency systems are immediately cost effective. They improve personnel efficiency, reduce costs per RVU, provide an alternative to film and exclude the use of any technology that is not cost effective. Implementation of these systems must begin with a clearly stated mission, a leadership statement and financial accountability. To guarantee an immediate financial gain in your department, you'll want to finance the system through material cost savings. Implementation should start with the digital modalities. The next step is to retrain staff and reengineer the workplace, followed by creating the necessary infrastructure of PCs in referring physicians' offices. Lastly, implement CR or digital radiography as prices drop and technologies improve in speed. PMID:10186419

  9. Cost-effectiveness of community health workers in tuberculosis control in Bangladesh.

    PubMed Central

    Islam, Md Akramul; Wakai, Susumu; Ishikawa, Nobukatsu; Chowdhury, A. M. R.; Vaughan, J. Patrick

    2002-01-01

    OBJECTIVE: To compare the cost-effectiveness of the tuberculosis (TB) programme run by the Bangladesh Rural Advancement Committee (BRAC), which uses community health workers (CHWs), with that of the government TB programme which does not use CHWs. METHODS: TB control statistics and cost data for July 1996 - June 1997 were collected from both government and BRAC thanas (subdistricts) in rural Bangladesh. To measure the cost per patient cured, total costs were divided by the total number of patients cured. FINDINGS: In the BRAC and government areas, respectively, a total of 186 and 185 TB patients were identified over one year, with cure rates among sputum-positive patients of 84% and 82%. However, the cost per patient cured was US$ 64 in the BRAC area compared to US$ 96 in the government area. CONCLUSION: The government programme was 50% more expensive for similar outcomes. Although both the BRAC and government TB control programmes appeared to achieve satisfactory cure rates using DOTS (a five-point strategy), the involvement of CHWs was found to be more cost-effective in rural Bangladesh. With the same budget, the BRAC programme could cure three TB patients for every two in the government programme. PMID:12132000

  10. Methods of assessing the cost-effectiveness of caries preventive agents and procedures.

    PubMed

    Horowitz, H S; Heifetz, S B

    1979-06-01

    Before public finance is committed to a particular public health measure it is essential that the project should be analytically evaluated. Cost-benefit analysis is one method of choosing between alternative programmes. It suffers from the disadvantage that, while costs can be accurately assessed, the benefit to an individual of freedom from pain, discomfort or inconvenience cannot be simply expressed in monetary terms. Such benefits may therefore be omitted from calculations of cost-benefit and a programme with valuable indirect or intangible benefits may not receive adequate consideration in competition with other alternatives. Futhermore, since benefits may only accrue some time after expenditure has been incurred, inflation distorts the significance of cost-benefit calculations. Cost-effectiveness analysis is an alternative method which enables one to determine the least expensive of several alternative methods of achieving a stated objective. The application of these concepts to preventive programmes against dental caries is described. Distinction must be made between the effectiveness of preventive measures during controlled clinical trials on limited numbers of subjects and their value when applied under field conditions to the whole community. Detailed comparisons are made between various methods of the application of fluorides caries prevention by community fluoridation water supply, school water fluoridation and topical application of fluorides. It is concluded that while completely accurate and valid analyses of cost-effectiveness are not possible, they do enable dentistry to view its activities more objectively and to indentify the real issues which should affect future decisions. PMID:110704

  11. Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam

    PubMed Central

    Nguyen, Thi-Phuong-Lan; Wright, E. Pamela; Nguyen, Thanh-Trung; Schuiling-Veninga, C. C. M.; Bijlsma, M. J.; Nguyen, Thi-Bach-Yen; Postma, M. J.

    2016-01-01

    Objective To inform development of guidelines for hypertension management in Vietnam, we evaluated the cost-effectiveness of different strategies on screening for hypertension in preventing cardiovascular disease (CVD). Methods A decision tree was combined with a Markov model to measure incremental cost-effectiveness of different approaches to hypertension screening. Values used as input parameters for the model were taken from different sources. Various screening intervals (one-off, annually, biannually) and starting ages to screen (35, 45 or 55 years) and coverage of treatment were analysed. We ran both a ten-year and a lifetime horizon. Input parameters for the models were extracted from local and regional data. Probabilistic sensitivity analysis was used to evaluate parameter uncertainty. A threshold of three times GDP per capita was applied. Results Cost per quality adjusted life year (QALY) gained varied in different screening scenarios. In a ten-year horizon, the cost-effectiveness of screening for hypertension ranged from cost saving to Int$ 758,695 per QALY gained. For screening of men starting at 55 years, all screening scenarios gave a high probability of being cost-effective. For screening of females starting at 55 years, the probability of favourable cost-effectiveness was 90% with one-off screening. In a lifetime horizon, cost per QALY gained was lower than the threshold of Int$ 15,883 in all screening scenarios among males. Similar results were found in females when starting screening at 55 years. Starting screening in females at 45 years had a high probability of being cost-effective if screening biannually was combined with increasing coverage of treatment by 20% or even if sole biannual screening was considered. Conclusion From a health economic perspective, integrating screening for hypertension into routine medical examination and related coverage by health insurance could be recommended. Screening for hypertension has a high probability of

  12. Comprehensive evaluation of cost effectiveness of solar electric power plants

    NASA Astrophysics Data System (ADS)

    Ibragimov, D. Y.; Filatov, A. I.

    1984-02-01

    The cost effectiveness of constructing a solar heating and electric power plant is evaluated on the basis of a compatibility analysis of its combination with a thermal electric power plant and a boiler-type heating plant, taking into account comprehensively economic factors as well as power requirements. Two variants of such a combination are considered and compared, assuming equal heating power and equal electric power respectively. Equations are set up for each variant covering fixed and variable costs of generating electric power and generating heat, as basis for comparing the two variants and optimizing them with respect to normalized annual total cost. Nomograms plotted for convenient numerical calculation of maximum economically worthwhile capital investment in a solar heating and electric power plant, depending on changes in various operating parameters, reveal that, as the time for constructing such a plant becomes longer, this maximum worthwhile investment in it increases for variant 1 and decreases for variant 2.

  13. Cost-effectiveness of an immunization programme in Indonesia

    PubMed Central

    Barnum, H. N.; Tarantola, D.; Setiady, I. F.

    1980-01-01

    The economic analysis reported below, based on hypothetical estimates of the programme impact, indicates that an expanded programme of immunization for diphtheria, pertussis, tetanus, and tuberculosis can be expected to be highly cost-effective in comparison with treatment. Sensitivity tests illustrate that this conclusion remains valid even when costs are increased by 20% and benefits reduced by 50%. A separate analysis was made of the DPT—tetanus toxoid and BCG components of the programme. The analysis revealed that although the BCG programme may not be justifiable when operated independently, its inclusion in a joint immunization programme is strongly justifiable on economic grounds (assuming a vaccine efficacy of 0.5). This result confirms one of the basic arguments advanced for the WHO programmes of expanded immunization and illustrates that other immunizations, such as for poliomyelitis and measles, which may not be cost-efficient by themselves may be economically justifiable when included as part of a larger immunization programme. PMID:6774826

  14. Cost-effective design of economic instruments in nutrition policy.

    PubMed

    Jensen, Jørgen D; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn. PMID:17408494

  15. Cost-effectiveness of implantable cardioverter defibrillator therapy.

    PubMed

    Morgan, John M

    2002-01-01

    Cost-efficacy assessment of implantable cardioverter defibrillator (ICD) therapy has proved contentious and may have limited uptake of ICD therapy, particularly in Europe. Published modeling assessments are too inaccurate to determine clinical practice, and assessments based on clinical studies are incomplete (from the cost-efficacy viewpoint). Although ICD therapy seems certain to be most cost-effective in patients who are likely to have good longevity if their risk of sudden cardiac death is countered, the benefit of ICD therapy is not necessarily limited to such groups. Physicians and health economists need to develop a better understanding of how to assess high-technology therapy costs so that uptake of such therapy is appropriately expedited with due regard to ethical and cost constraints. PMID:11843460

  16. Cost-effective telecom/datacom semiconductor lasers

    NASA Astrophysics Data System (ADS)

    Chen, Nong; Chen, Dick T. R.; Hsin, Wei; Chen, Steven Bo; Xiong, Frank; Erlig, Hernan; Chen, Paul; Yeh, Xian-li; Scott, David C.; Sherer, Axel

    2007-11-01

    The recent development of semiconductor laser technologies for cost-effective telecom/datacom applications is reviewed in details in this paper. This includes the laser design, laser chip technology, laser packaging technology and other low cost lasers (chip + packaging). Some design and simulation examples in Archcom laser production are described first. A latest trend in the wafer scale testing/characterization/screening technology for low cost semiconductor laser mass production is discussed then. An advanced long wavelength high power single mode surface emitting laser with wafer scale characterization using our unique mask free focused ion beam (FIB) etching technology is also demonstrated. Detailed descriptions on our wide temperature range (-50 °C to +105 °C) G-PON distributed feedback (DFB) semiconductor lasers with high performance and low cost wafer design are included. Cost reduction innovations in laser package with our beam profile improved laser and optical feedback insensitive (OFBI) laser are also addressed.

  17. Development of a cost effective microscope heater stage

    NASA Astrophysics Data System (ADS)

    Dugre, Joshua; Prayaga, Chandra; Wade, Aaron

    Utilizing 3D printing technology, a heater stage has been developed and implemented for microscopic systems. Due to the flexibility of 3D printing,the heater stage can be easily modified to fit any sample size with only slight modifications to the heating element being required. The sample in contact with the heating element can also easily be secured in a thermal insulator, such as aluminum foil. The thermal gradient of the heater stage has been recorded to be less than 1°C and has been compared to more expensive designs, and the cost effectiveness of the system has been determined. The system has been tested with a sample of the liquid crystal 8CB in order to determine the exact temperatures of the phase transitions of the crystal to verify that the system is applicable to a wide range of experimental physics. UWF Quality Enhancement Plan Award.

  18. Introduction to the Space Transportation System. [space shuttle cost effectiveness

    NASA Technical Reports Server (NTRS)

    Wilson, R. G.

    1973-01-01

    A new space transportation concept which is consistent with the need for more cost effective space operations has been developed. The major element of the Space Transportation System (STS) is the Space Shuttle. The rest of the system consists of a propulsive stage which can be carried within the space shuttle to obtain higher energy orbits. The final form of this propulsion stage will be called the Space Tug. A third important element, which is not actually a part of the STS since it has no propulsive capacity, is the Space Laboratory. The major element of the Space Shuttle is an aircraft-like orbiter which contains the crew, the cargo, and the liquid rocket engines in the rear.

