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Sample records for cost-effective digital control

  1. 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.

  2. Cost-effectiveness as a price control.

    PubMed

    Jena, Anupam B; Philipson, Tomas

    2007-01-01

    After a technology is developed, cost-effectiveness analysis can offer an economically sound approach to adoption decisions. Little attention has been paid, however, to the incentives these criteria induce for getting technologies to market in the first place. We argue that technology adoption procedures more fully take into account the key trade-off inherent in research and development: the decreased welfare of current patients as a result of higher prices versus the increased welfare of future patients as a result of the incentives for innovation that such prices provide. Empirical evidence from a case study of HIV/AIDS provides an illustration of our conclusions.

  3. Costs and Cost-Effectiveness of Plasmodium vivax Control

    PubMed Central

    White, Michael T.; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard

    2016-01-01

    The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax. The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum–specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. PMID:28025283

  4. [Cost-effectiveness evaluation of a digital radiography system].

    PubMed

    Guillaume, L; Joris, T; Mandry, D; Kammacher, L; Claudon, M

    2007-01-01

    To evaluate the impact of a completely automated digital radiography (DR) unit in a pediatric radiology department on productivity. Materials and methods. Comparative evaluation of DR and computerized radiography (CR) units on 193 patients imaged in a pediatric radiology department. The time to complete each step of all examinations was recorded. Half of the exams were performed using CR and the other half was performed using DR. There was a 52% time gain for simple projection exams using DR and a 51% time gain for dual projection exams using DR (p<0.001). A workflow study performed a 9 month period showed that DR could absorb 84% of work previously performed on two conventional radiography units. DR is necessary for digital imaging departments to increase productivity, while providing added ergonomic comfort and flexibility. It is particularly well suited for pediatric imaging departments.

  5. Cost-effective bidirectional digitized radio-over-fiber systems employing sigma delta modulation

    NASA Astrophysics Data System (ADS)

    Lee, Kyung Woon; Jung, HyunDo; Park, Jung Ho

    2016-11-01

    We propose a cost effective digitized radio-over-fiber (D-RoF) system employing a sigma delta modulation (SDM) and a bidirectional transmission technique using phase modulated downlink and intensity modulated uplink. SDM is transparent to different radio access technologies and modulation formats, and more suitable for a downlink of wireless system because a digital to analog converter (DAC) can be avoided at the base station (BS). Also, Central station and BS share the same light source by using a phase modulation for the downlink and an intensity modulation for the uplink transmission. Avoiding DACs and light sources have advantages in terms of cost reduction, power consumption, and compatibility with conventional wireless network structure. We have designed a cost effective bidirectional D-RoF system using a low pass SDM and measured the downlink and uplink transmission performance in terms of error vector magnitude, signal spectra, and constellations, which are based on the 10MHz LTE 64-QAM standard.

  6. Cost-Effectiveness of Automated Digital Microscopy for Diagnosis of Active Tuberculosis

    PubMed Central

    Jha, Swati; Ismail, Nazir; Clark, David; Lewis, James J.; Omar, Shaheed; Dreyer, Andries; Chihota, Violet; Churchyard, Gavin; Dowdy, David W.

    2016-01-01

    Background Automated digital microscopy has the potential to improve the diagnosis of tuberculosis (TB), particularly in settings where molecular testing is too expensive to perform routinely. The cost-effectiveness of TB diagnostic algorithms using automated digital microscopy remains uncertain. Methods Using data from a demonstration study of an automated digital microscopy system (TBDx, Applied Visual Systems, Inc.), we performed an economic evaluation of TB diagnosis in South Africa from the health system perspective. The primary outcome was the incremental cost per new TB diagnosis made. We considered costs and effectiveness of different algorithms for automated digital microscopy, including as a stand-alone test and with confirmation of positive results with Xpert MTB/RIF (‘Xpert’, Cepheid, Inc.). Results were compared against both manual microscopy and universal Xpert testing. Results In settings willing to pay $2000 per incremental TB diagnosis, universal Xpert was the preferred strategy. However, where resources were not sufficient to support universal Xpert, and a testing volume of at least 30 specimens per day could be ensured, automated digital microscopy with Xpert confirmation of low-positive results could facilitate the diagnosis of 79–84% of all Xpert-positive TB cases, at 50–60% of the total cost. The cost-effectiveness of this strategy was $1280 per incremental TB diagnosis (95% uncertainty range, UR: $340-$3440) in the base case, but improved under conditions likely reflective of many settings in sub-Saharan Africa: $677 per diagnosis (95% UR: $450-$935) when sensitivity of manual smear microscopy was lowered to 0.5, and $956 per diagnosis (95% UR: $40-$2910) when the prevalence of multidrug-resistant TB was lowered to 1%. Conclusions Although universal Xpert testing is the preferred algorithm for TB diagnosis when resources are sufficient, automated digital microscopy can identify the majority of cases and halve the cost of diagnosis and

  7. Cost effectiveness of Aedes aegypti control programmes: participatory versus vertical.

    PubMed

    Baly, A; Toledo, M E; Boelaert, M; Reyes, A; Vanlerberghe, V; Ceballos, E; Carvajal, M; Maso, R; La Rosa, M; Denis, O; Van der Stuyft, P

    2007-06-01

    We conducted an economic appraisal of two strategies for Aedes aegypti control: a vertical versus a community-based approach. Costs were calculated for the period 2000-2002 in three pilot areas of Santiago de Cuba where a community intervention was implemented and compared with three control areas with routine vertical programme activities. Reduction in A. aegypti foci was chosen as the measure of effectiveness. The pre-intervention number of foci (614 vs. 632) and economical costs for vector control (US$243746 vs. US$263486) were comparable in the intervention and control areas. During the intervention period (2001-2002), a 13% decrease in recurrent costs for the health system was observed. Within the control areas, these recurrent relative costs remained stable. The number of A. aegypti foci in the pilot areas and the control areas fell by 459 and 467, respectively. The community-based approach was more cost effective from a health system perspective (US$964 vs. US$1406 per focus) as well as from society perspective (US$1508 vs. US$1767 per focus).

  8. 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

  9. Cost-effectiveness of digital mammography screening before the age of 50 in The Netherlands.

    PubMed

    Sankatsing, Valérie D V; Heijnsdijk, Eveline A M; van Luijt, Paula A; van Ravesteyn, Nicolien T; Fracheboud, Jacques; de Koning, Harry J

    2015-10-15

    In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost €3,376/LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at €5,329 (biennial 48-74 vs. current strategy), €7,628 (biennial 45-74 vs. biennial 48-74), €10,826 (biennial 40-74 vs. biennial 45-74) and €18,759 (annual 40-49 + biennial 50-74 vs. biennial 40-74). Other strategies (49 + biennial 50-74 and annual 45-49 + biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.

  10. 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.

  11. 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.

  12. A high performance cost-effective digital complex correlator for an X-band polarimetry survey.

    PubMed

    Bergano, Miguel; Rocha, Armando; Cupido, Luís; Barbosa, Domingos; Villela, Thyrso; Boas, José Vilas; Rocha, Graça; Smoot, George F

    2016-01-01

    The detailed knowledge of the Milky Way radio emission is important to characterize galactic foregrounds masking extragalactic and cosmological signals. The update of the global sky models describing radio emissions over a very large spectral band requires high sensitivity experiments capable of observing large sky areas with long integration times. Here, we present the design of a new 10 GHz (X-band) polarimeter digital back-end to map the polarization components of the galactic synchrotron radiation field of the Northern Hemisphere sky. The design follows the digital processing trends in radio astronomy and implements a large bandwidth (1 GHz) digital complex cross-correlator to extract the Stokes parameters of the incoming synchrotron radiation field. The hardware constraints cover the implemented VLSI hardware description language code and the preliminary results. The implementation is based on the simultaneous digitized acquisition of the Cartesian components of the two linear receiver polarization channels. The design strategy involves a double data rate acquisition of the ADC interleaved parallel bus, and field programmable gate array device programming at the register transfer mode. The digital core of the back-end is capable of processing 32 Gbps and is built around an Altera field programmable gate array clocked at 250 MHz, 1 GSps analog to digital converters and a clock generator. The control of the field programmable gate array internal signal delays and a convenient use of its phase locked loops provide the timing requirements to achieve the target bandwidths and sensitivity. This solution is convenient for radio astronomy experiments requiring large bandwidth, high functionality, high volume availability and low cost. Of particular interest, this correlator was developed for the Galactic Emission Mapping project and is suitable for large sky area polarization continuum surveys. The solutions may also be adapted to be used at signal processing

  13. Optimal control and cost-effective analysis of malaria/visceral leishmaniasis co-infection

    PubMed Central

    Agusto, Folashade B.; ELmojtaba, Ibrahim M.

    2017-01-01

    In this paper, a deterministic model involving the transmission dynamics of malaria/visceral leishmaniasis co-infection is presented and studied. Optimal control theory is then applied to investigate the optimal strategies for curtailing the spread of the diseases using the use of personal protection, indoor residual spraying and culling of infected reservoirs as the system control variables. Various combination strategies were examined so as to investigate the impact of the controls on the spread of the disease. And we investigated the most cost-effective strategy of all the control strategies using three approaches, the infection averted ratio (IAR), the average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER). Our results show that the implementation of the strategy combining all the time dependent control variables is the most cost-effective control strategy. This result is further emphasized by using the results obtained from the cost objective functional, the ACER, and the ICER. PMID:28166308

  14. Digital flight control research

    NASA Technical Reports Server (NTRS)

    Potter, J. E.; Stern, R. G.; Smith, T. B.; Sinha, P.

    1974-01-01

    The results of studies which were undertaken to contribute to the design of digital flight control systems, particularly for transport aircraft are presented. In addition to the overall design considerations for a digital flight control system, the following topics are discussed in detail: (1) aircraft attitude reference system design, (2) the digital computer configuration, (3) the design of a typical digital autopilot for transport aircraft, and (4) a hybrid flight simulator.

  15. Cost-Effectiveness of Aflatoxin Control Methods: Economic Incentives

    USDA-ARS?s Scientific Manuscript database

    Multiple sectors in U.S. crop industries – growers, elevators, handlers/shellers, processors, distributors, and consumers – are affected by aflatoxin contamination of commodities, and have the potential to control it. Aflatoxin control methods at both preharvest and postharvest levels have been dev...

  16. Burner modifications for cost effective NO{sub x} control

    SciTech Connect

    Melick, T.A.; Hensley, M.E.; Gustafson, D.A.

    1998-12-31

    The development of commercial Low NO{sub x} Burners has provided Energy and Environmental Research Corporation (EER) with the expertise to modify existing burner equipment to provide the controlled fuel/air mixing conditions required for low NO{sub x} contribution. This approach represents a viable alternative to a full burner retrofit for many applications. EER has modified burners to lower NO{sub x} emissions at Louisville Gas and Electric`s (LG and E) Cane Run Station and at Jamestown Board of Public Utilities (JBPU). This paper discusses the method and results of these burner modifications.

  17. Identifying cost-effective dynamic policies to control epidemics.

    PubMed

    Yaesoubi, Reza; Cohen, Ted

    2016-12-10

    We describe a mathematical decision model for identifying dynamic health policies for controlling epidemics. These dynamic policies aim to select the best current intervention based on accumulating epidemic data and the availability of resources at each decision point. We propose an algorithm to approximate dynamic policies that optimize the population's net health benefit, a performance measure which accounts for both health and monetary outcomes. We further illustrate how dynamic policies can be defined and optimized for the control of a novel viral pathogen, where a policy maker must decide (i) when to employ or lift a transmission-reducing intervention (e.g. school closure) and (ii) how to prioritize population members for vaccination when a limited quantity of vaccines first become available. Within the context of this application, we demonstrate that dynamic policies can produce higher net health benefit than more commonly described static policies that specify a pre-determined sequence of interventions to employ throughout epidemics. Copyright © 2016 John Wiley & Sons, Ltd.