  19. RTM: Cost-effective processing of composite structures

    NASA Technical Reports Server (NTRS)

    Hasko, Greg; Dexter, H. Benson

    1991-01-01

    Resin transfer molding (RTM) is a promising method for cost effective fabrication of high strength, low weight composite structures from textile preforms. In this process, dry fibers are placed in a mold, resin is introduced either by vacuum infusion or pressure, and the part is cured. RTM has been used in many industries, including automotive, recreation, and aerospace. Each of the industries has different requirements of material strength, weight, reliability, environmental resistance, cost, and production rate. These requirements drive the selection of fibers and resins, fiber volume fractions, fiber orientations, mold design, and processing equipment. Research is made into applying RTM to primary aircraft structures which require high strength and stiffness at low density. The material requirements are discussed of various industries, along with methods of orienting and distributing fibers, mold configurations, and processing parameters. Processing and material parameters such as resin viscosity, perform compaction and permeability, and tool design concepts are discussed. Experimental methods to measure preform compaction and permeability are presented.

  20. Quality and cost-effective management of mental health care.

    PubMed

    Burton, W N; Hoy, D A; Bonin, R L; Gladstone, L

    1989-04-01

    Corporations have reduced their mental health care benefits by limits on coverage for such services. We report on a comprehensive mental health care program, including prevention and early intervention, hospital utilization review, and consulting psychiatrist, which has improved the quality and has significantly reduced inpatient insurance psychiatric hospitalization costs. Mental health service coverage was actually enhanced. Inpatient psychiatric hospitalization costs 12 months before and after the implementation of a concurrent psychiatric hospital utilization review program were reviewed for a major corporation. Total hospital days and average length of stay decreased by 43% whereas total inpatient psychiatric hospital charges decreased by $309,518. Total inpatient days decreased by 1045. Quality and cost-effective comprehensive psychiatric health care services can be offered by major corporations providing that such benefits are carefully designed and managed. PMID:2715844

  1. Cost-effective gel documentation using a web-cam.

    PubMed

    Goldmann, T; Zyzik, A; Loeschke, S; Lindsay, W; Vollmer, E

    2001-12-01

    In search for a cost effective gel documentation system applicable for different fields of molecular biology, we analyzed the capabilities of a cheap CCD-camera originally designed to capture images for transmission through the internet (web-cam) with regard to gel documentation. The camera was connected to a personal computer by universal serial bus (USB) and used for the documentation of DNA separated on agarose gels and stained by ethidium-bromide using the software provided with the camera. The web-cam provided digital images of sufficient quality for routine documentation and combined the low set-up costs of a Polaroid system with the low running costs of video capture systems, hence is ideal as a start-up system and as augmentation to existing equipment. PMID:11714515

  2. Endogenous cost-effectiveness analysis and health care technology adoption.

    PubMed

    Jena, Anupam B; Philipson, Tomas J

    2013-01-01

    Increased health care spending has placed pressure on public and private payers to prioritize spending. Cost-effectiveness (CE) analysis is the main tool used by payers to prioritize coverage of new therapies. We argue that reimbursement based on CE is subject to a form of the "Lucas critique"; the goals of CE policies may not materialize when firms affected by the policies respond optimally to them. For instance, because 'costs' in CE analysis reflect prices set optimally by firms rather than production costs, observed CE levels will depend on how firm pricing responds to CE policies. Observed CE is therefore endogenous. When CE is endogenously determined, policies aimed at lowering spending and improving overall CE may paradoxically raise spending and lead to the adoption of more resource-costly treatments. We empirically illustrate whether this may occur using data on public coverage decisions in the United Kingdom. PMID:23202262

  3. TECHNICAL NOTE: Cost effective realization of nanoscaled interdigitated electrodes

    NASA Astrophysics Data System (ADS)

    Van Gerwen, P.; Laureyn, W.; Campitelli, A.; Jacobs, P.; Detemple, P.; Baert, K.; Sansen, W.; Mertens, R.

    2000-09-01

    Nanoscaled interdigitated electrodes (IDEs) are being developed for the realization of miniaturized and highly-sensitive affinity biosensors. Until now, nanoscaled IDEs have been realized on silicon wafers using deep UV lithography or e-beam patterning. However, for many applications in the biochemical field there is a strong need for cheap and/or disposable sensor devices. Therefore, a new, cost effective fabrication method for nanoscaled IDEs, which can also be applied on cheap, micro-moulded plastic substrates, has been developed. The method is based on the directionality of a vacuum evaporation process and omits expensive lithography steps completely. The feasibility of this electrode deposition technique has been proven by realizing IDEs on silicon substrates. Future work is focused on the realization of IDEs on injection moulded plastic substrates.

  4. The cost-effectiveness of biodiversity surveys in tropical forests.

    PubMed

    Gardner, Toby A; Barlow, Jos; Araujo, Ivanei S; Avila-Pires, Teresa Cristina; Bonaldo, Alexandre B; Costa, Joana E; Esposito, Maria Cristina; Ferreira, Leandro V; Hawes, Joseph; Hernandez, Malva I M; Hoogmoed, Marinus S; Leite, Rafael N; Lo-Man-Hung, Nancy F; Malcolm, Jay R; Martins, Marlucia B; Mestre, Luiz A M; Miranda-Santos, Ronildon; Overal, William L; Parry, Luke; Peters, Sandra L; Ribeiro-Junior, Marco Antônio; da Silva, Maria N F; da Silva Motta, Catarina; Peres, Carlos A

    2008-02-01

    The identification of high-performance indicator taxa that combine practical feasibility and ecological value requires an understanding of the costs and benefits of surveying different taxa. We present a generic and novel framework for identifying such taxa, and illustrate our approach using a large-scale assessment of 14 different higher taxa across three forest types in the Brazilian Amazon, estimating both the standardized survey cost and the ecological and biodiversity indicator value for each taxon. Survey costs varied by three orders of magnitude, and dung beetles and birds were identified as especially suitable for evaluating and monitoring the ecological consequences of habitat change in our study region. However, an exclusive focus on such taxa occurs at the expense of understanding patterns of diversity in other groups. To improve the cost-effectiveness of biodiversity research we encourage a combination of clearer research goals and the use of an objective evidence-based approach to selecting study taxa. PMID:18031554

  5. Cost effectiveness of testing for chlamydial infections in asymptomatic women.

    PubMed

    Buhaug, H; Skjeldestad, F E; Backe, B; Dalen, A

    1989-08-01

    Routine testing for Chlamydia trachomatis during gynecological visits, as well as treatment of those found positive, has been suggested as a preventive measure against the serious consequences of chlamydial genital infections, e.g., pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. This article examines the cost and effectiveness of this practice. The study is based on a model that predicts how routine testing and treatment will affect the future number of cases of PID, infertility, and ectopic pregnancy. The costs of test and treatment are estimated, as are the savings resulting from prevention. Results indicate that although routine testing was not effective in reducing the overall morbidity caused by chlamydial infections, for women 18-22 years of age routine testing during regular gynecologic sessions can be a cost-effective personal health service. PMID:2502694

  6. Cost effectiveness of ergonomic redesign of electronic motherboard.

    PubMed

    Sen, Rabindra Nath; Yeow, Paul H P

    2003-09-01

    A case study to illustrate the cost effectiveness of ergonomic redesign of electronic motherboard was presented. The factory was running at a loss due to the high costs of rejects and poor quality and productivity. Subjective assessments and direct observations were made on the factory. Investigation revealed that due to motherboard design errors, the machine had difficulty in placing integrated circuits onto the pads, the operators had much difficulty in manual soldering certain components and much unproductive manual cleaning (MC) was required. Consequently, there were high rejects and occupational health and safety (OHS) problems, such as, boredom and work discomfort. Also, much labour and machine costs were spent on repairs. The motherboard was redesigned to correct the design errors, to allow more components to be machine soldered and to reduce MC. This eliminated rejects, reduced repairs, saved US dollars 581495/year and improved operators' OHS. The customer also saved US dollars 142105/year on loss of business. PMID:12963331

  7. Cost-effectiveness analysis of optimal control measures for tuberculosis.

    PubMed

    Rodrigues, Paula; Silva, Cristiana J; Torres, Delfim F M

    2014-10-01

    We propose and analyze an optimal control problem where the control system is a mathematical model for tuberculosis that considers reinfection. The control functions represent the fraction of early latent and persistent latent individuals that are treated. Our aim was to study how these control measures should be implemented, for a certain time period, in order to reduce the number of active infected individuals, while minimizing the interventions implementation costs. The optimal intervention is compared along different epidemiological scenarios, by varying the transmission coefficient. The impact of variation of the risk of reinfection, as a result of acquired immunity to a previous infection for treated individuals on the optimal controls and associated solutions, is analyzed. A cost-effectiveness analysis is done, to compare the application of each one of the control measures, separately or in combination. PMID:25245395

  8. Cost effectiveness in obstetrics and gynecology: The levonorgestrel intrauterine system.

    PubMed

    Mattson, Lisa

    2012-03-01

    Use of evidence-based practices that are both cost-effective and acceptable to patients is now a focus in health care. Considerable cost savings can be realized by reducing unintended pregnancies and improving control of menstrual-related morbidity. The levonorgestrel intrauterine system (LNG-IUS), often referred to by its brand name Mirena, has been approved by the Food and Drug Administration both for contraception and fortreating abnormal uterine bleeding. The device has been available in the United States since 2000 and has been used in Europe since 1990. Despite the fact that several evidence-based guidelines include use of the LNG-IUS, it remains underutilized in this country. This article reviews the benefits of the LNG-IUS as they pertain to women's health and to the cost of health care. PMID:22611822

  9. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    SciTech Connect

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard

    2003-03-30

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents accomplishments made from October 1, 2002 through September 30, 2003. The following have been accomplished and are reported in detail herein: Metal-to-Composite Interface (MCI) redesign and testing; Successful demonstration of MCI connection for both SR and ER/DW CDP; Specifications for a 127mm (5 inch) ID by 152.4 mm (6 inch) OD composite drill pipe have been finalized for Extended Reach/Deep Water applications (ER/DW); Field testing of Short Radius CDP (SR); Sealing composite laminate to contain high pressure; Amendments; Amendment for ''Smart'' feature added to ER/DW development along with time and funding to complete battery of qualification tests with option for field demonstration; and Preparation of papers for publication and conference presentations.

  10. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  11. Cost effectiveness of pharmacogenomics: a critical and systematic review.