  18. Modular motion control produces cost-effective conveying

    SciTech Connect

    Yackel, R.A.

    1997-08-01

    Collectively, US power plants move as much as 800 million tons of coal a year through the mining, transport, off-loading, stockpiling and consumption sequence, most typically through the use of belt conveyors. Plant operators oversee a process that moves mountains of coal accurately and dependably, guarding against overloading, loss of conveyor-to-conveyor synchronization, belt slippage and other malfunctions. A coal-conveying motion-control system should consist of modular, turnkey motion-sensing components that can be assembled and interconnected for any application without custom engineering. Such a system can be fail-safe, provide uninterrupted protection, resist difficult environmental conditions, integrate complex multiple functions and allow power plant operators to take instant action to protect against damage in the event of a system fault.

  19. Burner modifications for cost effective NO{sub x} control

    SciTech Connect

    Melick, T.A.; Hensley, M.E.; Gustafson, D.A.

    1998-07-01

    The development of commercial low NO{sub x} burners has provided Energy and Environmental Research Corporation (EER) with the expertise to modify existing burner equipment to provide the controlled fuel/air mixing conditions required for low NO{sub x} combustion. This approach represents a viable lower cost alternative to a full burner retrofit for many applications. EER has modified burners to lower NO{sub x} emissions at Louisville Gas and Electric's (LG and E) Cane Run Station and at Jamestown Board of Public Utilities (JBPU). This paper will discuss the method and results of these burner modifications on a 180 and 170 Mwe boiler for LG and E and four boilers at JBPU. NO{sub x} reductions of greater than 50% have been demonstrated with burner modifications only that have achieved NO{sub x} compliance on these six boilers. EER will also be modifying cell burners for Dayton Power and Light at their JM Stuart Station. Unit {number_sign}3 is a 605 Mwe B and W universal pressure opposed wall fired boiler. EER will retrofit the burners this October through November and results will be available by the first of December. With deregulation of the utility industry approaching, many utilities are looking for lower cost alternatives to satisfy NO{sub x} regulations. Justifying new low NO{sub x} burners on a boiler that is 30 to 40 years old and has limited remaining life is also difficult. Performing modifications to the existing burners provides the utility an option. Modifications are usually 2 to 4 times less expensive than new low NO{sub x} burners.

  20. [Analysis of Cost-effectiveness of screening for breast cancer with conventional mammography, digital and magnetic resonance imaging].

    PubMed

    Peregrino, Antonio Augusto de Freitas; Vianna, Cid Manso de Mello; de Almeida, Carlos Eduardo Veloso; Gonzáles, Gabriela Bittencourt; Machado, Samara Cristina Ferreira; Costa e Silva, Frances Valéria; Rodrigues, Marcus Paulo da Silva

    2012-01-01

    A cost-effectiveness analysis was conducted in screening for breast cancer. The use of conventional mammography, digital and magnetic resonance imaging were compared with natural disease history as a baseline. A Markov model projected breast cancer in a group of 100,000 women for a 30 year period, with screening every two years. Four distinct scenarios were modeled: (1) the natural history of breast cancer, as a baseline, (2) conventional film mammography, (3) digital mammography and (4) magnetic resonance imaging. The costs of the scenarios modeled ranged from R$ 194.216,68 for natural history, to R$ 48.614.338,31, for screening with magnetic resonance imaging. The difference in effectiveness between the interventions ranged from 300 to 78.000 years of life gained in the cohort. The ratio of incremental cost-effectiveness in terms of cost per life-year gains, conventional mammographic screening has produced an extra year for R$ 13.573,07. The ICER of magnetic resonance imaging was R$ 2.904.328,88, compared to no screening. In conclusion, it is more cost-effective to perform the screening with conventional mammography than other technological interventions.

  1. One Health approach to cost-effective rabies control in India

    PubMed Central

    Shah, Hiral A.; Pandey, Abhishek; Bilinski, Alyssa M.; Kakkar, Manish; Clark, Andrew D.; Galvani, Alison P.

    2016-01-01

    Over 20,000 rabies deaths occur annually in India, representing one-third of global human rabies. The Indian state of Tamil Nadu has pioneered a “One Health” committee to address the challenge of rabies in dogs and humans. Currently, rabies control in Tamil Nadu involves postexposure vaccination of humans after dog bites, whereas potential supplemental approaches include canine vaccination and sterilization. We developed a data-driven rabies transmission model fit to human rabies autopsy data and human rabies surveillance data from Tamil Nadu. Integrating local estimates for canine demography and costs, we predicted the impact of canine vaccination and sterilization on human health outcomes and evaluated cost-effectiveness according to the WHO criteria for India, which correspond to thresholds of $1,582 and $4,746 per disability-adjusted life-years (DALYs) for very cost-effective and cost-effective strategies, respectively. We found that highly feasible strategies focused on stray dogs, vaccinating as few as 7% of dogs annually, could very cost-effectively reduce human rabies deaths by 70% within 5 y, and a modest expansion to vaccinating 13% of stray dogs could cost-effectively reduce human rabies by almost 90%. Through integration over parameter uncertainty, we find that, for a cost-effectiveness threshold above $1,400 per DALY, canine interventions are at least 95% likely to be optimal. If owners are willing to bring dogs to central point campaigns at double the rate that campaign teams can capture strays, expanded annual targets become cost-effective. This case study of cost-effective canine interventions in Tamil Nadu may have applicability to other settings in India and beyond. PMID:27994161

  2. Cost-effectiveness of larviciding for urban malaria control in Tanzania.

    PubMed

    Maheu-Giroux, Mathieu; Castro, Marcia C

    2014-12-04

    Larviciding for malaria control can contribute to an Integrated Vector Management (IVM) approach. This intervention is currently supported in settings where breeding habitats are 'few, fixed, and findable', such as urban areas of sub-Saharan Africa, but the knowledge base regarding the cost-effectiveness of larviciding is non-existent. Programme costs and effectiveness data were collected from the Dar es Salaam Urban Malaria Control Programme in Tanzania. Cost-effectiveness ratios (CER) were estimated from the provider and societal perspectives for standard indicators using different malaria transmission scenarios. CER for microbial larviciding were highly dependent on the assumed baseline malaria incidence rates. Using the societal perspective, net CER were estimated (in 2012 US dollars) at $43 (95% uncertainty intervals [UI]: $15-181) per disability-adjusted life year averted (DALY) when malaria incidence was 902 infections per 1,000 individuals, increasing to $545 (95% UI: $337-1,558) per DALY at an incidence of 122 per 1,000. Larviciding was shown to be cost-effective in Tanzania for incidences as low as 40 infections per 1,000 people per year. This is believed to be the first study to estimate the cost-effectiveness of larviciding for urban malaria control in sub-Saharan Africa. The results support the use of larviciding as a cost-effective intervention in urban areas and managers of national malaria control programme should consider this intervention as part of an IVM approach.

  3. Economics of infection control surveillance technology: cost-effective or just cost?

    PubMed

    Furuno, Jon P; Schweizer, Marin L; McGregor, Jessina C; Perencevich, Eli N

    2008-04-01

    Previous studies have suggested that informatics tools, such as automated alert and decision support systems, may increase the efficiency and quality of infection control surveillance. However, little is known about the cost-effectiveness of these tools. We focus on 2 types of economic analyses that have utility in assessing infection control interventions (cost-effectiveness analysis and business-case analysis) and review the available literature on the economics of computerized infection control surveillance systems. Previous studies on the effectiveness of computerized infection control surveillance have been limited to assessments of whether these tools increase the sensitivity and specificity of surveillance over traditional methods. Furthermore, we identified only 2 studies that assessed the costs associated with computerized infection control surveillance. Thus, it remains unknown whether computerized infection control surveillance systems are cost-effective and whether use of these systems improves patient outcomes. The existing data are insufficient to allow for a summary conclusion on the cost-effectiveness of infection control surveillance technology. All future studies of computerized infection control surveillance systems should aim to collect outcomes and economic data to inform decision making and assist hospitals with completing business-cases analyses.

  4. Cost-effectiveness of blindness prevention by the Onchocerciasis Control Programme in Upper Volta*

    PubMed Central

    Prost, A.; Prescott, N.

    1984-01-01

    The article presents a cost-effectiveness analysis of the Onchocerciasis Control Programme in Upper Volta. The analysis uses a new approach to the measurement of health project effectiveness, by considering the number of healthy years of life added by the prevention of permanent disability and premature death attributable to onchocercal blindness. The approach emphasizes the central role of social value judgements in allocating health resources—in particular the relative weights assigned to preventing disability and postponing death, present and future health benefits, and health gains among productive and non-productive individuals. The quantitative results yield the following cost-effectiveness estimates for blindness prevention through onchocerciasis control: US$20 per year of healthy life and per productive year of healthy life added, and US$150 per discounted year of healthy life and per discounted productive year of healthy life added. As an illustrative example, a comparison is made with estimates of the cost-effectiveness of measles immunization. PMID:6439428

  5. Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

    PubMed

    Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

    2013-07-01

    An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

  6. Precision digital control systems

    NASA Astrophysics Data System (ADS)

    Vyskub, V. G.; Rozov, B. S.; Savelev, V. I.

    This book is concerned with the characteristics of digital control systems of great accuracy. A classification of such systems is considered along with aspects of stabilization, programmable control applications, digital tracking systems and servomechanisms, and precision systems for the control of a scanning laser beam. Other topics explored are related to systems of proportional control, linear devices and methods for increasing precision, approaches for further decreasing the response time in the case of high-speed operation, possibilities for the implementation of a logical control law, and methods for the study of precision digital control systems. A description is presented of precision automatic control systems which make use of electronic computers, taking into account the existing possibilities for an employment of computers in automatic control systems, approaches and studies required for including a computer in such control systems, and an analysis of the structure of automatic control systems with computers. Attention is also given to functional blocks in the considered systems.

  7. Cost-effectiveness analysis of breast cancer control interventions in Peru.

    PubMed

    Zelle, Sten G; Vidaurre, Tatiana; Abugattas, Julio E; Manrique, Javier E; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N; Lauer, Jeremy A; Sepulveda, Cecilia R; Venegas, Diego; Baltussen, Rob

    2013-01-01

    In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if

  8. Cost effectiveness of tobacco control policies in Vietnam: the case of population-level interventions.

    PubMed

    Higashi, Hideki; Truong, Khoa D; Barendregt, Jan J; Nguyen, Phuong K; Vuong, Mai L; Nguyen, Thuy T; Hoang, Phuong T; Wallace, Angela L; Tran, Tien V; Le, Cuong Q; Doran, Christopher M

    2011-05-01

    Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries. The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam. Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis. All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. cost-effective option, followed by excise tax increases, mass media campaigns, public smoking bans and work place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector. All four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.

  9. Cost-effectiveness of a smokeless tobacco control mass media campaign in India.

    PubMed

    Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark

    2017-08-10

    Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. A Cost-Effective Atomic Force Microscope for Undergraduate Control Laboratories

    ERIC Educational Resources Information Center

    Jones, C. N.; Goncalves, J.

    2010-01-01

    This paper presents a simple, cost-effective and robust atomic force microscope (AFM), which has been purposely designed and built for use as a teaching aid in undergraduate controls labs. The guiding design principle is to have all components be open and visible to the students, so the inner functioning of the microscope has been made clear to…

  11. A Cost-Effective Atomic Force Microscope for Undergraduate Control Laboratories

    ERIC Educational Resources Information Center

    Jones, C. N.; Goncalves, J.

    2010-01-01

    This paper presents a simple, cost-effective and robust atomic force microscope (AFM), which has been purposely designed and built for use as a teaching aid in undergraduate controls labs. The guiding design principle is to have all components be open and visible to the students, so the inner functioning of the microscope has been made clear to…

  12. Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction

    PubMed Central

    Fast, Shannon M.; González, Marta C.; Markuzon, Natasha

    2015-01-01

    Background Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence. Methodology The spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response. Conclusions The model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy. PMID:26288274

  13. Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction.

    PubMed

    Fast, Shannon M; González, Marta C; Markuzon, Natasha

    2015-01-01

    Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence. The spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response. The model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy.

  14. Tobacco control policies specified according to socioeconomic status: health disparities and cost-effectiveness.

    PubMed

    Over, Eelco A B; Feenstra, Talitha L; Hoogenveen, Rudolf T; Droomers, Mariël; Uiters, Ellen; van Gelder, Boukje M

    2014-06-01

    Little is known about the cost-effectiveness of tobacco control policy for different socioeconomic status (SES) groups. We aimed to evaluate SES-specific cost-effectiveness ratios of policies with known favorable effect in low-SES groups: a tobacco tax increase and reimbursement of cessation support. A computer model of the adult population specified by smoking behavior (never/current/former smoker), age, gender, and SES simulated policy scenarios reflecting the implementation of a €0.22 tobacco tax increase or full reimbursement of cessation support, which were compared. Relating differences in costs to quality-adjusted life years (QALYs) gained generated cost-effectiveness ratios for each SES group. In a cohort of 11 million people, the tobacco tax increase resulted in 27,000 additional quitters after 5 years, who were proportionally divided among the SES groups. Reimbursement led to 59,000 additional quitters, with relatively more quitters in higher-SES groups. The number of QALYs gained were 3,400-6,200 among the various SES groups for the tax increase and 6,300-14,000 for the reimbursement scenario. For both interventions, favorability of the cost-effectiveness ratios increased with SES: costs per QALY decreased from €6,100 to €4,500 for the tax increase and from €21,000 to €11,000 for reimbursement. The reimbursement policy produced the greatest overall health gain. Surprisingly, neither tax increase nor reimbursement reduced health disparities. Differences in use were too small to compensate for improved health gains per quitter among higher-SES groups. Both policies qualified as cost-effective overall, with more favorable cost-effectiveness ratios for high-SES than for low-SES groups.

  15. Optimal control and cost effectiveness analysis for Newcastle disease eco-epidemiological model in Tanzania.

    PubMed

    Hugo, Alfred; Makinde, Oluwole Daniel; Kumar, Santosh; Chibwana, Fred F

    2017-12-01

    In this paper, a deterministic compartmental eco- epidemiological model with optimal control of Newcastle disease (ND) in Tanzania is proposed and analysed. Necessary conditions of optimal control problem were rigorously analysed using Pontryagin's maximum principle and the numerical values of model parameters were estimated using maximum likelihood estimator. Three control strategies were incorporated such as chicken vaccination (preventive), human education campaign and treatment of infected human (curative) and its' impact were graphically observed. The incremental cost effectiveness analysis technique used to determine the most cost effectiveness strategy and we observe that combination of chicken vaccination and human education campaign strategy is the best strategy to implement in limited resources. Therefore, ND can be controlled if the farmers will apply chicken vaccination properly and well in time.

  16. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review.

    PubMed

    Li, Rui; Zhang, Ping; Barker, Lawrence E; Chowdhury, Farah M; Zhang, Xuanping

    2010-08-01

    To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving- 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control and early detection of complications compared

  17. A professional and cost effective digital video editing and image storage system for the operating room.

    PubMed

    Scollato, A; Perrini, P; Benedetto, N; Di Lorenzo, N

    2007-06-01

    We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high standard of quality makes the proposed system one of the lowest priced products available today.

  18. Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials.

    PubMed

    Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Yamauchi, Keita

    2016-06-01

    A systematic review of the cost-effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial-based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1-5) that were randomized controlled trials with high-quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost-effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client-centred approach) suggested potentially cost-effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future

  19. A Cost-Effective Transparency-Based Digital Imaging for Efficient and Accurate Wound Area Measurement

    PubMed Central

    Li, Pei-Nan; Li, Hong; Wu, Mo-Li; Wang, Shou-Yu; Kong, Qing-You; Zhang, Zhen; Sun, Yuan; Liu, Jia; Lv, De-Cheng

    2012-01-01

    Wound measurement is an objective and direct way to trace the course of wound healing and to evaluate therapeutic efficacy. Nevertheless, the accuracy and efficiency of the current measurement methods need to be improved. Taking the advantages of reliability of transparency tracing and the accuracy of computer-aided digital imaging, a transparency-based digital imaging approach is established, by which data from 340 wound tracing were collected from 6 experimental groups (8 rats/group) at 8 experimental time points (Day 1, 3, 5, 7, 10, 12, 14 and 16) and orderly archived onto a transparency model sheet. This sheet was scanned and its image was saved in JPG form. Since a set of standard area units from 1 mm2 to 1 cm2 was integrated into the sheet, the tracing areas in JPG image were measured directly, using the “Magnetic lasso tool” in Adobe Photoshop program. The pixel values/PVs of individual outlined regions were obtained and recorded in an average speed of 27 second/region. All PV data were saved in an excel form and their corresponding areas were calculated simultaneously by the formula of Y (PV of the outlined region)/X (PV of standard area unit) × Z (area of standard unit). It took a researcher less than 3 hours to finish area calculation of 340 regions. In contrast, over 3 hours were expended by three skillful researchers to accomplish the above work with traditional transparency-based method. Moreover, unlike the results obtained traditionally, little variation was found among the data calculated by different persons and the standard area units in different sizes and shapes. Given its accurate, reproductive and efficient properties, this transparency-based digital imaging approach would be of significant values in basic wound healing research and clinical practice. PMID:22666449

  20. A cost-effective transparency-based digital imaging for efficient and accurate wound area measurement.

    PubMed

    Li, Pei-Nan; Li, Hong; Wu, Mo-Li; Wang, Shou-Yu; Kong, Qing-You; Zhang, Zhen; Sun, Yuan; Liu, Jia; Lv, De-Cheng

    2012-01-01

    Wound measurement is an objective and direct way to trace the course of wound healing and to evaluate therapeutic efficacy. Nevertheless, the accuracy and efficiency of the current measurement methods need to be improved. Taking the advantages of reliability of transparency tracing and the accuracy of computer-aided digital imaging, a transparency-based digital imaging approach is established, by which data from 340 wound tracing were collected from 6 experimental groups (8 rats/group) at 8 experimental time points (Day 1, 3, 5, 7, 10, 12, 14 and 16) and orderly archived onto a transparency model sheet. This sheet was scanned and its image was saved in JPG form. Since a set of standard area units from 1 mm(2) to 1 cm(2) was integrated into the sheet, the tracing areas in JPG image were measured directly, using the "Magnetic lasso tool" in Adobe Photoshop program. The pixel values/PVs of individual outlined regions were obtained and recorded in an average speed of 27 second/region. All PV data were saved in an excel form and their corresponding areas were calculated simultaneously by the formula of Y (PV of the outlined region)/X (PV of standard area unit) × Z (area of standard unit). It took a researcher less than 3 hours to finish area calculation of 340 regions. In contrast, over 3 hours were expended by three skillful researchers to accomplish the above work with traditional transparency-based method. Moreover, unlike the results obtained traditionally, little variation was found among the data calculated by different persons and the standard area units in different sizes and shapes. Given its accurate, reproductive and efficient properties, this transparency-based digital imaging approach would be of significant values in basic wound healing research and clinical practice.

  1. Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

    PubMed Central

    Li, Rui; Zhang, Ping; Barker, Lawrence E.; Chowdhury, Farah M.; Zhang, Xuanping

    2010-01-01

    OBJECTIVE To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. RESULTS Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control

  2. Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

    PubMed Central

    Zelle, Sten G.; Vidaurre, Tatiana; Abugattas, Julio E.; Manrique, Javier E.; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N.; Lauer, Jeremy A.; Sepulveda, Cecilia R.; Venegas, Diego; Baltussen, Rob

    2013-01-01

    Objectives In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this

  3. Costs and cost-effectiveness of malaria control interventions - a systematic review

    PubMed Central

    2011-01-01

    Background The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment (IPT), diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. Methods A systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives. Results Fifty-five studies of the costs and forty three studies of the cost-effectiveness of malaria interventions were identified, 78% of which were undertaken in sub-Saharan Africa, 18% in Asia and 4% in South America. The median financial cost of protecting one person for one year was $2.20 (range $0.88-$9.54) for ITNs, $6.70 (range $2.22-$12.85) for IRS, $0.60 (range $0.48-$1.08) for IPT in infants, $4.03 (range $1.25-$11.80) for IPT in children, and $2.06 (range $0.47-$3.36) for IPT in pregnant women. The median financial cost of diagnosing a case of malaria was $4.32 (range $0.34-$9.34). The median financial cost of treating an episode of uncomplicated malaria was $5.84 (range $2.36-$23.65) and the median financial cost of treating an episode of severe malaria was $30.26 (range $15.64-$137.87). Economies of scale were observed in the implementation of ITNs, IRS and IPT, with lower unit costs reported in studies with larger numbers of beneficiaries. From a provider perspective, the median incremental cost effectiveness ratio per disability adjusted life year averted was $27 (range $8.15-$110) for ITNs, $143 (range $135-$150) for IRS, and

  4. Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial.

    PubMed

    Romeo, Renee; Knapp, Martin; Hellier, Jennifer; Dewey, Michael; Ballard, Clive; Baldwin, Robert; Bentham, Peter; Burns, Alistair; Fox, Chris; Holmes, Clive; Katona, Cornelius; Lawton, Claire; Lindesay, James; Livingston, Gill; McCrae, Niall; Moniz-Cook, Esme; Murray, Joanna; Nurock, Shirley; O'Brien, John; Poppe, Michaela; Thomas, Alan; Walwyn, Rebecca; Wilson, Kenneth; Banerjee, Sube

    2013-02-01

    Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes. To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia. A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0-13 weeks and 0-39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods. There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively. In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the

  5. 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

  6. Cost-effectiveness of the Health X Project for tuberculosis control in China.

    PubMed

    Wang, W-B; Zhang, H; Petzold, M; Zhao, Q; Xu, B; Zhao, G-M

    2014-08-01

    Between 2002 and 2008, China's National Tuberculosis Control Programme created the Health X Project, financed in part by a World Bank loan, with additional funding from the UK Department for International Development. To assess the cost-effectiveness of the Project and its impact from a financial point of view on tuberculosis (TB) control in China. A decision-analytic model was used to evaluate the cost-effectiveness of the Project. Sensitivity analysis was used to assess the impact of different scenarios and assumptions on results. The primary outcome of the study was cost per disability-adjusted life-year (DALY) saved and incremental DALYs saved. In comparison with alternative scenario 1, the Project detected 1.6 million additional cases, 44 000 deaths were prevented and a total of 18.4 million DALYs saved. The Project strategies cost approximately Chinese yuan (CNY) 953 per DALY saved (vs. CNY1140 in the control areas), and saved an estimated CNY17.5 billion in comparison with the unchanged alternative scenario (scenario 1) or CNY10.8 billion with the control scenario (scenario 2). The Project strategies were affordable and of comparable cost-effectiveness to those of other developing countries. The results also provide strong support for the existing policy of scaling up DOTS in China.

  7. Programmable Digital Controller

    NASA Technical Reports Server (NTRS)

    Wassick, Gregory J.