    PubMed

    Wong, William B; Carlson, Josh J; Thariani, Rahber; Veenstra, David L

    2010-01-01

    The use of pharmacogenetic testing in clinical practice is limited thus far. A potential barrier to the widespread implementation of pharmacogenetic testing is the lack of evidence on whether testing provides good value for money. The objective of this review was to provide a systematic and critical review of economic evaluations of pharmacogenetic testing. A literature search using publically available databases was performed for articles published up to October 2009. To be included, studies had to meet the definition of being a pharmacogenomic study (defined as use of information on human genetic variation to target drug therapy) and an economic evaluation (defined as an evaluation of both costs and clinical outcomes). Articles that met these criteria were subsequently reviewed and graded using the Quality of Health Economic Studies (QHES) instrument. Lastly, the evidence for biomarker validity and utility were qualitatively assessed using expert opinion. A total of 34 articles were identified using our defined criteria. The most common disease category was thromboembolic-related diseases (26%), while the most common biomarkers were thiopurine methyltransferase and cytochrome P450 2C9 (18% each). Almost all studies were published after 2004 (91%). Two types of studies were identified: cost-effectiveness studies and cost-utility studies, with roughly half of the overall studies being cost-utility studies (53%) and a majority of these published within the last 3 years. The average quality score was 77 (range 29-99). Of the biomarkers reviewed, it was estimated that most had demonstrated clinical validity, but only two had demonstrated clinical utility. Despite a recent increase in the number of economic evaluations of pharmacogenetic applications, further studies examining the clinical validity and utility of these biomarkers are needed to support cost-effectiveness assessments. PMID:20936884

  12. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  13. Detecting Proximal Secondary Caries Lesions: A Cost-effectiveness Analysis.

    PubMed

    Schwendicke, F; Brouwer, F; Paris, S; Stolpe, M

    2016-02-01

    When choosing detection methods for secondary caries lesions, dentists need to weigh sensitivity, allowing early initiation of retreatments to avoid lesion progression, against specificity, aiming to reduce risks of false-positive diagnoses and invasive overtreatments. We assessed the cost-effectiveness of different detection methods for proximal secondary lesions using Monte Carlo microsimulations. A vital permanent molar with an occlusal-proximal restoration was simulated over the lifetime of an initially 20-y-old. Three methods were compared: biannual tactile detection, radiographic detection every 2 y, and biannual laser fluorescence detection. Methods were employed either on their own or in pairwise combinations at sensitive and specific thresholds estimated with systematically collected data. A mixed public-private payer perspective in the context of German health care was applied. Effectiveness was calculated as years of tooth retention. Net-benefit analyses were used to evaluate cost-effectiveness acceptability at different willingness-to-pay thresholds. Radiographic detection verified by tactile assessment (both at specific thresholds) was least costly (mean, 1,060 euros) but had limited effectiveness (mean retention time, 50 y). The most effective but also more costly combination was laser fluorescence detection verified by radiography, again at specific thresholds (1157 euros, 53 y, acceptable if willingness to pay >32 euro/y). In the majority of simulations, not combining detection methods or applying them at sensitive thresholds was less effective and more costly. Net benefits were not greatly altered by applying different discounting rates or using different baseline prevalence of secondary lesions. Current detection methods for secondary lesions should best be used in combination, not on their own, at specific thresholds to avoid false-positive diagnoses leading to costly and invasive overtreatment. The relevant characteristics, such as predictive

  14. Cost-Effectiveness Analysis of Papillary Thyroid Cancer Surveillance

    PubMed Central

    Wang, Laura Y.; Roman, Benjamin R.; Migliacci, Jocelyn C.; Palmer, Frank L.; Tuttle, R. Michael; Shaha, Ashok R.; Shah, Jatin P.; Patel, Snehal G.; Ganly, Ian

    2016-01-01

    BACKGROUND The recent overdiagnosis of subclinical, low-risk papillary thyroid cancer (PTC) coincides with a growing national interest in cost-effective health care practices. The aim of this study was to measure the relative cost-effectiveness of disease surveillance of low-risk PTC patients versus intermediate- and high-risk patients in accordance with American Thyroid Association risk categories. METHODS Two thousand nine hundred thirty-two patients who underwent thyroidectomy for differentiated thyroid cancer between 2000 and 2010 were identified from the institutional database; 1845 patients were excluded because they had non-PTC cancer, underwent less than total thyroidectomy, had a secondary cancer, or had <36 months of follow-up. In total, 1087 were included for analysis. The numbers of postoperative blood tests, imaging scans and biopsies, clinician office visits, and recurrence events were recorded for the first 36 months of follow-up. Costs of surveillance were determined with the Physician Fee Schedule and Clinical Lab Fee Schedule of the Centers for Medicare and Medicaid Services. RESULTS The median age was 44 years (range, 7–83 years). In the first 36 months after thyroidectomy, there were 3, 44, and 22 recurrences (0.8%, 7.8%, and 13.4%) in the low-, intermediate-, and high-risk categories, respectively. The cost of surveillance for each recurrence detected was US $147,819, US $22,434, and US $20,680, respectively. CONCLUSIONS The cost to detect a recurrence in a low-risk patient is more than 6 and 7 times greater than the cost for intermediate- and high-risk PTC patients. It is difficult to justify this allocation of resources to the surveillance of low-risk patients. Surveillance strategies for the low-risk group should, therefore, be restructured. PMID:26280253

  15. Discounting, preferences, and paternalism in cost-effectiveness analysis.

    PubMed

    Tinghög, Gustav

    2012-09-01

    When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in cost-effectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-or-death implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle. PMID:21909720

  16. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    PubMed

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness. PMID:14999922

  17. Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus: A Randomized Controlled Trial in China.

    PubMed

    Tang, Qi; Sun, Zhipeng; Zhang, Nengwei; Xu, Guangzhong; Song, Peipei; Xu, Lingzhong; Tang, Wei

    2016-05-01

    To compare the remission of type 2 diabetes mellitus (T2DM) through treatment with laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB), and to analyze the cost-effectiveness of medical treatment, LSG, and LRYGB in T2DM patients (BMI ≥ 28).A 2-group randomized controlled trial was conducted at Diabetes Surgery Centre, Beijing Shijitan Hospital in Beijing, China. Subjects were 80 patients ages 16 to 65 years with a body mass index of 28 kg/m or more and duration of T2DM no more than 15 years. Subjects were randomly assigned (1:1) to undergo either LSG (n = 40) or LRYGB (n = 40) between February 3, 2011 and October 31, 2013. Of those patients, 72 (90%) were available at follow-up at 2 years. These patients included 34 (85%) who underwent LSG and 38 (95%) who underwent LRYGB. This study presents the follow-up data at 2 years, which compared LSG and LRYGB in T2DM patients. Partial remission and complete remission were determined, and weight loss, BMI, changes in abdominal circumference, cholesterol, and triglycerides were measured. The cost-effectiveness of each type of bariatric surgery was analyzed with a Markov simulation model that yielded quality-adjusted life-years (QALYs) and costs.From our analysis results, LSG and LRYGB are both have taken a great effect on the reduction of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and bodyweight in patients with T2DM. The cost-effectiveness ratios of medical treatment, LSG, and LRYGB respectively are 1589.02, 1028.97, and 1197.44 dollars per QALY.Our analysis indicates that LSG appear to provide a cost-effective method of T2DM treatment for the patients. PMID:27196454

  18. Will Sofosbuvir/Ledipasvir (Harvoni) Be Cost-Effective and Affordable for Chinese Patients Infected with Hepatitis C Virus? An Economic Analysis Using Real-World Data

    PubMed Central

    Duan, Zhong-Ping; Dou, Xiao-Guang; Xie, Qing; Zhang, Wen-Hong; Lu, Lun-Gen; Fan, Jian-Gao; Cheng, Jun; Wang, Gui-Qiang; Ren, Hong; Wang, Jiu-Ping; Yang, Xing-Xiang; Jia, Zhan-Sheng; Fu, Qing-Chun; Wang, Xiao-Jin; Shang, Jia; Zhang, Yue-Xin; Han, Ying; Du, Ning; Shao, Qing; Ji, Dong; Li, Fan; Li, Bing; Liu, Jia-Liang; Niu, Xiao-Xia; Wang, Cheng; Wu, Vanessa; Wong, April; Wang, Yu-Dong; Hou, Jin-Lin; Jia, Ji-Dong; Zhuang, Hui; Lau, George

    2016-01-01

    Background Little is known on the cost-effectiveness of novel regimens for hepatitis C virus (HCV) compared with standard-of-care with pegylated interferon (pegIFN) and ribavirin (RBV) therapy in developing countries. We evaluated cost-effectiveness of sofosbuvir/ledipasvir for 12 weeks compared with a 48-week pegIFN-RBV regimen in Chinese patients with genotype 1b HCV infection by economic regions. Methods A decision analytic Markov model was developed to estimate quality-adjusted-life-years, lifetime cost of HCV infection and incremental cost-effectiveness ratios (ICERs). SVR rates and direct medical costs were obtained from real-world data. Parameter uncertainty was assessed by one-way and probabilistic sensitivity analyses. Threshold analysis was conducted to estimate the price which can make the regimen cost-effective and affordable. Results Sofosbuvir/ledipasvir was cost-effective in treatment-experienced patients with an ICER of US$21,612. It varied by economic regions. The probability of cost-effectiveness was 18% and 47% for treatment-naive and experienced patients, and it ranged from 15% in treatment-naïve patients in Central-China to 64% in treatment-experienced patients in Eastern-China. The price of 12-week sofosbuvir/ledipasvir treatment needs to be reduced by at least 81% to US$18,185 to make the regimen cost-effective in all patients at WTP of one time GDP per capita. The price has to be US$105 to make the regimen affordable in average patients in China. Conclusion Sofosbuvir/ledipasvir regimen is not cost-effective in most Chinese patients with genotype 1b HCV infection. The results vary by economic regions. Drug price of sofosbuvir/ledipasvir needs to be substantially reduced when entering the market in China to ensure the widest accessibility. PMID:27276081

  19. Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.

    PubMed

    Moise, Nathalie; Huang, Chen; Rodgers, Anthony; Kohli-Lynch, Ciaran N; Tzong, Keane Y; Coxson, Pamela G; Bibbins-Domingo, Kirsten; Goldman, Lee; Moran, Andrew E

    2016-07-01

    The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled. PMID:27181996

  20. Cost-Effectiveness Analysis in Practice: Interventions to Improve High School Completion

    ERIC Educational Resources Information Center

    Hollands, Fiona; Bowden, A. Brooks; Belfield, Clive; Levin, Henry M.; Cheng, Henan; Shand, Robert; Pan, Yilin; Hanisch-Cerda, Barbara

    2014-01-01

    In this article, we perform cost-effectiveness analysis on interventions that improve the rate of high school completion. Using the What Works Clearinghouse to select effective interventions, we calculate cost-effectiveness ratios for five youth interventions. We document wide variation in cost-effectiveness ratios between programs and between…

  1. Comparing the Cost-Effectiveness of Simulation Modalities: A Case Study of Peripheral Intravenous Catheterization Training

    ERIC Educational Resources Information Center

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-01-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three…

  2. [Challenges and Outcomes of the Process for Achieving Certification].