    2012-01-01

    An existing three-channel analog servo loop controller has been redesigned for piezoelectric-transducer-based (PZT-based) etalon control applications to a digital servo loop controller. This change offers several improvements over the previous analog controller, including software control over proportional-integral-derivative (PID) parameters, inclusion of other data of interest such as temperature and pressure in the control laws, improved ability to compensate for PZT hysteresis and mechanical mount fluctuations, ability to provide pre-programmed scanning and stepping routines, improved user interface, expanded data acquisition, and reduced size, weight, and power.

  8. Cost-effective control strategies for animal and zoonotic diseases in pastoralist populations.

    PubMed

    Zinsstag, J; Abakar, M F; Ibrahim, M; Tschopp, R; Crump, L; Bonfoh, B; Schelling, E

    2016-11-01

    Animal diseases and zoonoses abound among pastoralist livestock, which is composed of cattle, sheep, goats, yak, camels, llamas, reindeer, horses and donkeys. There is endemic and, periodically, epidemic transmission of highly contagious viral and bacterial diseases in Africa, Asia and Latin America. Pastoralist livestock is often multiparasitised with endo- and ectoparasites, as well as being affected by vectorborne viral and protozoal diseases. Pastoral livestock can be a reservoir of such diseases and can also, conversely, be at risk from exposure to wildlife reservoirs. Public and private animal health services currently underperform in almost all pastoral areas due to structural reforms and lack of income, as indicated in assessments of national Veterinary Services by the World Organisation for Animal Health. Control of infectious disease in industrialised countries has been achieved through large-scale public funding of control measures and compensation for culled stock. Such means are not available in pastoralist areas of most low- and middle-income countries (LMICs). While the cost-effectiveness and profitability of the control of animal diseases and zoonoses is less of a consideration for industrialised countries, in the experience of the authors, understanding the economic implications of a control programme is a prerequisite for successful attempts to improve animal health in LMICs. The incremental costs of animal disease control can potentially be shared using crosssector assessments, integrated control, and regional coordination efforts to mitigate transboundary disease risks. In this paper, the authors discuss cost-effective animal disease and zoonoses control in LMICs. It illustrates frameworks and examples of integrated control and cross-sector economics, showing conditions under which these diseases could be controlled in a cost-effective way.

  9. Digital flight control systems

    NASA Technical Reports Server (NTRS)

    Caglayan, A. K.; Vanlandingham, H. F.

    1977-01-01

    The design of stable feedback control laws for sampled-data systems with variable rate sampling was investigated. These types of sampled-data systems arise naturally in digital flight control systems which use digital actuators where it is desirable to decrease the number of control computer output commands in order to save wear and tear of the associated equipment. The design of aircraft control systems which are optimally tolerant of sensor and actuator failures was also studied. Detection of the failed sensor or actuator must be resolved and if the estimate of the state is used in the control law, then it is also desirable to have an estimator which will give the optimal state estimate even under the failed conditions.

  10. Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.

    PubMed Central

    Floyd, Katherine; Arora, V. K.; Murthy, K. J. R.; Lonnroth, Knut; Singla, Neeta; Akbar, Y.; Zignol, Matteo; Uplekar, Mukund

    2006-01-01

    OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. FINDINGS: The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. CONCLUSION: PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients. PMID:16799727

  11. Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.

    PubMed

    Floyd, Katherine; Arora, V K; Murthy, K J R; Lonnroth, Knut; Singla, Neeta; Akbar, Y; Zignol, Matteo; Uplekar, Mukund

    2006-06-01

    To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients.

  12. Modeling the Cost Effectiveness of Malaria Control Interventions in the Highlands of Western Kenya

    PubMed Central

    Stuckey, Erin M.; Stevenson, Jennifer; Galactionova, Katya; Baidjoe, Amrish Y.; Bousema, Teun; Odongo, Wycliffe; Kariuki, Simon; Drakeley, Chris; Smith, Thomas A.; Cox, Jonathan; Chitnis, Nakul

    2014-01-01

    Introduction Tools that allow for in silico optimization of available malaria control strategies can assist the decision-making process for prioritizing interventions. The OpenMalaria stochastic simulation modeling platform can be applied to simulate the impact of interventions singly and in combination as implemented in Rachuonyo South District, western Kenya, to support this goal. Methods Combinations of malaria interventions were simulated using a previously-published, validated model of malaria epidemiology and control in the study area. An economic model of the costs of case management and malaria control interventions in Kenya was applied to simulation results and cost-effectiveness of each intervention combination compared to the corresponding simulated outputs of a scenario without interventions. Uncertainty was evaluated by varying health system and intervention delivery parameters. Results The intervention strategy with the greatest simulated health impact employed long lasting insecticide treated net (LLIN) use by 80% of the population, 90% of households covered by indoor residual spraying (IRS) with deployment starting in April, and intermittent screen and treat (IST) of school children using Artemether lumefantrine (AL) with 80% coverage twice per term. However, the current malaria control strategy in the study area including LLIN use of 56% and IRS coverage of 70% was the most cost effective at reducing disability-adjusted life years (DALYs) over a five year period. Conclusions All the simulated intervention combinations can be considered cost effective in the context of available resources for health in Kenya. Increasing coverage of vector control interventions has a larger simulated impact compared to adding IST to the current implementation strategy, suggesting that transmission in the study area is not at a level to warrant replacing vector control to a school-based screen and treat program. These results have the potential to assist malaria

  13. Digital numerically controlled oscillator

    NASA Technical Reports Server (NTRS)

    Cellier, A.; Huey, D. C.; Ma, L. N. (Inventor)

    1980-01-01

    The frequency and phase of an output signal from an oscillator circuit are controlled with accuracy by a digital input word. Positive and negative alterations in output frequency are both provided for by translating all values of input words so that they are positive. The oscillator reference frequency is corrected only in one direction, by adding phase to the output frequency of the oscillator. The input control word is translated to a single algebraic sign and the digital 1 is added thereto. The translated input control word is then accumulated. A reference clock signal having a frequency at an integer multiple of the desired frequency of the output signal is generated. The accumulated control word is then compared with a threshold level. The output signal is adjusted in a single direction by dividing the frequency of the reference clock signal by a first integer or by an integer different from the first integer.

  14. Cost-Effectiveness of Catheter Ablation for Rhythm Control of Atrial Fibrillation

    PubMed Central

    Blackhouse, Gord; Assasi, Nazila; Xie, Feng; Gaebel, Kathryn; Campbell, Kaitryn; Healey, Jeff S.; O'Reilly, Daria

    2013-01-01

    Objective. The objective of this study is to evaluate the cost-effectiveness of catheter ablation for rhythm control compared to antiarrhythmic drug (AAD) therapy in patients with atrial fibrillation (AF) who have previously failed on an AAD. Methods. An economic model was developed to compare (1) catheter ablation and (2) AAD (amiodarone 200 mg/day). At the end of the initial 12 month phase of the model, patients are classified as being in normal sinus rhythm or with AF, based on data from a meta-analysis. In the 5-year Markov phase of the model, patients are at risk of ischemic stroke each 3-month model cycle. Results. The model estimated that, compared to the AAD strategy, ablation had $8,539 higher costs, 0.033 fewer strokes, and 0.144 more QALYS over the 5-year time horizon. The incremental cost per QALY of ablation compared to AAD was estimated to be $59,194. The probability of ablation being cost-effective for willingness to pay thresholds of $50,000 and $100,000 was estimated to be 0.89 and 0.90, respectively. Conclusion. Based on current evidence, pulmonary vein ablation for treatment of AF is cost-effective if decision makers willingness to pay for a QALY is $59,194 or higher. PMID:24089640

  15. Development of a cost-effective PC-based motion control system

    SciTech Connect

    Hollar, D.L.

    1998-01-01

    A cost-effective PC-based motion control system was developed and evaluated for use on a laser welding system. The motion system is capable of X-Y simultaneous contouring and provides a rotary axis of motion also. The system motion paths can be specified in either Relative or Absolute motion. The PC controls all of the laser power supply and shutter I/O operations. All of the motion programming and operator interfacing is via the Windows {reg_sign}95 operating system.

  16. Economic evaluation of iodine deficiency disorder control program in Sikkim: a cost effectiveness study.

    PubMed

    Pandav, Chandrakant S

    2012-01-01

    Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.

  17. Digital Optical Control System

    NASA Astrophysics Data System (ADS)

    Jordan, David H.; Tipton, Charles A.; Christmann, Charles E.; Hochhausler, Nils P.

    1988-09-01

    We describe the digital optical control system (DOGS), a state-of-the-art controller for electrical feedback in an optical system. The need for a versatile optical controller arose from a number of unique experiments being performed by the Air Force Weapons Laboratory. These experiments use similar detectors and actuator-controlled mirrors, but the control requirements vary greatly. The experiments have in common a requirement for parallel control systems. The DOGS satisfies these needs by allowing several control systems to occupy a single chassis with one master controller. The architecture was designed to allow upward compatibility with future configurations. Combinations of off-the-shelf and custom boards are configured to meet the requirements of each experiment. The configuration described here was used to control piston error to X/80 at a wavelength of 0.51 Am. A peak sample rate of 8 kHz, yielding a closed loop bandwidth of 800 Hz, was achieved.

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

    PubMed

    Alfaro-Murillo, Jorge A; Parpia, Alyssa S; Fitzpatrick, Meagan C; Tamagnan, Jules A; Medlock, Jan; Ndeffo-Mbah, Martial L; Fish, Durland; Ávila-Agüero, María L; Marín, Rodrigo; Ko, Albert I; Galvani, Alison P

    2016-05-01

    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. 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. 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 in real-time within our user-friendly tool to provide updated

  19. 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

  20. Cost-Effectiveness of Chagas Disease Vector Control Strategies in Northwestern Argentina

    PubMed Central

    Vazquez-Prokopec, Gonzalo M.; Spillmann, Cynthia; Zaidenberg, Mario; Kitron, Uriel; Gürtler, Ricardo E.

    2009-01-01

    Background Control and prevention of Chagas disease rely mostly on residual spraying of insecticides. In Argentina, vector control shifted from a vertical to a fully horizontal strategy based on community participation between 1992 and 2004. The effects of such strategy on Triatoma infestans, the main domestic vector, and on disease transmission have not been assessed. Methods and Findings Based on retrospective (1993–2004) records from the Argentinean Ministry of Health for the Moreno Department, Northwestern Argentina, we performed a cost-effectiveness (CE) analysis and compared the observed CE of the fully horizontal vector control strategy with the expected CE for a vertical or a mixed (i.e., vertical attack phase followed by horizontal surveillance) strategy. Total direct costs (in 2004 US$) of the horizontal and mixed strategies were, respectively, 3.3 and 1.7 times lower than the costs of the vertical strategy, due to reductions in personnel costs. The estimated CE ratios for the vertical, mixed and horizontal strategies were US$132, US$82 and US$45 per averted human case, respectively. When per diems were excluded from the costs (i.e., simulating the decentralization of control activities), the CE of vertical, mixed and horizontal strategies was reduced to US$60, US$42 and US$32 per averted case, respectively. Conclusions and Significance The mixed strategy would have averted between 1.6 and 4.0 times more human cases than the fully horizontal strategy, and would have been the most cost-effective option to interrupt parasite transmission in the Department. In rural and dispersed areas where waning vertical vector programs cannot accomplish full insecticide coverage, alternative strategies need to be developed. If properly implemented, community participation represents not only the most appealing but also the most cost-effective alternative to accomplish such objectives. PMID:19156190

  1. Cost-effectiveness of Novel System of Mosquito Surveillance and Control, Brazil

    PubMed Central

    Pepin, Kim M.; Marques-Toledo, Cecilia; Scherer, Luciano; Morais, Maira M.; Ellis, Brett