    PubMed

    Kadosaka, Yoshihiko; Suzuki, Reiko; Yoshika, Masamichi; Tsuta, Koji

    2016-02-01

    Clinical laboratory tests have been indispensable for medical services in recent years, and such a situation is associated with the offering of accurate test results by clinical laboratory units. A large number of facilities wishing to achieve ISO 15189 Certification follow preparatory procedures with support from consulting companies. However, in our facility, a limited budget did not allow us to use such services. As a solution, we participated in the Future Lab Session in OSAKA (FLS), a support group for the achievement of ISO 15189 Certification, when it was organized. Aiming to extensively cover and fulfill its responsibility for all processes, including clinical interpretations of the results obtained through patient preparation, in order to continuously offer high-quality test results to clinicians, our clinical laboratory unit underwent examination for certification, and consequently realized the necessity of third-party evaluation. The provision of laboratory services, fully complying with these standards, contributes to medical safety, in addition to accuracy improvement. Although the certification and its maintenance are costly, it is sufficiently cost-effective to achieve it, when focusing on improved efficiency and the enhanced quality and safety of medical services after work standardization. PMID:27311281

  3. Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery

    PubMed Central

    Khan, Ashiya; Amitava, Abadan Khan; Rizvi, Syed Ali Raza; Siddiqui, Ziya; Kumari, Namita; Grover, Shivani

    2015-01-01

    Context: Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Statistical Analysis Used: Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Results: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF-14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE. Conclusions: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country. PMID:26265639

  4. Identifying cost-effective CO{sub 2} control levels for amine-based CO{sub 2} capture systems

    SciTech Connect

    Rao, A.B.; Rubin, E.S.

    2006-04-12

    Studies of CO{sub 2} capture and storage (CCS) from coal-fired power plants typically assume a capture efficiency near 90%, although the basis for a particular choice usually is not discussed. Nor do studies systematically explore a range of CO{sub 2} capture efficiencies to identify the most cost-effective levels of CO, control and the key factors that affect such levels. An exploration of these issues is the focus of this paper. As part of the United States Department of Energy's Carbon Sequestration Program, we have developed an integrated modeling framework (called IECM-cs) to evaluate the performance and cost of alternative CCS technologies and power systems in the context of plant-level multipollutant control requirements. This paper uses IECM-cs to identify the most cost-effective level of CO, control using currently available amine-based CO{sub 2} capture technology for PC plants. Two general cases are of interest. First, we examine the effects of systematically increasing the CO{sub 2} capture efficiency of an amine-based system for PC applications over a broad range. We report two measures of cost: (i) capital cost and (ii) cost-effectiveness (cost per tonne of CO{sub 2} avoided) relative to similar plants without CCS. Second, we examine the cost-effectiveness of plant designs that partially bypass the amine capture unit so as to achieve low to moderate reductions of CO{sub 2}, but at lower overall cost. Results from these cases are compared to the conventional case of a capture unit treating the entire flue gas stream. In each case, we identify the most cost-effective strategies and the key factors that affect those results.

  5. Interviews with Students of High Confidence and Low Achievement. Mathematics Education Diagnostic and Instructional Centre (MEDIC) Report No. 5-76.

    ERIC Educational Resources Information Center

    Feghali, Issa

    A previous study had confirmed that a substantial number of low achievers in grades 5 through 8 had high algorithmic confidence in each of the four arithmetic operations with whole numbers. The purpose of the present study was to follow up the results through interviewing low achievement-high confidence students in order to ascertain if they…

  6. Cost-effective mask-sharing technology for SOI LIGBT and PLDMOS

    NASA Astrophysics Data System (ADS)

    Huang, Yong; Qiao, Ming; Zhou, Xin; Liang, Tao; Li, Yang; Li, Zhaoji; Zhang, Bo

    2016-04-01

    Cost-effective mask-sharing technology for the 200 V silicon-on-insulator (SOI) lateral insulated gate bipolar transistor (LIGBT) and p-channel lateral double-diffused MOS (PLDMOS) are proposed in this paper. N-well and P-body implantations are shared as an N-buffer implantation of the LIGBT and P-buffer implantation of the PLDMOS, respectively, which reduces two masks compared with the conventional process. The structure and process parameters for LIGBT and PLDMOS with the new process are optimized by simulation to achieve good performance. The experimental results indicate that the LIGBT and PLDMOS using the new process maintain the same performance compared to the conventional devices.

  7. Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

    SciTech Connect

    Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; Sanyal, Jibonananda; Starke, Michael R.

    2015-05-27

    We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype, we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.

  8. Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

    DOE PAGESBeta

    Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; Sanyal, Jibonananda; Starke, Michael R.

    2015-05-27

    We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype,more » we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.« less

  9. Cost-effective and Rapid Blood Analysis on a Cell-phone

    PubMed Central

    Zhu, Hongying; Sencan, Ikbal; Wong, Justin; Dimitrov, Stoyan; Tseng, Derek; Nagashima, Keita; Ozcan, Aydogan

    2013-01-01

    We demonstrate a compact and cost-effective imaging cytometry platform installed on a cell-phone for the measurement of the density of red and white blood cells as well as hemoglobin concentration in human blood samples. Fluorescent and bright-field images of blood samples are captured using separate optical attachments to the cell-phone and are rapidly processed through a custom-developed smart application running on the phone for counting of blood cells and determining hemoglobin density. We evaluated the performance of this cell-phone based blood analysis platform using anonymous human blood samples and achieved comparable results to a standard bench-top hematology analyser. Test results can either be stored on the cell-phone memory or be transmitted to a central server, providing remote diagnosis opportunities even in field settings. PMID:23392286

  10. Cost and cost effectiveness of long-lasting insecticide-treated bed nets - a model-based analysis

    PubMed Central

    2012-01-01

    Background The World Health Organization recommends that national malaria programmes universally distribute long-lasting insecticide-treated bed nets (LLINs). LLINs provide effective insecticide protection for at least three years while conventional nets must be retreated every 6-12 months. LLINs may also promise longer physical durability (lifespan), but at a higher unit price. No prospective data currently available is sufficient to calculate the comparative cost effectiveness of different net types. We thus constructed a model to explore the cost effectiveness of LLINs, asking how a longer lifespan affects the relative cost effectiveness of nets, and if, when and why LLINs might be preferred to conventional insecticide-treated nets. An innovation of our model is that we also considered the replenishment need i.e. loss of nets over time. Methods We modelled the choice of net over a 10-year period to facilitate the comparison of nets with different lifespan (and/or price) and replenishment need over time. Our base case represents a large-scale programme which achieves high coverage and usage throughout the population by distributing either LLINs or conventional nets through existing health services, and retreats a large proportion of conventional nets regularly at low cost. We identified the determinants of bed net programme cost effectiveness and parameter values for usage rate, delivery and retreatment cost from the literature. One-way sensitivity analysis was conducted to explicitly compare the differential effect of changing parameters such as price, lifespan, usage and replenishment need. Results If conventional and long-lasting bed nets have the same physical lifespan (3 years), LLINs are more cost effective unless they are priced at more than USD 1.5 above the price of conventional nets. Because a longer lifespan brings delivery cost savings, each one year increase in lifespan can be accompanied by a USD 1 or more increase in price without the cheaper net

  11. Cost-effectiveness of sevelamer versus calcium carbonate plus atorvastatin to reduce LDL in patients with chronic renal insufficiency with dyslipidemia and hyperphosphatemia.

    PubMed

    Brophy, D F; Wallace, J F; Kennedy, D T; Gehr, T W; Holdford, D A

    2000-08-01

    We conducted a cost-effectiveness analysis to compare costs and clinical outcomes of sevelamer versus calcium carbonate plus atorvastatin for treatment of dyslipidemia in patients with chronic renal insufficiency. The model was from the third-party payer perspective. Efficacy and adverse event rates for each regimen were obtained from published clinical trials. Drug costs were based on average wholesale prices; monitoring costs were based on Medicare reimbursement rates. Our model suggests that the combination of calcium carbonate plus atorvastatin is substantially more cost-effective than sevelamer in reducing low-density lipoprotein (LDL) in these patients. One-way sensitivity analyses were performed to assess if 25% and 50% price reductions in sevelamer affected overall cost-effectiveness results. A 50% sevelamer price reduction was less expensive than combination therapy but remained less cost-effective. A two-way sensitivity analysis on the probability that a patient achieves the goal of a 35% LDL reduction resulted in calcium carbonate plus atorvastatin remaining more cost-effective. Further cost-effectiveness studies are necessary to corroborate our data. PMID:10939556

  12. Cost-Effectiveness Analysis of Infrapopliteal Drug-Eluting Stents

    SciTech Connect

    Katsanos, Konstantinos Karnabatidis, Dimitris; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Siablis, Dimitris

    2013-02-15

    IntroductionThere are no cost-utility data about below-the-knee placement of drug-eluting stents. The authors determined the cost-effectiveness of infrapopliteal drug-eluting stents for critical limb ischemia (CLI) treatment. The event-free individual survival outcomes defined by the absence of any major events, including death, major amputation, and target limb repeat procedures, were reconstructed on the basis of two published infrapopliteal series. The first included spot Bail-out use of Sirolimus-eluting stents versus bare metal stents after suboptimal balloon angioplasty (Bail-out SES).The second was full-lesion Primary Everolimus-eluting stenting versus plain balloon angioplasty and bail-out bare metal stenting as necessary (primary EES). The number-needed-to-treat (NNT) to avoid one major event and incremental cost-effectiveness ratios (ICERs) were calculated for a 3-year postprocedural period for both strategies. Overall event-free survival was significantly improved in both strategies (hazard ratio (HR) [confidence interval (CI)]: 0.68 [0.41-1.12] in Bail-out SES and HR [CI]: 0.53 [0.29-0.99] in Primary EES). Event-free survival gain per patient was 0.89 (range, 0.11-3.0) years in Bail-out SES with an NNT of 4.6 (CI: 2.5-25.6) and a corresponding ICER of 6,518 Euro-Sign (range 1,685-10,112 Euro-Sign ). Survival gain was 0.91 (range 0.25-3.0) years in Primary EES with an NNT of 2.7 (CI: 1.7-5.8) and an ICER of 11,581 Euro-Sign (range, 4,945-21,428 Euro-Sign ) per event-free life-year gained. Two-way sensitivity analysis showed that stented lesion length >10 cm and/or DES list price >1000 Euro-Sign were associated with the least economically favorable scenario in both strategies. Both strategies of bail-out SES and primary EES placement in the infrapopliteal arteries for CLI treatment exhibit single-digit NNT and relatively low corresponding ICERs.