    2013-01-01

    Of all countries in the Western Hemisphere, Brazil has the highest economic losses caused by dengue fever. We evaluated the cost-effectiveness of a novel system of vector surveillance and control, Monitoramento Inteligente da Dengue (Intelligent Dengue Monitoring System [MID]), which was implemented in 21 cities in Minas Gerais, Brazil. Traps for adult female mosquitoes were spaced at 300-m intervals throughout each city. In cities that used MID, vector control was conducted specifically at high-risk sites (indicated through daily updates by MID). In control cities, vector control proceeded according to guidelines of the Brazilian government. We estimated that MID prevented 27,191 cases of dengue fever and saved an average of $227 (median $58) per case prevented, which saved approximately $364,517 in direct costs (health care and vector control) and $7,138,940 in lost wages (societal effect) annually. MID was more effective in cities with stronger economies and more cost-effective in cities with higher levels of mosquito infestation. PMID:23628282

  2. Cost-effectiveness of novel system of mosquito surveillance and control, Brazil.

    PubMed

    Pepin, Kim M; Marques-Toledo, Cecilia; Scherer, Luciano; Morais, Maira M; Ellis, Brett; Eiras, Alvaro E

    2013-04-01

    Of all countries in the Western Hemisphere, Brazil has the highest economic losses caused by dengue fever. We evaluated the cost-effectiveness of a novel system of vector surveillance and control, Monitoramento Inteligente da Dengue (Intelligent Dengue Monitoring System [MID]), which was implemented in 21 cities in Minas Gerais, Brazil. Traps for adult female mosquitoes were spaced at 300-m intervals throughout each city. In cities that used MID, vector control was conducted specifically at high-risk sites (indicated through daily updates by MID). In control cities, vector control proceeded according to guidelines of the Brazilian government. We estimated that MID prevented 27,191 cases of dengue fever and saved an average of $227 (median $58) per case prevented, which saved approximately $364,517 in direct costs (health care and vector control) and $7,138,940 in lost wages (societal effect) annually. MID was more effective in cities with stronger economies and more cost-effective in cities with higher levels of mosquito infestation.

  3. Analysis of U.S. produced water controls -- Are they cost-effective?

    SciTech Connect

    Veil, J.A.

    1995-12-31

    The US Environmental Protection Agency (EPA) establishes controls on produced water discharges into US waters through effluent limitations guidelines (ELGs), and general and individual discharge permits. Over the past 20 years, produced water controls have become much stricter, and in some areas, no discharge of produced water is allowed. In setting discharge standards, EPA considers vast amounts of data, makes assumptions regarding which data and what approaches are representative, selects the most appropriate analytical methods, and interprets the analytical results. Despite EPA`s considerable efforts to accurately understand and characterize the economic and environmental impacts of produced water discharges before proposing and adopting ELGs and issuing permits, current US produced water controls may be overly restrictive and not cost-effective. This paper summarizes several studies that have reviewed in detail EPA`s data, assumptions, and analytical methods for earlier proposed regulations and general permits. These include the offshore oil and gas ELGs, EPA`s Region 6 general permit for coastal waters, and most recently, the proposed ELGs for the coastal oil and gas industry. By substituting different data, using revised assumptions, and reanalyzing data that are equally or more valid, the studies reach alternate conclusions on the cost-effectiveness of current produced water controls.

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

    PubMed

    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

    2007-05-17

    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. 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. 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. 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.

  5. Cost Effectiveness of ’NOLA’ Controlled Motors, Including Effect of Higher Harmonics.

    DTIC Science & Technology

    1980-12-01

    SCHOOL OF ENGI. UNCASIFEDR 0MCASERDEC 88 AFIT/GE/EE/84S-ie F/G 9/3 N I fllfllfllfl...fflf 2-0 1*261114 S..P - k, Z11W 00.--~ \\ ~OF THES ISHR i,/E7-T...Approved for public release; distribution unlimited. 411i .1~J AFIT/GE/EE/84S-i0 COST EFFECTIVENESS OF "NOLA" CONTROLLED MOTORS, INCLUDING EFFECT OF...HIGHER HARMONICS THESIS * 0 Presented to the Faculty of the School of Engineering of the Air Force Institute of Technology Air University In Partial

  6. Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial

    PubMed Central

    Hollinghurst, Sandra; Edwards, Louisa; Thomas, Clare; Foster, Alexis; Davies, Ben; Gaunt, Daisy; Montgomery, Alan A.; Salisbury, Chris

    2016-01-01

    Background Depression is a prevalent long-term condition that is associated with substantial resource use. Telehealth may offer a cost-effective means of supporting the management of people with depression. Aims To investigate the cost-effectiveness of a telehealth intervention (‘Healthlines') for patients with depression. Method A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. Patients were recruited through primary care, and the intervention was delivered via a telehealth service. Participants with a confirmed diagnosis of depression and PHQ-9 score ≥10 were recruited from 43 English general practices. A series of up to 10 scripted, theory-led, telephone encounters with health information advisers supported participants to effect a behaviour change, use online resources, optimise medication and improve adherence. The intervention was delivered alongside usual care and was designed to support rather than duplicate primary care. Cost-effectiveness from a combined health and social care perspective was 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). Cost–consequence analysis included cost of lost productivity, participant out-of-pocket expenditure and the clinical outcome. Results A total of 609 participants were randomised – 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. Forty-five per cent of participants had missing quality of life data, 41% had missing cost data and 51% of participants had missing data on either cost or utility, or both. Multiple imputation was used for the base-case analysis. The intervention was associated with incremental mean per-patient National Health Service/personal social services cost of £168 (95% CI £43 to £294) and an incremental QALY gain of 0.001 (95% CI −0.023 to 0.026). The incremental cost-effectiveness ratio

  7. 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

  8. Controlled Suction with Venous Catheter Irrigation in Neurosurgery: A Cost Effective Technique.

    PubMed

    Panigrahi, Manas; Kumari, Manoranjitha; Vooturi, Sudhindra

    2017-01-01

    Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous IS using a widely available central venous catheter and a controlled suction cannula. We used a controlled suction cannula attached to a central suction system. A single lumen central venous catheter is passed through the keyhole of a controlled suction cannula, which is connected to a continuous irrigation system. The operative field was clean throughout the procedure, obviating the need for an assisting surgeon to irrigate into the deep operating field and, hence, reducing the duration of surgery. The proposed IS system could be surgeon friendly, easily manageable, yet cost-effective and efficient. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Cost-Effectiveness of Caries Prevention in Practice: A Randomized Controlled Trial.

    PubMed

    O'Neill, C; Worthington, H V; Donaldson, M; Birch, S; Noble, S; Killough, S; Murphy, L; Greer, M; Brodison, J; Verghis, R; Tickle, M

    2017-07-01

    A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners; secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs); pain; and extraction. Cumulative costs were related to each of the trial's outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist's time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P < 0.05) per child. When all health care costs were compared, the intervention group's mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P < 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39-£79.52). Sensitivity analyses did not materially affect the study's findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention

  10. Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial

    PubMed Central

    Pinnock, Hilary; McKenzie, Lynda; Price, David; Sheikh, Aziz

    2005-01-01

    Background Only about a third of people with asthma attend an annual review. Clinicians need to identify cost-effective ways to improve access and ensure regular review. Aim To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma reviews. Design of study Cost-effectiveness analysis based on a 3-month randomised controlled trial. Setting Four general practices in England. Methods Adults due an asthma review were randomised to telephone or face-to-face consultations. Trial nurses recorded proportion reviewed, duration of consultation, and abortive calls/missed appointments. Data on use of healthcare resources were extracted from GP records. Cost-effectiveness was assessed from the health service perspective; sensitivity analyses were based on proportion reviewed and duration of consultation. Results A total of 278 people with asthma were randomised to surgery (n = 141) or telephone (n = 137) review. One-hundred-and-one (74%) of those with asthma in the telephone group were reviewed versus 68 (48%) in the surgery group (P <0.001). Telephone consultations were significantly shorter (mean duration telephone = 11.19 minutes [standard deviation {SD} = 4.79] versus surgery = 21.87 minutes [SD = 6.85], P < 0.001). Total respiratory healthcare costs per patient over 3 months were similar (telephone = 64.49 [SD = 73.33] versus surgery = 59.48 [SD = 66.02], P = 0.55). Total costs of providing 101 telephone versus 68 face-to-face asthma reviews were also similar (telephone = 725.84 versus surgery = 755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = 7.19 [SD = 2.49] versus surgery = 11.11 [SD = 3.50]; mean difference = −3.92 [95% confidence interval = −4.84 to 3.01], P < 0.001). Conclusions Telephone consultations enable a greater proportion of asthma patients to be reviewed at no additional cost to the health service. This mode of delivering care improves access and reduces cost per consultation achieved

  11. Optimal combinations of control strategies and cost-effective analysis for visceral leishmaniasis disease transmission

    PubMed Central

    Biswas, Santanu; Subramanian, Abhishek; ELMojtaba, Ibrahim M.; Chattopadhyay, Joydev; Sarkar, Ram Rup

    2017-01-01

    Visceral leishmaniasis (VL) is a deadly neglected tropical disease that poses a serious problem in various countries all over the world. Implementation of various intervention strategies fail in controlling the spread of this disease due to issues of parasite drug resistance and resistance of sandfly vectors to insecticide sprays. Due to this, policy makers need to develop novel strategies or resort to a combination of multiple intervention strategies to control the spread of the disease. To address this issue, we propose an extensive SIR-type model for anthroponotic visceral leishmaniasis transmission with seasonal fluctuations modeled in the form of periodic sandfly biting rate. Fitting the model for real data reported in South Sudan, we estimate the model parameters and compare the model predictions with known VL cases. Using optimal control theory, we study the effects of popular control strategies namely, drug-based treatment of symptomatic and PKDL-infected individuals, insecticide treated bednets and spray of insecticides on the dynamics of infected human and vector populations. We propose that the strategies remain ineffective in curbing the disease individually, as opposed to the use of optimal combinations of the mentioned strategies. Testing the model for different optimal combinations while considering periodic seasonal fluctuations, we find that the optimal combination of treatment of individuals and insecticide sprays perform well in controlling the disease for the time period of intervention introduced. Performing a cost-effective analysis we identify that the same strategy also proves to be efficacious and cost-effective. Finally, we suggest that our model would be helpful for policy makers to predict the best intervention strategies for specific time periods and their appropriate implementation for elimination of visceral leishmaniasis. PMID:28222162

  12. Optimal combinations of control strategies and cost-effective analysis for visceral leishmaniasis disease transmission.

    PubMed

    Biswas, Santanu; Subramanian, Abhishek; ELMojtaba, Ibrahim M; Chattopadhyay, Joydev; Sarkar, Ram Rup

    2017-01-01

    Visceral leishmaniasis (VL) is a deadly neglected tropical disease that poses a serious problem in various countries all over the world. Implementation of various intervention strategies fail in controlling the spread of this disease due to issues of parasite drug resistance and resistance of sandfly vectors to insecticide sprays. Due to this, policy makers need to develop novel strategies or resort to a combination of multiple intervention strategies to control the spread of the disease. To address this issue, we propose an extensive SIR-type model for anthroponotic visceral leishmaniasis transmission with seasonal fluctuations modeled in the form of periodic sandfly biting rate. Fitting the model for real data reported in South Sudan, we estimate the model parameters and compare the model predictions with known VL cases. Using optimal control theory, we study the effects of popular control strategies namely, drug-based treatment of symptomatic and PKDL-infected individuals, insecticide treated bednets and spray of insecticides on the dynamics of infected human and vector populations. We propose that the strategies remain ineffective in curbing the disease individually, as opposed to the use of optimal combinations of the mentioned strategies. Testing the model for different optimal combinations while considering periodic seasonal fluctuations, we find that the optimal combination of treatment of individuals and insecticide sprays perform well in controlling the disease for the time period of intervention introduced. Performing a cost-effective analysis we identify that the same strategy also proves to be efficacious and cost-effective. Finally, we suggest that our model would be helpful for policy makers to predict the best intervention strategies for specific time periods and their appropriate implementation for elimination of visceral leishmaniasis.

  13. Cost effectiveness of regulation-compliant filtration to control sediment and metal pollution in urban runoff.

    PubMed

    Smith, C Scott; Lejano, Raul P; Ogunseitan, Oladele A; Hipi, J Aaron

    2007-11-01

    The implementation of Total Maximum Daily Load (TMDL) to control urban runoff presents major structural and managerial challenges for cities. We developed a decision support system (DSS) for TMDL compliance at the city level to solve for a phased, least-cost strategy toward meeting four TMDLs using stormwater filtration. Based on a case-study city, we modeled wet weather flows and associated discharge of Total Suspended Sediment (TSS), cadmium, copper, and zinc to receiving waters by coupling U.S. EPA's Storm Water Management Model (SWMM v. 5.0) with the geographic dataset of the urban drainage network. We linked a mixed integer linear programming algorithm to the watershed model for deriving cost-effective selection and placement of curb inlet filters to meet mass- and concentration-based TMDL requirements. The least cost solution for meeting the city's TMDL waste load allocations for TSS (73.9% reduction), Cd (50.6% reduction), Cu (30.0% reduction), and Zn (55.7% reduction) would require 1071 filter inserts at a cost of $1.7 million. In contrast, random placement of 1071 filters or uniform placement of 1266 filters is effective only for TSS and would cost $4.0 million and $4.8 million, respectively. Our results demonstrate the increases in cost-effectiveness of using an optimization-based DSS for urban watershed management.

  14. Using counterfactuals to evaluate the cost-effectiveness of controlling biological invasions.

    PubMed

    McConnachie, Matthew M; van Wilgen, Brian W; Ferraro, Paul J; Forsyth, Aurelia T; Richardson, David M; Gaertner, Mirijam; Cowling, Richard M

    2016-03-01

    Prioritizing limited conservation funds for controlling biological invasions requires accurate estimates of the effectiveness of interventions to remove invasive species and their cost-effectiveness (cost per unit area or individual). Despite billions of dollars spent controlling biological invasions worldwide, it is unclear whether those efforts are effective, and cost-effective. The paucity of evidence results from the difficulty in measuring the effect of invasive species removal: a researcher must estimate the difference in outcomes (e.g. invasive species cover) between where the removal program intervened and what might have been observed if the program had not intervened. In the program evaluation literature, this is called a counterfactual analysis, which formally compares what actually happened and what would have happened in the absence of an intervention. When program implementation is not randomized, estimating counterfactual outcomes is especially difficult. We show how a thorough understanding of program implementation, combined with a matching empirical design can improve the way counterfactual outcomes are estimated in nonexperimental contexts. As a practical demonstration, we estimated the cost-effectiveness of South Africa's Working for Water program, arguably the world's most ambitious invasive species control program, in removing invasive alien trees from different land use types, across a large area in the Cape Floristic Region. We estimated that the proportion of the treatment area covered by invasive trees would have been 49% higher (5.5% instead of 2.7% of the grid cells occupied) had the program not intervened. Our estimates of cost per hectare to remove invasive species, however, are three to five times higher than the predictions made when the program was initiated. Had there been no control (counter-factual), invasive trees would have spread on untransformed land, but not on land parcels containing plantations or land transformed by

  15. Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).

    PubMed

    Mol, F; van Mello, N M; Strandell, A; Jurkovic, D; Ross, J A; Yalcinkaya, T M; Barnhart, K T; Verhoeve, H R; Graziosi, G C; Koks, C A; Mol, B W; Ankum, W M; van der Veen, F; Hajenius, P J; van Wely, M

    2015-09-01

    Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher. Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy. We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively. We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention-to-treat principle. Mean direct medical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95% confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by

  16. [Cost effective planning of controlled trials with diagnostic instruments of limited reproducibility].

    PubMed

    Krummenauer, F; Förster, G

    1999-06-01

    This paper proposes a simple approach for sample size prediction in controlled diagnostic or clinical trials for group comparison when the diagnostic (imaging) instrument under consideration shows limited reliability and thus calls for taking replicate measurements on each study subject. Using a specified cost function for the overall trial, a cost optimum replication number per subject is predicted, resulting in a cost-optimum predicted group size. This approach results in remarkable cost-effectiveness, as single assessment costs based on the imaging method under consideration only present a small fraction of the overall costs of preparing study subjects for a series of measurement replications by, for example, injection of nuclear or contrast agents.

  17. Spatially-Distributed Cost-Effectiveness Analysis Framework to Control Phosphorus from Agricultural Diffuse Pollution.

    PubMed

    Geng, Runzhe; Wang, Xiaoyan; Sharpley, Andrew N; Meng, Fande

    2015-01-01

    Best management practices (BMPs) for agricultural diffuse pollution control are implemented at the field or small-watershed scale. However, the benefits of BMP implementation on receiving water quality at multiple spatial is an ongoing challenge. In this paper, we introduce an integrated approach that combines risk assessment (i.e., Phosphorus (P) index), model simulation techniques (Hydrological Simulation Program-FORTRAN), and a BMP placement tool at various scales to identify the optimal location for implementing multiple BMPs and estimate BMP effectiveness after implementation. A statistically significant decrease in nutrient discharge from watersheds is proposed to evaluate the effectiveness of BMPs, strategically targeted within watersheds. Specifically, we estimate two types of cost-effectiveness curves (total pollution reduction and proportion of watersheds improved) for four allocation approaches. Selection of a ''best approach" depends on the relative importance of the two types of effectiveness, which involves a value judgment based on the random/aggregated degree of BMP distribution among and within sub-watersheds. A statistical optimization framework is developed and evaluated in Chaohe River Watershed located in the northern mountain area of Beijing. Results show that BMP implementation significantly (p >0.001) decrease P loss from the watershed. Remedial strategies where BMPs were targeted to areas of high risk of P loss, deceased P loads compared with strategies where BMPs were randomly located across watersheds. Sensitivity analysis indicated that aggregated BMP placement in particular watershed is the most cost-effective scenario to decrease P loss. The optimization approach outlined in this paper is a spatially hierarchical method for targeting nonpoint source controls across a range of scales from field to farm, to watersheds, to regions. Further, model estimates showed targeting at multiple scales is necessary to optimize program efficiency

  18. Cost-effectiveness of interventions to prevent HIV and STDs among women: a randomized controlled trial.

    PubMed

    Ruger, Jennifer Prah; Abdallah, Arbi Ben; Ng, Nora Y; Luekens, Craig; Cottler, Linda

    2014-10-01

    Injection drug use is a leading transmission route of HIV and STDs, and disease prevention among drug users is an important public health concern. This study assesses cost-effectiveness of behavioral interventions for reducing HIV and STDs infections among injection drug-using women. Cost-effectiveness analysis was conducted from societal and provider perspectives for randomized trial data and Bernoullian model estimates of infections averted for three increasingly intensive interventions: (1) NIDA's standard intervention (SI); (2) SI plus a well woman exam (WWE); and (3) SI, WWE, plus four educational sessions (4ES). Trial results indicate that 4ES was cost-effective relative to WWE, which was dominated by SI, for most diseases. Model estimates, however, suggest that WWE was cost-effective relative to SI and dominated 4ES for all diseases. Trial and model results agree that WWE is cost-effective relative to SI per hepatitis C infection averted ($109 308 for in trial, $6 016 in model) and per gonorrhea infection averted ($9 461 in trial, $14 044 in model). In sensitivity analysis, trial results are sensitive to 5 % change in WWE effectiveness relative to SI for hepatitis C and HIV. In the model, WWE remained cost-effective or cost-saving relative to SI for HIV prevention across a range of assumptions. WWE is cost-effective relative to SI for preventing hepatitis C and gonorrhea. WWE may have similar effects as the costlier 4ES.

  19. Modelling geographic variation in the cost-effectiveness of control policies for infectious vector diseases: the example of Chagas disease.

    PubMed

    Castillo-Riquelme, Marianela; Chalabi, Zaid; Lord, Joanne; Guhl, Felipe; Campbell-Lendrum, Diarmid; Davies, Clive; Fox-Rushby, Julia

    2008-03-01

    Few cost-effectiveness analysis (CEA) models have accounted for geographic variation in input parameters. This paper describes a deterministic discrete-time multi-state model to estimate the cost-effectiveness of vector control policies for Chagas disease, where implementation varies according to village characteristics. The model outputs include the total number of new infections, disability adjusted life years (DALYs) incurred, costs of associated healthcare, and total costs of the Ministry of Health's control policy for house surveillance and spraying. Incremental net benefits were estimated to determine Colombian villages in which it is cost-effective to implement the control policy. The robustness of these conclusions was evaluated by deterministic sensitivity analyses. The model should help provide a decision-support system to compare control policies and to allocate resources geographically.

  20. Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania

    PubMed Central

    Ngalesoni, Frida; Ruhago, George; Mayige, Mary; Oliveira, Tiago Cravo; Robberstad, Bjarne; Norheim, Ole Frithjof; Higashi, Hideki

    2017-01-01

    Background Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. Aims We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. Materials and methods A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. Results Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. Conclusions Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government’s ability to implement these interventions. PMID:28767722

  1. Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania.

    PubMed

    Ngalesoni, Frida; Ruhago, George; Mayige, Mary; Oliveira, Tiago Cravo; Robberstad, Bjarne; Norheim, Ole Frithjof; Higashi, Hideki

    2017-01-01

    Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government's ability to implement these interventions.

  2. Psycho-educational CBT-Insomnia workshops in the community. A cost-effectiveness analysis alongside a randomised controlled trial.

    PubMed

    Bonin, Eva-Maria; Beecham, Jennifer; Swift, Naomi; Raikundalia, Shriti; Brown, June S L

    2014-04-01

    Around one in three of the UK population suffer from sleep problems, resulting in high costs to society. Cognitive behaviour therapy for insomnia (CBT-I) has been shown to be effective. Community-based workshops may be a cost-effective way to provide CBT-I to groups that are usually hard to reach or reluctant to seek treatment. A sample of 151 participants aged 18 or over from five London boroughs who self-referred were randomised into a group receiving workshops and a waiting list control group. 111 provided complete data on service use and outcome measures. Results from the cost-effectiveness and cost-utility analyses are presented using cost-effectiveness acceptability curves. At a maximum willingness to pay per quality-adjusted life-year (QALY) of £30,000, the probability of the intervention being cost-effective is 80%. If commissioners are willing to pay £150 per point improvement on the Insomnia Severity Index, which is approximately the cost of the intervention, there is a 97% probability of cost-effectiveness. Community-based CBT-I workshops are likely to be a cost-effective intervention to improve insomnia symptoms and are a promising low-level option to include within the panoply of interventions that are encouraged within the UK policy of increasing access to psychological therapies.

  3. Impact and cost-effectiveness of a comprehensive Schistosomiasis japonica control program in the Poyang Lake region of China.

    PubMed

    Yu, Qing; Zhao, Geng-Ming; Hong, Xian-Lin; Lutz, Eric A; Guo, Jia-Gang

    2013-11-28

    Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003-2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%-544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%-1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence.

  4. Impact and Cost-Effectiveness of a Comprehensive Schistosomiasis japonica Control Program in the Poyang Lake Region of China

    PubMed Central

    Yu, Qing; Zhao, Geng-Ming; Hong, Xian-Lin; Lutz, Eric A.; Guo, Jia-Gang

    2013-01-01

    Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003–2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%–544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%–1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence. PMID:24287861

  5. Modeling of Control Costs, Emissions, and Control Retrofits for Cost Effectiveness and Feasibility Analyses

    EPA Pesticide Factsheets

    Learn about EPA’s use of the Integrated Planning Model (IPM) to develop estimates of SO2 and NOx emission control costs, projections of futureemissions, and projections of capacity of future control retrofits, assuming controls on EGUs.