  13. HIV prevention cost-effectiveness: a systematic review

    PubMed Central

    2009-01-01

    Background After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Methods Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY). Results We found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). Conclusion There are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision

  14. Blood conservation for myocardial revascularization. Is it cost effective?

    PubMed

    Breyer, R H; Engelman, R M; Rousou, J A; Lemeshow, S

    1987-04-01

    A total of 284 patients undergoing myocardial revascularization were prospectively studied to determine if the use of intraoperative autotransfusion or intraoperative autotransfusion plus postoperative reinfusion of shed mediastinal blood decreased transfusion requirements and the use of one or both techniques was cost effective. The Haemonetics Cell Saver System was used for intraoperative autotransfusion and the Sorenson Receptaseal autotransfusion system for postoperative reinfusion of shed mediastinal blood. During Phase 1, the Cell Saver System was used for 57 patients and 93 patients served as a control group. During Phase 2, the Cell Saver System plus the autotransfusion system were used in 43 patients and 91 patients were in the control group. Separate parallel analyses to compare the blood conservation groups to control groups were conducted for each phase of the study. The patient groups were comparable with regard to age, sex, preoperative red cell mass, preoperative hematocrit value, number of bypasses, and use of internal mammary grafts. Blood conservation techniques resulted in significant reductions in the use of bank blood. During Phase 1, Cell Saver System patients received an average of 2.8 units of packed cells versus 4.7 units for control patients. Transfusion was avoided entirely in 14% of Cell Saver System patients compared to 3% of control patients. During Phase 2, patients subjected to both the Cell Saver System and the autotransfusion system received an average of 1 unit of packed red cells versus 3 units for control patients. Transfusion was required in only 42% of patients subjected to both the Cell Saver System and the autotransfusion system compared to 85% of control patients. Multiple logistic regression analysis confirmed that the use of the Cell Saver System in Phase 1 and the Cell Saver System and autotransfusion system in Phase 2 were each independently predictive of decreased transfusion requirements. The total "blood

  15. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

    PubMed Central

    Gu, Dongfeng; He, Jiang; Coxson, Pamela G.; Rasmussen, Petra W.; Huang, Chen; Thanataveerat, Anusorn; Tzong, Keane Y.; Xiong, Juyang; Wang, Miao; Zhao, Dong; Goldman, Lee; Moran, Andrew E.

    2015-01-01

    Background Hypertension is China’s leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world’s largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs. Methods and Findings The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35–84 y over 2015–2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140–159/90–99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating

  16. Emotional intelligence as a predictor of self-efficacy among students with different levels of academic achievement at Kermanshah University of Medical Sciences

    PubMed Central

    GHARETEPEH, AMENEH; SAFARI, YAHYA; PASHAEI, TAHEREH; RAZAEI, MANSOUR; BAGHER KAJBAF, MOHAMMAD

    2015-01-01

    Introduction studies have indicated that emotional intelligence is positively related to self-efficacy and can predict the academic achievement. The present study aimed to investigate the role of emotional intelligence in identifying self-efficacy among the students of Public Health School with different levels of academic achievement. Methods This correlational study was conducted on all the students of Public Health School. 129 students were included in the study through census method. Data were collected using Emotional Intelligence and self-efficacy questionnaires and analyzed using descriptive statistics and regression analysis by SPSS 14. Results The average score of students with high academic achievement was higher in self-efficacy (39.78±5.82) and emotional intelligence (117.07±10.33) variables and their components than that of students with low academic achievement (39.17±5.91, 112.07±13.23). The overall emotional intelligence score to predict self-efficacy explanation was different among students with different levels of academic achievement (p<0.001). Self-efficacy structure was explained through self-awareness and self-motivation components in students with low academic achievement (r=0.571). In students with high academic achievement, self-awareness, self-motivation and social consciousness played an effective role in explaining self-efficacy (r=0.677, p<0.001). Conclusion Emotional intelligence and self-efficacy play an important role in achieving academic success and emotional intelligence can explain self-efficacy. Therefore, it is recommended to teach emotional intelligence skills to students with low academic achievement through training workshops. PMID:25927067

  17. Model VESL Program Guide, Office Information Systems, International: One Semester Intensive Training Certificate of Achievement Programs in General, Medical, and Legal Office.

    ERIC Educational Resources Information Center

    Alvarez, Irma J.

    The Office Information Systems-International Program at Southwestern College, in California, was designed to provide Hispanic students with training for entry-level office employment. This model program guide stems from a project to improve curricula and delivery and focuses on changes in three intensive bilingual programs in general, medical, and…

  18. Cost-effective laser interference lithography using a 405 nm AlInGaN semiconductor laser

    NASA Astrophysics Data System (ADS)

    Byun, Ikjoo; Kim, Joonwon

    2010-05-01

    This paper presents a cost-effective interference lithography system that uses a 405 nm AlInGaN semiconductor laser. This method is cost-effective because the AlInGaN semiconductor laser has a long coherence length (~20 m) and low price (e.g. only 1/3 that of the HeCd laser). This system successfully fabricated uniform nano-periodic patterns (line, dot and hole) in a photoresist (PR) over a 2 × 2 cm sample area. The PR patterns agreed well with simulations. Tall silicon nano-structures were fabricated by deep reactive ion etching (DRIE) using a PR pattern as a direct etch mask layer. Aspect ratios of 25 with smooth and vertical sidewalls were achieved after 32 DRIE cycles.

  19. Cost-effectiveness of Crohn’s disease post-operative care

    PubMed Central

    Wright, Emily K; Kamm, Michael A; Dr Cruz, Peter; Hamilton, Amy L; Ritchie, Kathryn J; Bell, Sally J; Brown, Steven J; Connell, William R; Desmond, Paul V; Liew, Danny

    2016-01-01

    AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection. METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo. RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented. CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated. PMID:27076772

  20. The cost-effectiveness of an intensive treatment protocol for severe dyslexia in children.

    PubMed

    Hakkaart-van Roijen, Leona; Goettsch, Wim G; Ekkebus, Michel; Gerretsen, Patty; Stolk, Elly A

    2011-08-01

    Studies of interventions for dyslexia have focused entirely on outcomes related to literacy. In this study, we considered a broader picture assessing improved quality of life compared with costs. A model served as a tool to compare costs and effects of treatment according to a new protocol and care as usual. Quality of life was measured and valued by proxies using a general quality-of-life instrument (EQ-5D). We considered medical cost and non-medical cost (e.g. remedial teaching). The model computed cost per successful treatment and cost per quality adjusted life year (QALY) in time. About 75% of the total costs was related to diagnostic tests to distinguish between children with severe dyslexia and children who have reading difficulties for other reasons. The costs per successful treatment of severe dyslexia were €36 366. Successful treatment showed a quality-of-life gain of about 11%. At primary school, the average cost per QALY for severe dyslexia amounted to €58 647. In the long term, the cost per QALY decreased to €26 386 at secondary school and €17 663 thereafter. The results of this study provide evidence that treatment of severe dyslexia is cost-effective when the investigated protocol is followed. PMID:21793122

  1. Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis

    PubMed Central

    Ivy, Julie S.; Patel, Divya A.; Patel, Sejal N.; Smith, Dean G.; Ransom, Scott B.; Fenner, Dee; DeLancey, John O.L.

    2010-01-01

    Abstract Background The potential benefit in preventing pelvic floor disorders (PFDs) is a frequently cited reason for requesting or performing cesarean delivery on maternal request (CDMR). However, for primigravid women without medical/obstetric indications, the lifetime cost-effectiveness of CDMR remains unknown, particularly with regard to lifelong pelvic floor consequences. Our objective was to assess the cost-effectiveness of CDMR in comparison to trial of labor (TOL) for primigravid women without medical/obstetric indications with a single childbirth over their lifetime, while explicitly accounting for the management of PFD throughout the lifetime. Methods We used Monte Carlo simulation of a decision model containing 249 chance events and 101 parameters depicting lifelong maternal and neonatal outcomes in the following domains: actual mode of delivery, emergency hysterectomy, transient maternal morbidity and mortality, perinatal morbidity and mortality, and the lifelong management of PFDs. Parameter estimates were obtained from published literature. The analysis was conducted from a societal perspective. All costs and quality-adjusted life-years (QALYs) were discounted to the present value at childbirth. Results The estimated mean cost and QALYs were $14,259 (95% confidence interval [CI] $8,964-$24,002) and 58.21 (95% CI 57.43-58.67) for CDMR and $13,283 (95% CI $7,861-$23,829) and 57.87 (95% CI 56.97-58.46) for TOL over the combined lifetime of the mother and the child. Parameters related to PFDs play an important role in determining cost and quality of life. Conclusions When a woman without medical/obstetric indications has only one childbirth in her lifetime, cost-effectiveness analysis does not reveal a clearly preferable mode of delivery. PMID:20088671

  2. A model to estimate the cost effectiveness of the indoorenvironment improvements in office work

    SciTech Connect

    Seppanen, Olli; Fisk, William J.

    2004-06-01

    Deteriorated indoor climate is commonly related to increases in sick building syndrome symptoms, respiratory illnesses, sick leave, reduced comfort and losses in productivity. The cost of deteriorated indoor climate for the society is high. Some calculations show that the cost is higher than the heating energy costs of the same buildings. Also building-level calculations have shown that many measures taken to improve indoor air quality and climate are cost-effective when the potential monetary savings resulting from an improved indoor climate are included as benefits gained. As an initial step towards systemizing these building level calculations we have developed a conceptual model to estimate the cost-effectiveness of various measures. The model shows the links between the improvements in the indoor environment and the following potential financial benefits: reduced medical care cost, reduced sick leave, better performance of work, lower turn over of employees, and lower cost of building maintenance due to fewer complaints about indoor air quality and climate. The pathways to these potential benefits from changes in building technology and practices go via several human responses to the indoor environment such as infectious diseases, allergies and asthma, sick building syndrome symptoms, perceived air quality, and thermal environment. The model also includes the annual cost of investments, operation costs, and cost savings of improved indoor climate. The conceptual model illustrates how various factors are linked to each other. SBS symptoms are probably the most commonly assessed health responses in IEQ studies and have been linked to several characteristics of buildings and IEQ. While the available evidence indicates that SBS symptoms can affect these outcomes and suspects that such a linkage exists, at present we can not quantify the relationships sufficiently for cost-benefit modeling. New research and analyses of existing data to quantify the financial

  3. Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

    PubMed Central

    2011-01-01

    Background Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area. PMID:21605383

  4. [Evaluation of cost effectiveness in primary health care].