  6. Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control.

    PubMed

    Bress, Adam P; Bellows, Brandon K; King, Jordan B; Hess, Rachel; Beddhu, Srinivasan; Zhang, Zugui; Berlowitz, Dan R; Conroy, Molly B; Fine, Larry; Oparil, Suzanne; Morisky, Donald E; Kazis, Lewis E; Ruiz-Negrón, Natalia; Powell, Jamie; Tamariz, Leonardo; Whittle, Jeff; Wright, Jackson T; Supiano, Mark A; Cheung, Alfred K; Weintraub, William S; Moran, Andrew E

    2017-08-24

    In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. We determined that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime. In this simulation study, intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or

  7. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda

    PubMed Central

    BROOKER, SIMON; KABATEREINE, NARCIS B; FLEMING, FIONA; DEVLIN, NANCY

    2009-01-01

    Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intra-country variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with districts officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US$ per schoolchild treated and an incremental cost effectiveness ratio (cost in US$ per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US$ 0.54 and the cost-effectiveness was US$ 3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children which received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$ 0.41-0.91) and cost per anaemia case averted (US$ 1.70-9.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations. PMID:18024966

  8. Cost-effectiveness of family psychoeducation to prevent relapse in major depression: results from a randomized controlled trial.

    PubMed

    Shimodera, Shinji; Furukawa, Toshi A; Mino, Yoshio; Shimazu, Kae; Nishida, Atsushi; Inoue, Shimpei

    2012-05-14

    Family psychoeducation is a relatively simple and straightforward intervention whose prophylactic effectiveness and cost-effectiveness is well-established for schizophrenia. We have recently demonstrated its effectiveness for unipolar depression, but its cost-effectiveness has never been examined. We hereby report a cost-effectiveness analysis alongside a randomized controlled trial in order to assess its cost-effectiveness for preventing relapse/recurrence in depression. Fifty-seven patients diagnosed with major depression and undergoing its maintenance treatment, and their primary family members were randomized to treatment as usual (TAU) only or to TAU plus family psychoeducation, which consisted of four 2-hour multiple-family sessions consisting of didactic lectures about depression (30 minutes) and group discussion and problem solving (60-90 minutes). The economic analyses were undertaken from the perspective of the National Health Insurance (NHI), assuming the most reasonable price of US$50 per psychoeducation session per patient. The main outcome measures included relapse-free days and direct costs to the NHI. The intervention group enjoyed 272 (SD: 7.1) relapse-free days, while the control group spent 214 (SD: 90.8) relapse-free days (Cox proportional hazard ratio=0.17, 95%CI: 0.04 to 0.75, p=0.002). Cost-effectiveness acceptability curves suggested that the family psychoeducation has 90% or more chances of being cost-effective if the decision-maker is prepared to pay US$20 for one additional relapse-free day. This cost-effectiveness finding was robust when the price for family psychoeducation ranged between 50% to 150% of the baseline scenario in sensitivity analyses. If a relapse-free day is considered to be worth $30 or more, all the pricing scenarios have a close to 100% probability of being cost-effective. Family psychoeducation is effective in the relapse prevention of depression and is highly likely to be cost-effective if a relapse-free day is

  9. Digital Fire Control Systems Support

    DTIC Science & Technology

    2012-09-27

    Systems ( DFCS ) for the M119A2 and M777A2. The DFCS is a fully integrated digital fire control system that has weapon platform application to the...Lightweight 155 mm (LW155) Towed Howitzer and the M119A2 Lightweight 105mm Towed Howitzer. 15. SUBJECT TERMS Digital Fire Control Systems ( DFCS ) 16...Joint Lightweight 155, has been tasked to develop and maintain the Digital Fire Control Systems ( DFCS ) for the M119A2 and M777A2. The DFCS is a fully

  10. Cost-Effectiveness of a Hypertension Control Intervention in Three Community Health Centers in China

    PubMed Central

    Bai, Yamin; Zhao, Yanfang; Wang, Guijing; Wang, Huicheng; Liu, Kejun; Zhao, Wenhua

    2015-01-01

    Background Hypertension and associated chronic diseases impose enormous and growing health and economic burdens worldwide. The objective of this study was to investigate the cost-effectiveness (CE) of a hypertension control program in China. Methods We collected information on program costs and health outcomes in three community health centers over a 1-year period. The participants were 4902 people with hypertension (systolic blood pressure [SBP] ≥140 mm Hg and/ or diastolic blood pressure [DBP] ≥90 mm Hg, or on hypertension medication) aged 18 years and older. The SBP and DBP changes in the populations were estimated from a random sample of 818 participants by conducting face-to-face interviews and physical examinations. We derived CE measures based on the costs and effects on health outcomes. Findings The total cost of implementing the intervention was Renminbi (RMB) 240 772 yuan (US$35 252), or 49 yuan (US$7.17) per participant in 2009. On average, SBP decreased from 143 to 131 mm Hg (P < .001) and DBP decreased from 84 to 78 mm Hg (P < .001), the SBP decreases ranged from 7.6 to 17.8 mm Hg and DBP decreases ranged from 3.9 to 8.3 mm Hg. CE ratios ranged from RMB 3.6 to 5.0 yuan (US$0.53-US$0.73) per person per mm Hg SBP decrease, and from RMB 6.3 to 9.7 yuan (US$0.92-US$1.42) per person per mm Hg DBP decrease. Interpretation Per capita costs varied widely across the communities, as did changes in SBP and DBP, but CE was similar. The findings suggest (a) a positive correlation between per capita costs and program effectiveness, (b) differences in intervention levels, and (c) differences in health status. CE results could be helpful to policy makers in making resource allocation decisions. PMID:23799707

  11. Cognitive-Behavioral Treatment for Panic Disorder with Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis

    ERIC Educational Resources Information Center

    Roberge, Pasquale; Marchand, Andre; Reinharz, Daniel; Savard, Pierre

    2008-01-01

    A randomized, controlled trial was conducted to examine the cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants were randomly assigned to standard (n = 33), group (n = 35), and brief (n = 32) treatment conditions. Results show significant clinical and statistical improvement…

  12. Cognitive-Behavioral Treatment for Panic Disorder with Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis

    ERIC Educational Resources Information Center

    Roberge, Pasquale; Marchand, Andre; Reinharz, Daniel; Savard, Pierre

    2008-01-01

    A randomized, controlled trial was conducted to examine the cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants were randomly assigned to standard (n = 33), group (n = 35), and brief (n = 32) treatment conditions. Results show significant clinical and statistical improvement…

  13. Cost effectiveness of novel oral anticoagulants for stroke prevention in atrial fibrillation depending on the quality of warfarin anticoagulation control.

    PubMed

    Janzic, Andrej; Kos, Mitja

    2015-04-01

    Vitamin K antagonists, such as warfarin, are standard treatments for stroke prophylaxis in patients with atrial fibrillation. Patient outcomes depend on quality of warfarin management, which includes regular monitoring and dose adjustments. Recently, novel oral anticoagulants (NOACs) that do not require regular monitoring offer an alternative to warfarin. The aim of this study was to evaluate whether cost effectiveness of NOACs for stroke prevention in atrial fibrillation depends on the quality of warfarin control. We developed a Markov decision model to simulate warfarin treatment outcomes in relation to the quality of anticoagulation control, expressed as percentage of time in the therapeutic range (TTR). Standard treatment with adjusted-dose warfarin and improved anticoagulation control by genotype-guided dosing were compared with dabigatran, rivaroxaban, apixaban and edoxaban. The analysis was performed from the Slovenian healthcare payer perspective using 2014 costs. In the base case, the incremental cost-effectiveness ratio for apixaban, dabigatran and edoxaban was below the threshold of €25,000 per quality-adjusted life-years compared with adjusted-dose warfarin with a TTR of 60%. The probability that warfarin was a cost-effective option was around 1%. This percentage rises as the quality of anticoagulation control improves. At a TTR of 70%, warfarin was the preferred treatment in half the iterations. The cost effectiveness of NOACs for stroke prevention in patients with nonvalvular atrial fibrillation who are at increased risk for stroke is highly sensitive to warfarin anticoagulation control. NOACs are more likely to be cost-effective options in settings with poor warfarin management than in settings with better anticoagulation control, where they may not represent good value for money.

  14. Cost-effectiveness of bronchial thermoplasty in commercially-insured patients with poorly controlled, severe, persistent asthma.

    PubMed

    Cangelosi, Michael J; Ortendahl, Jesse D; Meckley, Lisa M; Bentley, Tanya G K; Anene, Ayanna M; Shriner, Kelly M; Fox, John

    2015-04-01

    We examined the cost-effectiveness of treating poorly controlled, severe, persistent asthma patients with bronchial thermoplasty (BT), a novel technology that uses thermal energy to reduce airway smooth muscle mass, with 5-year outcome data demonstrating a durable reduction in asthma exacerbations. We conducted a model-based cost-effectiveness analysis assessing 5-year healthcare utilization, patient quality of life and adverse events. We utilized Markov modeling to estimate the costs and quality-of-life impact of BT compared with high-dose combination therapy among poorly controlled, severe, persistent asthma patients: those requiring high-dose combination therapy and having experienced an asthma exacerbation-related ER visit in the past year. The cost-effectiveness of BT was US$5495 per quality-adjusted life year; and approximately 22% of sensitivity analysis iterations estimated BT to reduce costs and increase quality of life. BT is a cost-effective treatment option for patients with poorly controlled, severe, persistent asthma.

  15. Cost-effectiveness of breast cancer control strategies in Central America: the cases of Costa Rica and Mexico.

    PubMed

    Niëns, Laurens M; Zelle, Sten G; Gutiérrez-Delgado, Cristina; Rivera Peña, Gustavo; Hidalgo Balarezo, Blanca Rosa; Rodriguez Steller, Erick; Rutten, Frans F H

    2014-01-01

    This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50-70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40-70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible

  16. Cost-Effectiveness of Breast Cancer Control Strategies in Central America: The Cases of Costa Rica and Mexico

    PubMed Central

    Niëns, Laurens M.; Zelle, Sten G.; Gutiérrez-Delgado, Cristina; Rivera Peña, Gustavo; Hidalgo Balarezo, Blanca Rosa; Rodriguez Steller, Erick; Rutten, Frans F. H.

    2014-01-01

    This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50–70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40–70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible

  17. Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET).

    PubMed

    Green, Colin; Richards, David A; Hill, Jacqueline J; Gask, Linda; Lovell, Karina; Chew-Graham, Carolyn; Bower, Peter; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Bland, J Martin; Gilbody, Simon; Lewis, Glyn; Manning, Chris; Hughes-Morley, Adwoa; Barkham, Michael

    2014-01-01

    Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking. To assess the cost-effectiveness of collaborative care in a UK primary care setting. An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane. The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: -0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: -202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual. Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.

  18. Cost-Effectiveness of Collaborative Care for Depression in UK Primary Care: Economic Evaluation of a Randomised Controlled Trial (CADET)

    PubMed Central

    Green, Colin; Richards, David A.; Hill, Jacqueline J.; Gask, Linda; Lovell, Karina; Chew-Graham, Carolyn; Bower, Peter; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Bland, J. Martin; Gilbody, Simon; Lewis, Glyn; Manning, Chris; Hughes-Morley, Adwoa; Barkham, Michael

    2014-01-01

    Background Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking. Aims To assess the cost-effectiveness of collaborative care in a UK primary care setting. Methods An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane. Results The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: –0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: –202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual. Conclusion Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting. PMID:25121991

  19. Cost-Effectiveness of Nicotine Patches for Smoking Cessation in Pregnancy: A Placebo Randomized Controlled Trial (SNAP).