    PubMed

    Busse, R; Graf von der Schulenburg, J M; Drummond, M

    1997-08-01

    Evaluation of Cost-Effectiveness in Health Care considers the background, methodology and potential political influence of economic evaluation (EE) in health care, the following conclusions can be drawn: EE is not just about cost cutting--it considers both costs and outcomes. EE needs to be integrated with decision-making procedures at different levels, namely the macro (policy) level, the meso (management) level, and the micro (clinical) level. EE needs to be seen as a part of a broader effort in health technology assessment and in relation to parallel efforts, e.g. guidelines development, quality assurance, evidence-based medicine. EE needs to be methodologically sound, but is not always possible to undertake the perfect study due to constraints of resources, time, information availability. Ways of setting priorities for EE need to be developed; this means selecting relevant topics and researchable questions. EE needs to be locally relevant; this means taking into account the variations of setting--within and between countries--and differences between trials (efficacy) and regular practice (community effectiveness). Factors that either encourage or inhibit the adoption of study results, i.e. adequate dissemination, professional support, financial incentives or political will, have to be considered. PMID:9377699

  5. Cost effective passive sampling device for volatile organic compounds monitoring

    NASA Astrophysics Data System (ADS)

    Thammakhet, Chongdee; Muneesawang, Vilailuk; Thavarungkul, Panote; Kanatharana, Proespichaya

    A laboratory-built passive sampler was developed as a simple and cost effective device for monitoring volatile organic compounds (VOCs) such as benzene, toluene and xylene (BTX). Common glass bottles (screw cap, 10 ml, 67.6×10.6 mm ID), packed with 75 mg of activated Tenax TA, were used as passive samplers. After exposed to real sample, the adsorbent was desorbed using a laboratory-built thermal desorption device. The analytes were purged to fill a sampling loop and then injected by a gas sampling valve to a gas chromatograph with a flame ionization detector (FID). All parameters, i.e. , desorption time, purge flow rate, gas chromatograph conditions were optimized to obtain high sensitivity, resolution and short analysis time. The system was calibrated by BTX standard gas and the linear regression coefficient of greater than 0.99 was obtained with detection limits 0.3, 0.2 and 0.7 μg m -3 for benzene, toluene and xylene, respectively. The proposed method was implemented for the monitoring of BTX at 10 gasoline stations in Hat Yai, Thailand. The concentrations were found in the range of N.D.-19, 12-200 and 23-200 μg m -3 for benzene, toluene and xylene, respectively.

  6. Cost-Effectiveness in Low- and Middle-Income Countries

    PubMed Central

    Shillcutt, Samuel D.; Walker, Damian G.; Goodman, Catherine A.; Mills, Anne J.

    2010-01-01

    Cost-effectiveness analysis (CEA) is increasingly important in public health decision making, including in low- and middle-income countries. The decision makers' valuation of a unit of health gain, or ceiling ratio (λ), is important in CEA as the relative value against which acceptability is defined, although values are usually chosen arbitrarily in practice. Reference case estimates for λ are useful to promote consistency, facilitate new developments in decision analysis, compare estimates against benefit-cost ratios from other economic sectors, and explicitly inform decisions about equity in global health budgets. The aim of this article is to discuss values for λ used in practice, including derivation based on affordability expectations (such as $US150 per disability-adjusted life-year [DALY]), some multiple of gross national income or gross domestic product, and preference-elicitation methods, and explore the implications associated with each approach. The background to the debate is introduced, the theoretical bases of current values are reviewed, and examples are given of their application in practice. Advantages and disadvantages of each method for defining λ are outlined, followed by an exploration of methodological and policy implications. PMID:19888791

  7. Climate targets and cost-effective climate stabilization pathways

    NASA Astrophysics Data System (ADS)

    Held, H.

    2015-08-01

    Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

  8. Cost effectiveness of the stream-gaging program in Ohio

    USGS Publications Warehouse

    Shindel, H.L.; Bartlett, W.P.

    1986-01-01

    This report documents the results of the cost effectiveness of the stream-gaging program in Ohio. Data uses and funding sources were identified for 107 continuous stream gages currently being operated by the U.S. Geological Survey in Ohio with a budget of $682,000; this budget includes field work for other projects and excludes stations jointly operated with the Miami Conservancy District. No stream gage were identified as having insufficient reason to continue their operation; nor were any station identified as having uses specifically only for short-term studies. All 107 station should be maintained in the program for the foreseeable future. The average standard error of estimation of stream flow records is 29.2 percent at its present level of funding. A minimum budget of $679,000 is required to operate the 107-gage program; a budget less than this does no permit proper service and maintenance of the gages and recorders. At the minimum budget, the average standard error is 31.1 percent The maximum budget analyzed was $1,282,000, which resulted in an average standard error of 11.1 percent. A need for additional gages has been identified by the other agencies that cooperate in the program. It is suggested that these gage be installed as funds can be made available.

  9. Cost effectiveness of the stream-gaging program in Louisiana

    USGS Publications Warehouse

    Herbert, R.A.; Carlson, D.D.

    1985-01-01

    This report documents the results of a study of the cost effectiveness of the stream-gaging program in Louisiana. Data uses and funding sources were identified for the 68 continuous-record stream gages currently (1984) in operation with a budget of $408,700. Three stream gages have uses specific to a short-term study with no need for continued data collection beyond the study. The remaining 65 stations should be maintained in the program for the foreseeable future. In addition to the current operation of continuous-record stations, a number of wells, flood-profile gages, crest-stage gages, and stage stations, are serviced on the continuous-record station routes; thus, increasing the current budget to $423,000. The average standard error of estimate for data collected at the stations is 34.6%. Standard errors computed in this study are one measure of streamflow errors, and can be used as guidelines in comparing the effectiveness of alternative networks. By using the routes and number of measurements prescribed by the ' Traveling Hydrographer Program, ' the standard error could be reduced to 31.5% with the current budget of $423,000. If the gaging resources are redistributed, the 34.6% overall level of accuracy at the 68 continuous-record sites and the servicing of the additional wells or gages could be maintained with a budget of approximately $410,000. (USGS)

  10. Cost effective waste management through composting in Africa.

    PubMed

    Couth, R; Trois, C

    2012-12-01

    Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012. PMID:22857939

  11. Cost effective ER data acquisition using a dynamic characterization strategy

    SciTech Connect

    Skinner, Kenneth M.; Salpas, Peter A.

    2007-07-01

    The important first step in remediating contaminated sites is completing characterization. The process for characterization of natural environmental media (i.e., soil, sediment, surface water, groundwater) involves three basic steps: (1) develop a plan, (2) implement the plan by collecting information necessary to define the nature and extent of contaminants in the natural media, and (3) integrate, interpret and report the results. Because of budgetary constraints, these three steps are typically applied linearly with the expectation that by the end of one application of the process the site will be characterized with sufficient resolution to make decisions about remedial actions. Our experience over the past 13 years at a complex site in Tennessee has shown that this linear approach to characterization does not produce the desired resolution. Because characterization is typically a process of defining unknowns the inflexible nature of the linear approach makes it impractical to react as the conceptual understanding of site contaminants changes in response to the acquisition of new data. An alternative, flexible approach to characterization has been developed based on lessons learned. Over the past 3 years the flexible approach has cost-effectively produced the information needed for decision making. (authors)

  12. Cost-Effective Allocation of Agricultural Best Management Practices

    NASA Astrophysics Data System (ADS)

    Arabi, M.; Govindaraju, R. S.; Engel, B. A.

    2007-12-01

    Implementation of conservation programs is perceived as being crucial for restoring and protecting waters and watersheds from nonpoint source pollution. Success of these programs depends to a great extent on planning tools that can assist the watershed management process. Herein, a novel optimization methodology is presented for deriving watershed-scale sediment and nutrient control plans that incorporate multiple, and often conflicting, objectives. The method combines the use of a watershed model (SWAT), representation of best management practices, an economic component, and a genetic algorithm-based spatial search procedure. For a small watershed in Indiana located in the Midwestern portion of the United States, selection and placement of best management practices by optimization was found to be nearly three times more cost-effective than targeting strategies for the same level of protection specified in terms of maximum monthly sediment, phosphorus, and nitrogen loads. Conversely, for the same cost, the optimization plan reduced the maximum monthly loads by a factor of two when compared to the targeting plan. The optimization methodology developed in this paper can facilitate attaining water quality goals at significantly lower costs than commonly used cost-share and targeting strategies.

  13. A cost-effective strategy for nonoscillatory convection without clipping

    NASA Technical Reports Server (NTRS)

    Leonard, B. P.; Niknafs, H. S.

    1990-01-01

    Clipping of narrow extrema and distortion of smooth profiles is a well known problem associated with so-called high resolution nonoscillatory convection schemes. A strategy is presented for accurately simulating highly convective flows containing discontinuities such as density fronts or shock waves, without distorting smooth profiles or clipping narrow local extrema. The convection algorithm is based on non-artificially diffusive third-order upwinding in smooth regions, with automatic adaptive stencil expansion to (in principle, arbitrarily) higher order upwinding locally, in regions of rapidly changing gradients. This is highly cost effective because the wider stencil is used only where needed-in isolated narrow regions. A recently developed universal limiter assures sharp monotonic resolution of discontinuities without introducing artificial diffusion or numerical compression. An adaptive discriminator is constructed to distinguish between spurious overshoots and physical peaks; this automatically relaxes the limiter near local turning points, thereby avoiding loss of resolution in narrow extrema. Examples are given for one-dimensional pure convection of scalar profiles at constant velocity.

  14. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    SciTech Connect

    James C. Leslie; Jeffrey R. Jean; Hans Neubert; Lee Truong

    2001-10-30

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report discusses and illustrates all progress in the first two years of this NETL/DOE supported program. The following have been accomplished and are reported in detail herein: (1) Specifications for both 5 5/16 inch and 3 3/8 inch composite drill pipe have been finalized. (2) All basic laboratory testing has been completed and has provide sufficient data for the selection of materials for the composite tubing, adhesives, and abrasion coatings. (3) Successful demonstration of composite/metal joint interfacial connection. (4) Upgrade of facilities to provide a functional pilot plant manufacturing facility. (5) Arrangements to have the 3 3/8 inch CDP used in a drilling operation early in C.Y. 2002. (6) Arrangements to have the 5 5/16 inch CDP marketed and produced by a major drill pipe manufacturer.

  15. How cost-effective would a vaccine be against schistosomiasis?

    PubMed

    1996-08-01

    An estimated 20 million people suffer severe disease or disability from schistosomiasis and about 50,000 die from the disease annually. While the inexpensive and effective drug praziquantel exists, there is a high risk of reinfection following treatment, necessitating long-term annual retreatment. Vaccine research has identified several antigens in Schistosoma mansoni, one of the worm species which causes human disease. However, tests of 6 of these antigens in animals for their protective potential as vaccines or vaccine components have yielded only inconsistent and largely disappointing results. The antigens are nonetheless capable of producing immune responses indicative of protection in people living in endemic areas and therefore have potential. A schistosomiasis vaccine administered to at least 80% of children in a schistosomiasis-endemic area of a low-income country, and providing protection for at least 90% of those receiving the full dose, would cost US$64-405 per healthy year of life saved. The vaccine, however, must provide protection for at least 10 years, cost no more than US$5 per completely vaccinated child, including delivery, and be delivered through the EPI system. Such a schistosomiasis vaccine would be relatively cost-effective compared with mass chemotherapy with praziquantel for children aged 6-15 years. PMID:12321483

  16. Cost effectiveness of inpatient rehabilitation in patients with brain injury.

    PubMed

    Cooney, Marie Therese; Carroll, Áine

    2016-04-01

    Rehabilitation following acquired brain injury improves health outcomes, reduces disability, and improves quality of life. We assessed the cost effectiveness of inpatient rehabilitation after brain injury in individuals with brain injury admitted to the Irish national tertiary specialist rehabilitation centre in 2011. Patients' score on the Disability Rating Scale (DRS) was recorded on admission and at discharge after intensive inpatient rehabilitation. Cost savings attributed to the rehabilitation programme were calculated as the difference between direct care costs on admission and discharge. Direct costs of care were calculated as the weekly cost of the care-assistant hours required to care for patients on the basis of their level of disability or daily nursing-home bed cost when this was required. Of 63 patients, complete DRS information for admission and discharge was available for 41. DRS scores, and therefore average levels of functioning, differed significantly at admission (2.3, between mildly and moderately dependent) and discharge (1.1, independent in special environments, p<0.01). Average weekly care costs fell from €629 to €242, with costs recouped within 30 months. Thus, substantial savings result from inpatient rehabilitation, and these savings could have been greater had we considered also the economic benefit of enabling patients to return to employment. PMID:27037377

  17. Rotavirus vaccine: a cost effective control measure for India.

    PubMed

    Kumar, Arun; Goel, Manish K; Jain, Ram Bilas; Khanna, Pardeep; Vibha, Vibha

    2012-04-01

    Globally, rotavirus diarrhea results in 453,000 deaths in children younger than 5 y—37% of deaths attributable to diarrhea and 5% of all deaths in children younger than 5 y. India alone accounts for 22% (~100,000 deaths) of all deaths attributable to rotavirus infection. Two oral rotavirus vaccines are available: Rotarix, a monovalent P1A[8] G1 vaccine (GlaxoSmithKline), and RotaTeq, a pentavalent bovine-human reassortant vaccine (Merck). Rotarix is administered in a 2-dose schedule with the first and second doses of DTP (DTP1, DTP2). RotaTeq requires a 3-dose schedule with DTP1, DTP2 and DTP3 with an interval of 4–10 weeks between doses. The first dose of either vaccine should be administered to infants aged 6–15 weeks irrespective of the history of previous rotavirus infection, and the maximum age for administering the last dose of either vaccine should be 32 weeks. Although India would require funding from international health organizations/GAVI until new indigenous rotavirus vaccine candidates are developed at a cheaper price, introduction of vaccination into the national immunization program would be a cost-effective step toward control of the rotavirus diarrhea-related morbidity and mortality in India. PMID:23071989

  18. Development and Manufacture of Cost Effective Composite Drill Pipe

    SciTech Connect

    James C. Leslie; Jeffrey R. Jean; Hans Neubert; Lee Truong; James T. Heard

    2002-09-29

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report reiterates the presentation made to DOE/NETL in Morgantown, WV on August 1st, 2002 with the addition of accomplishments made from that time forward until the issue date. The following have been accomplished and are reported in detail herein: {sm_bullet} Specifications for both 5-1/2'' and 1-5/8'' composite drill pipe have been finalized. {sm_bullet} Full scale testing of Short Radius (SR) CDP has been conducted. {sm_bullet} Successful demonstration of metal to composite interface (MCI) connection. {sm_bullet} Preparations for full scale manufacturing of ER/DW CDP have begun. {sm_bullet} Manufacturing facility rearranged to accommodate CDP process flow through plant. {sm_bullet} Arrangements to have the 3 3/8'' CDP used in 4 separate drilling applications in Oman, Oklahoma, and Texas.

  19. Cost-Effective Marine Protection--A Pragmatic Approach.

    PubMed

    Oinonen, Soile; Hyytiäinen, Kari; Ahlvik, Lassi; Laamanen, Maria; Lehtoranta, Virpi; Salojärvi, Joona; Virtanen, Jarno

    2016-01-01

    This paper puts forward a framework for probabilistic and holistic cost-effectiveness analysis to provide support in selecting the least-cost set of measures to reach a multidimensional environmental objective. Following the principles of ecosystem-based management, the framework includes a flexible methodology for deriving and populating criteria for effectiveness and costs and analyzing complex ecological-economic trade-offs under uncertainty. The framework is applied in the development of the Finnish Programme of Measures (PoM) for reaching the targets of the EU Marine Strategy Framework Directive (MSFD). The numerical results demonstrate that substantial cost savings can be realized from careful consideration of the costs and multiple effects of management measures. If adopted, the proposed PoM would yield improvements in the state of the Baltic Sea, but the overall objective of the MSFD would not be reached by the target year of 2020; for various environmental and administrative reasons, it would take longer for most measures to take full effect. PMID:26751965

  20. Cost-Effective Marine Protection - A Pragmatic Approach

    PubMed Central

    Oinonen, Soile; Hyytiäinen, Kari; Ahlvik, Lassi; Laamanen, Maria; Lehtoranta, Virpi; Salojärvi, Joona; Virtanen, Jarno

    2016-01-01

    This paper puts forward a framework for probabilistic and holistic cost-effectiveness analysis to provide support in selecting the least-cost set of measures to reach a multidimensional environmental objective. Following the principles of ecosystem-based management, the framework includes a flexible methodology for deriving and populating criteria for effectiveness and costs and analyzing complex ecological-economic trade-offs under uncertainty. The framework is applied in the development of the Finnish Programme of Measures (PoM) for reaching the targets of the EU Marine Strategy Framework Directive (MSFD). The numerical results demonstrate that substantial cost savings can be realized from careful consideration of the costs and multiple effects of management measures. If adopted, the proposed PoM would yield improvements in the state of the Baltic Sea, but the overall objective of the MSFD would not be reached by the target year of 2020; for various environmental and administrative reasons, it would take longer for most measures to take full effect. PMID:26751965

  1. Chapter 15: Public health policy and cost-effectiveness analysis.

    PubMed

    Goldie, Sue J

    2003-01-01

    Recent scientific advances are providing an opportunity to revisit strategies for cervical cancer prevention. How to invest health resources wisely, such that public health benefits are maximized-and opportunity costs are minimized-is a critical question in the setting of enhanced cytologic screening methods, human papillomavirus DNA testing, and vaccine development. Developing sound clinical guidelines and public health policy will require careful consideration of the incremental benefits, harms, and costs associated with new interventions compared with existing interventions, at both an individual and a population level. In addition to an intervention's effectiveness, public health decision making requires the consideration of its feasibility, sustainability, and affordability. No clinical trial or single cohort study will be able to simultaneously consider all of these components. Cost-effectiveness analysis and disease-simulation modeling, capitalizing on data from multiple sources, can serve as a valuable tool to extend the time horizon of clinical trials, to evaluate more strategies than possible in a single clinical trial, and to assess the relative costs and benefits of alternative policies to reduce mortality from cervical cancer. PMID:12807953

  2. Cost-effectiveness of adalimumab, infliximab or vedolizumab as first-line biological therapy in moderate-to-severe ulcerative colitis

    PubMed Central

    Yokomizo, Lauren; Limketkai, Berkeley; Park, K T

    2016-01-01

    Background There are no head-to-head randomised controlled trials (RCTs) comparing the effectiveness of biologics in ulcerative colitis (UC). We aimed to assess the cost-effectiveness of adalimumab, infliximab and vedolizumab as first-line agents to induce clinical remission and mucosal healing (MH) in UC. Methods We constructed a decision tree based on a payer's perspective in the USA to estimate the first year costs of adalimumab, infliximab or vedolizumab to achieve clinical remission and MH in patients with moderate-to-severe UC. Transition probabilities were derived from ACT, ULTRA and GEMINI RCT data. Costs were derived from Medicare reimbursement rates and wholesale drug prices. Results Assuming a biological-naïve cohort, infliximab 5 mg/kg every 8 weeks was more cost-effective ($99 171 per MH achieved) than adalimumab 40 mg every other week ($316 378 per MH achieved) and vedolizumab every 8 weeks ($301 969 per MH achieved) at 1 year. Non-drug administration cost of infliximab exceeding $1974 per infusion would make adalimumab more cost-effective. First-line UC therapy with vedolizumab would be cost-effective if the drug acquisition price was <$2537 for each 300 mg administration during the 1-year time horizon. Conclusions If non-drug costs of infliximab administration are not excessive (<$2000), infliximab is the most cost-effective first-line biologic for moderate-to-severe UC. Exceeding this threshold infusion-related cost would make adalimumab the more cost-effective therapy. Considering its drug costs in the USA, vedolizumab appears to be appropriately used as a second-line biologic after antitumour necrosis factor failure. PMID:27195130

  3. Feasibility and Cost-Effectiveness of Treating Multidrug-Resistant Tuberculosis: A Cohort Study in the Philippines

    PubMed Central

    Tupasi, Thelma E; Gupta, Rajesh; Quelapio, Ma Imelda D; Orillaza, Ruth B; Mira, Nona Rachel; Mangubat, Nellie V; Belen, Virgil; Arnisto, Nida; Macalintal, Lualhati; Arabit, Michael; Lagahid, Jaime Y; Espinal, Marcos; Floyd, Katherine

    2006-01-01

    Background Multidrug-resistant tuberculosis (MDR-TB) is an important global health problem, and a control strategy known as DOTS-Plus has existed since 1999. However, evidence regarding the feasibility, effectiveness, cost, and cost-effectiveness of DOTS-Plus is still limited. Methodology/Principal Findings We evaluated the feasibility, effectiveness, cost, and cost-effectiveness of a DOTS-Plus pilot project established at Makati Medical Center in Manila, the Philippines, in 1999. Patients with MDR-TB are treated with regimens, including first- and second-line drugs, tailored to their drug susceptibility pattern (i.e., individualised treatment). We considered the cohort enrolled between April 1999 and March 2002. During this three-year period, 118 patients were enrolled in the project; 117 were considered in the analysis. Seventy-one patients (61%) were cured, 12 (10%) failed treatment, 18 (15%) died, and 16 (14%) defaulted. The average cost per patient treated was US$3,355 from the perspective of the health system, of which US$1,557 was for drugs, and US$837 from the perspective of patients. The mean cost per disability-adjusted life year (DALY) gained by the DOTS-Plus project was US$242 (range US$85 to US$426). Conclusions Treatment of patients with MDR-TB using the DOTS-Plus strategy and individualised drug regimens can be feasible, comparatively effective, and cost-effective in low- and middle-income countries. PMID:16968123

  4. Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

    PubMed Central

    Dixon, Padraig; Edwards, Louisa; Thomas, Clare; Gaunt, Daisy; Foster, Alexis; Large, Shirley; Montgomery, Alan A

    2016-01-01

    Objectives To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk. Design A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial. Setting Patients recruited through primary care, and intervention delivered via telehealth service. Participants Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor. Intervention A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care. Primary and secondary outcome measures Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework. Results 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis. Conclusions There is evidence to suggest that the Healthlines telehealth

  5. Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis

    PubMed Central

    Pareek, Manish; Watson, John P; Ormerod, L Peter; Kon, Onn Min; Woltmann, Gerrit; White, Peter J; Abubakar, Ibrahim; Lalvani, Ajit

    2011-01-01

    Summary Background Continuing rises in tuberculosis notifications in the UK are attributable to cases in foreign-born immigrants. National guidance for immigrant screening is hampered by a lack of data about the prevalence of, and risk factors for, latent tuberculosis infection in immigrants. We aimed to determine the prevalence of latent infection in immigrants to the UK to define which groups should be screened and to quantify cost-effectiveness. Methods In our multicentre cohort study and cost-effectiveness analysis we analysed demographic and test results from three centres in the UK (from 2008 to 2010) that used interferon-γ release-assay (IGRA) to screen immigrants aged 35 years or younger for latent tuberculosis infection. We assessed factors associated with latent infection by use of logistic regression and calculated the yields and cost-effectiveness of screening at different levels of tuberculosis incidence in immigrants' countries of origin with a decision analysis model. Findings Results for IGRA-based screening were positive in 245 of 1229 immigrants (20%), negative in 982 (80%), and indeterminate in two (0·2%). Positive results were independently associated with increases in tuberculosis incidence in immigrants' countries of origin (p=0·0006), male sex (p=0·046), and age (p<0·0001). National policy thus far would fail to detect 71% of individuals with latent infection. The two most cost-effective strategies were to screen individuals from countries with a tuberculosis incidence of more than 250 cases per 100 000 (incremental cost-effectiveness ratio [ICER] was £17 956 [£1=US$1·60] per prevented case of tuberculosis) and at more than 150 cases per 100 000 (including immigrants from the Indian subcontinent), which identified 92% of infected immigrants and prevented an additional 29 cases at an ICER of £20 819 per additional case averted. Interpretation Screening for latent infection can be implemented cost-effectively at a level of

  6. Three-Dimensional (3-D) Printing: A Cost-Effective Solution for Improving Global Accessibility to Prostheses.

    PubMed

    Silva, Kyle; Rand, Stephanie; Cancel, David; Chen, Yuxi; Kathirithamby, Rani; Stern, Michelle

    2015-12-01

    The lack of access to prostheses is a global problem, partially caused by the high cost associated with the current manufacturing process. Three-dimensional printing is gaining use in the medical field, and one such area is prosthetics. In addition to using cost-effective materials, this technology allows for rapid prototyping, making it an efficient solution for the development of affordable prostheses. If the rehabilitation medicine community embraces this novel technology, we can help alleviate the global disparity of access to prostheses. PMID:26709247

  7. Mobile source emission control cost-effectiveness: Issues, uncertainties, and results

    SciTech Connect

    Wang, M.Q.

    1994-12-01

    Emissions from mobile sources undoubtedly contribute to US urban air pollution problems. Consequently, mobile source control measures, ranging from vehicle emission standards to reducing vehicle travel, have been adopted or proposed to help attain air quality standards. To rank various mobile source control measures, various government agencies and private organizations calculate cost-effectiveness in dollars per ton of emissions reduced. Arguments for or against certain control measures are often made on the basis of the calculated cost-effectiveness. Yet, different studies may yield significantly different cost-effectiveness results, because of the various methodologies used and assumptions regarding the values of costs and emission reductions. Because of the methodological differences, the cost-effectiveness results may not be comparable between studies. Use of incomparable cost-effectiveness results may result in adoption of ineffective control measures. This paper first discusses some important methodological issues involved in cost-effectiveness calculation for mobile sources and proposes appropriate, systematic methods for dealing with these issues. Various studies have been completed recently to evaluate the cost-effectiveness of mobile source emission control measures. These studies resulted in wide variations in the cost-effectiveness for same control measures. Methodological assumptions used in each study are presented and, based on the proposed methods for cost-effectiveness calculation, adjustments are applied to the original estimates in each study to correct inappropriate methodological assumptions and to make the studies comparable. Finally, mobile source control measures are ranked on the basis of the adjusted cost-effectiveness estimates.

  8. Cost-effectiveness of a helpline for suicide prevention.

    PubMed

    Pil, Lore; Pauwels, Kirsten; Muijzers, Ekke; Portzky, Gwendolyn; Annemans, Lieven

    2013-07-01

    We evaluated the cost-effectiveness and budget impact of a suicide helpline in Belgium, consisting of a telephone- and a chat service. An age- and gender-dependent Markov model with a ten-year time horizon and a one-year cycle length was developed, assuming a societal perspective, to predict cumulative costs and quality-adjusted life-years (QALYs) in the helpline users. The model included six transition states: the initial state (at risk), first attempt, re-attempt, follow-up, suicide and death from other causes. Data on the effect of the helpline and costs associated with model states were obtained from the literature. One-way and probabilistic sensitivity analyses were performed to capture uncertainty. In addition, the budget impact of the helpline was analysed. Over ten years, the telephone- as well as the chat service could avoid about 36% of suicides and attempts in this high-risk population. In males, 0.063 QALYs (95% confidence interval, CI 0.030-0.097) and 0.035 QALYs (95%CI -0.026-0.096) were gained by users of the telephone- and chat service respectively. The corresponding values for females were 0.019 QALYs (95%CI -0.015-0.052) and a QALY-neutral result of -0.005 (95%CI -0.071-0.062). There were net societal savings of respectively €2382 (95%CI 1953-2859) and €2282 (95%CI 1855-2758) in male users; €2171 (95%CI 1735-2664) and €2458 (95%CI 1945-3025) in female users. At the population level, an investment of €218,899 saved €1,452,022 for the public health service (national health insurance), mainly due to the telephone service. The analysis predicted that both means of telemedicine for suicide prevention in Flanders are cost-saving, and have a modest effect on QALYs. PMID:24163237

  9. Cost effective waste management through composting in Africa

    SciTech Connect

    Couth, R.; Trois, C.

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer The financial/social/institutional sustainability of waste management in Africa is analysed. Black-Right-Pointing-Pointer This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. Black-Right-Pointing-Pointer This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  10. Development of a cost-effective machine vision system for in-field sorting and grading of apples: Fruit orientation and size estimation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this research was to develop an in-field apple presorting and grading system to separate undersized and defective fruit from fresh market-grade apples. To achieve this goal, a cost-effective machine vision inspection prototype was built, which consisted of a low-cost color camera, L...

  11. Cost-effective sampling network design for contaminant plume monitoring under general hydrogeological conditions.

    PubMed

    Wu, Jianfeng; Zheng, Chunmiao; Chien, Calvin C

    2005-03-01

    A new simulation-optimization methodology is developed for cost-effective sampling network design associated with long-term monitoring of large-scale contaminant plumes. The new methodology is similar in concept to the one presented by Reed et al. (Reed, P.M., Minsker, B.S., Valocchi, A.J., 2000a. Cost-effective long-term groundwater monitoring design using a genetic algorithm and global mass interpolation. Water Resour. Res. 36 (12), 3731-3741) in that an optimization model based on a genetic algorithm is coupled with a flow and transport simulator and a global mass estimator to search for optimal sampling strategies. However, this study introduces the first and second moments of a three-dimensional contaminant plume as new constraints in the optimization formulation, and demonstrates the proposed methodology through a real-world application. The new moment constraints significantly increase the accuracy of the plume interpolated from the sampled data relative to the plume simulated by the transport model. The plume interpolation approaches employed in this study are ordinary kriging (OK) and inverse distance weighting (IDW). The proposed methodology is applied to the monitoring of plume evolution during a pump-and-treat operation at a large field site. It is shown that potential cost savings up to 65.6% may be achieved without any significant loss of accuracy in mass and moment estimations. The IDW-based interpolation method is computationally more efficient than the OK-based method and results in more potential cost savings. However, the OK-based method leads to more accurate mass and moment estimations. A comparison of the sampling designs obtained with and without the moment constraints points to their importance in ensuring a robust long-term monitoring design that is both cost-effective and accurate in mass and moment estimations. Additional analysis demonstrates the sensitivity of the optimal sampling design to the various coefficients included in the

  12. A holistic framework for design of cost-effective minimum water utilization network.

    PubMed

    Wan Alwi, S R; Manan, Z A; Samingin, M H; Misran, N

    2008-07-01

    Water pinch analysis (WPA) is a well-established tool for the design of a maximum water recovery (MWR) network. MWR, which is primarily concerned with water recovery and regeneration, only partly addresses water minimization problem. Strictly speaking, WPA can only lead to maximum water recovery targets as opposed to the minimum water targets as widely claimed by researchers over the years. The minimum water targets can be achieved when all water minimization options including elimination, reduction, reuse/recycling, outsourcing and regeneration have been holistically applied. Even though WPA has been well established for synthesis of MWR network, research towards holistic water minimization has lagged behind. This paper describes a new holistic framework for designing a cost-effective minimum water network (CEMWN) for industry and urban systems. The framework consists of five key steps, i.e. (1) Specify the limiting water data, (2) Determine MWR targets, (3) Screen process changes using water management hierarchy (WMH), (4) Apply Systematic Hierarchical Approach for Resilient Process Screening (SHARPS) strategy, and (5) Design water network. Three key contributions have emerged from this work. First is a hierarchical approach for systematic screening of process changes guided by the WMH. Second is a set of four new heuristics for implementing process changes that considers the interactions among process changes options as well as among equipment and the implications of applying each process change on utility targets. Third is the SHARPS cost-screening technique to customize process changes and ultimately generate a minimum water utilization network that is cost-effective and affordable. The CEMWN holistic framework has been successfully implemented on semiconductor and mosque case studies and yielded results within the designer payback period criterion. PMID:17449168

  13. Cost-effective targeting of conservation investments to reduce the northern Gulf of Mexico hypoxic zone.

    PubMed

    Rabotyagov, Sergey S; Campbell, Todd D; White, Michael; Arnold, Jeffrey G; Atwood, Jay; Norfleet, M Lee; Kling, Catherine L; Gassman, Philip W; Valcu, Adriana; Richardson, Jeffrey; Turner, R Eugene; Rabalais, Nancy N

    2014-12-30

    A seasonally occurring summer hypoxic (low oxygen) zone in the northern Gulf of Mexico is the second largest in the world. Reductions in nutrients from agricultural cropland in its watershed are needed to reduce the hypoxic zone size to the national policy goal of 5,000 km(2) (as a 5-y running average) set by the national Gulf of Mexico Task Force's Action Plan. We develop an integrated assessment model linking the water quality effects of cropland conservation investment decisions on the more than 550 agricultural subwatersheds that deliver nutrients into the Gulf with a hypoxic zone model. We use this integrated assessment model to identify the most cost-effective subwatersheds to target for cropland conservation investments. We consider targeting of the location (which subwatersheds to treat) and the extent of conservation investment to undertake (how much cropland within a subwatershed to treat). We use process models to simulate the dynamics