    PubMed

    Essex, Holly N; Parrott, Steve; Wu, Qi; Li, Jinshuo; Cooper, Sue; Coleman, Tim

    2015-06-01

    Smoking during pregnancy is the most important, preventable cause of adverse pregnancy outcomes including miscarriage, premature birth, and low birth weight with huge financial costs to the National Health Service. However, there are very few published economic evaluations of smoking cessation interventions in pregnancy and previous studies are predominantly U.S.-based and do not present incremental cost-effectiveness ratios (ICER). A number of studies have demonstrated cost-effectiveness of nicotine replacement therapy (NRT) in the general population, but this has yet to be tested among pregnant smokers. A cost-effectiveness analysis was undertaken alongside the smoking, nicotine, and pregnancy trial to compare NRT patches plus behavioral support to behavioral support alone, for pregnant women who smoked. At delivery, biochemically verified quit rates were slightly higher at 9.4% in the NRT group compared to 7.6% in the control group (odds ratio = 1.26, 95% CI = 0.82-1.96), at an increased cost of around £90 per participant. Higher costs in the NRT group were mainly attributable to the cost of NRT patches (mean = £46.07). The incremental cost-effectiveness ratio associated with NRT was £4,926 per quitter and a sensitivity analysis including only singleton births yielded an ICER of £4,156 per quitter. However, wide confidence intervals indicated a high level of uncertainty. Without a specific willingness to pay threshold, and due to high levels of statistical uncertainty, it is hard to determine the cost-effectiveness of NRT in this population. Furthermore, future research should address compliance issues, as these may dilute any potential effects of NRT, thus reducing the cost-effectiveness. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Digital control of HVDC converters

    SciTech Connect

    Pilotto, L.A.S.; Roitman, M.; Alves, J.E.R.

    1989-05-01

    This paper presents the project of a completely digital HVDC converter controller based on a 16-bit microcomputer. It was decided to achieve as much as possible by software in order to minimize functions performed by external hardware. The presented design comprises software programmed functions such as a PID current control amplifier, voltage dependent current order limiters and an alpha-minimum symmetrization unit, among others. HVDC control principles are briefly reviewed and a detailed description of both the hardware and software structure of the controller is presented. The digital controller was implemented in an HVDC simulator and several dynamic performance tests demonstrated the efficiency of the proposed methodology.

  1. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility.

    PubMed

    Manca, Andrea; Hawkins, Neil; Sculpher, Mark J

    2005-05-01

    In trial-based cost-effectiveness analysis baseline mean utility values are invariably imbalanced between treatment arms. A patient's baseline utility is likely to be highly correlated with their quality-adjusted life-years (QALYs) over the follow-up period, not least because it typically contributes to the QALY calculation. Therefore, imbalance in baseline utility needs to be accounted for in the estimation of mean differential QALYs, and failure to control for this imbalance can result in a misleading incremental cost-effectiveness ratio. This paper discusses the approaches that have been used in the cost-effectiveness literature to estimate absolute and differential mean QALYs alongside randomised trials, and illustrates the implications of baseline mean utility imbalance for QALY calculation. Using data from a recently conducted trial-based cost-effectiveness study and a micro-simulation exercise, the relative performance of alternative estimators is compared, showing that widely used methods to calculate differential QALYs provide incorrect results in the presence of baseline mean utility imbalance regardless of whether these differences are formally statistically significant. It is demonstrated that multiple regression methods can be usefully applied to generate appropriate estimates of differential mean QALYs and an associated measure of sampling variability, while controlling for differences in baseline mean utility between treatment arms in the trial. Copyright 2004 John Wiley & Sons, Ltd

  2. Digitally controlled distributed phase shifter

    DOEpatents

    Hietala, Vincent M.; Kravitz, Stanley H.; Vawter, Gregory A.

    1993-01-01

    A digitally controlled distributed phase shifter is comprised of N phase shifters. Digital control is achieved by using N binary length-weighted electrodes located on the top surface of a waveguide. A control terminal is attached to each electrode thereby allowing the application of a control signal. The control signal is either one or two discrete bias voltages. The application of the discrete bias voltages changes the modal index of a portion of the waveguide that corresponds to a length of the electrode to which the bias voltage is applied, thereby causing the phase to change through the underlying portion of the waveguide. The digitally controlled distributed phase shift network has a total phase shift comprised of the sum of the individual phase shifters.

  3. Digitally controlled distributed phase shifter

    DOEpatents

    Hietala, V.M.; Kravitz, S.H.; Vawter, G.A.

    1993-08-17

    A digitally controlled distributed phase shifter is comprised of N phase shifters. Digital control is achieved by using N binary length-weighted electrodes located on the top surface of a waveguide. A control terminal is attached to each electrode thereby allowing the application of a control signal. The control signal is either one or two discrete bias voltages. The application of the discrete bias voltages changes the modal index of a portion of the waveguide that corresponds to a length of the electrode to which the bias voltage is applied, thereby causing the phase to change through the underlying portion of the waveguide. The digitally controlled distributed phase shift network has a total phase shift comprised of the sum of the individual phase shifters.

  4. Digitally controlled distributed phase shifter

    SciTech Connect

    Hietala, V.M.; Kravitz, S.H.; Vawter, G.A.

    1992-12-31

    A digitally controlled distributed phase shifter is comprised of N phase shifters. Digital control is achieved by using N binary length-weighted electrodes located on the top surface of a waveguide. A control terminal is attached to each electrode thereby allowing the application of a control signal. The control signal is either one of two discrete bias voltages. The application of the discrete bias voltages change the modal index of a portion of the waveguide that corresponds to a length of the electrode to which the bias voltage is applied, thereby causing the phase to change through the underlying portion of the waveguide. The digitally controlled distributed phase shift network has a total phase shift comprised of the sum of the individual phase shifters.

  5. Cost-effectiveness of Community Health Workers in controlling diabetes epidemic on the U.S.-Mexico border.

    PubMed

    Ryabov, I

    2014-07-01

    This study attempted to evaluate clinical outcomes and long-term cost-effectiveness of an intervention involving Community Health Workers (CHW's, a.k.a. promotoras de salud in Spanish) in assisting Mexican-American diabetes type-2 patients with controlling their condition. The intervention has been carried out in Hidalgo County, TX which is situated on the U.S.-Mexico border. The design of the study is experimental. The sample (n = 30) was recruited from Mexican-American diabetes patients aged 30 or above. The intervention group received monthly visits from CHW's, while the control group did not. Incremental lifetime health outcomes and related expenditures were calculated using the CDC Diabetes Cost-Effectiveness Model (DCEM) which is a probabilistic computer simulation model of disease progression and cost-effectiveness for type 2 diabetes patients. The DCEM allows projection of lifetime healthcare costs and Quality-Adjusted Life-Years (QALYs). The intervention group showed a significant improvement in glycemic control and cholesterol management after two years of intervention. The intervention is expected to reduce long-term complications, resulting in an increase in residual life-years and quality-adjusted life-years. The incremental cost-effectiveness ratio has been estimated to be $13,810, which is below the level of comparable studies. Intervention has a substantial impact on the medical costs of type 2 diabetes treatment. The estimates presented in this model may be used to analyse the cost-effectiveness of interventions involving CHW's for type 2 diabetes. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  6. Space Digital Controller for Improved Motor Control

    NASA Astrophysics Data System (ADS)

    Alves-Nunes, Samuel; Daras, Gaetan; Dehez, Bruno; Maillard, Christophe; Bekemans, Marc; Michel, Raymond

    2014-08-01

    Performing digital motor control into space equipment is a new challenge. The new DPC (Digital Programmable Controller) is the first chip that we can use as a micro-controller, allowing us to drive motors with digital control schemes. In this paper, the digital control of hybrid stepper motors is considered. This kind of motor is used for solar array rotation and antenna actuation. New digital control technology brings a lot of advantages, allowing an important reduction of thermal losses inside the motor, and a reduction of thermal constraints on power drive electronic components. The opportunity to drive motors with a digital controller also brings many new functionalities like post-failure torque analysis, micro- vibrations and cogging torque reduction, or electro- mechanical damping of solar array oscillations. To evaluate the performance of the system, Field-Oriented Control (FOC) is implemented on a hybrid stepper motor. A test-bench, made of an active load, has been made to emulate the mechanical behaviour of the solar array, by the use of a torsionally-compliant model. The experimental results show that we can drastically reduce electrical power consumption, compared with the currently used open-loop control scheme.

  7. All digital pulsewidth control loop

    NASA Astrophysics Data System (ADS)

    Huang, Hong-Yi; Jan, Shiun-Dian; Pu, Ruei-Iun

    2013-03-01

    This work presents an all-digital pulsewidth control loop (ADPWCL). The proposed system accepts a wide range of input duty cycles and performs a fast correction to the target output pulsewidth. An all-digital delay-locked loop (DLL) with fast locking time using a simplified time to digital converter and a new differential two-step delay element is proposed. The area of the delay element is much smaller than that in conventional designs, while having the same delay range. A test chip is verified in a 0.18-µm CMOS process. The measured duty cycle ranges from 4% to 98% with 7-bit resolution.

  8. Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education ‘booster’ sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, −0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, −1,415 to −128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes. Trial registration Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007). PMID:24927851

  9. Cost-effectiveness of adherence therapy versus health education for people with schizophrenia: randomised controlled trial in four European countries

    PubMed Central

    2013-01-01

    Background Non-adherence to anti-psychotics is common, expensive and affects recovery. We therefore examine the cost-effectiveness of adherence therapy for people with schizophrenia by multi-centre randomised trial in Amsterdam, London, Leipzig and Verona. Methods Participants received 8 sessions of adherence therapy or health education. We measured lost productivity and use of health/social care, criminal justice system and informal care at baseline and one year to estimate and compare mean total costs from health/social care and societal perspectives. Outcomes were the Short Form 36 (SF-36) mental component score (MCS) and quality-adjusted life years (QALYs) gained (SF-36 and EuroQoL 5 dimension (EQ5D)). Cost-effectiveness was examined for all cost and outcome combinations using cost-effectiveness acceptability curves (CEACs). Results 409 participants were recruited. There were no cost or outcome differences between adherence therapy and health education. The probability of adherence therapy being cost-effective compared to health education was between 0.3 and 0.6 for the six cost-outcome combinations at the willingness to pay thresholds we examined. Conclusions Adherence therapy appears equivalent to health education. It is unclear whether it would have performed differently against a treatment as usual control, whether such an intervention can impact on quality of life in the short-term, or whether it is likely to be cost-effective in some sites but not others. Trial registration Trial registration: Current Controlled Trials ISRCTN01816159 PMID:23705862

  10. A cost-effective, case-control study on the association between breast cancer and pregnancy through web mining.

    PubMed

    Yoon, Hong-Jun; Xu, Songhua; Tourassi, Georgia

    2013-05-01

    We report a case-control, breast cancer epidemiological study through mining people stories from the Internet. The aim of the study is to test whether mining openly available, personal stories from the Internet can be a cost-effective way for reliable epidemiological discoveries. As a case study, we focus on the association between breast cancer risk and pregnancy, which is clearly established through controlled clinical survey studies. Specifically, we mined 30,000 online obituary articles. Replicating a case-control study design, our web mining based approach confirmed the general trends reported by traditional epidemiological studies. Our web mining study demonstrates promising preliminary evidence that online content mining can be a cost-effective way for epidemiological knowledge discovery.

  11. Optimal isolation control strategies and cost-effectiveness analysis of a two-strain avian influenza model.

    PubMed

    Agusto, F B

    2013-09-01

    The most important and effective measures against disease outbreaks in the absence of valid medicines or vaccine are quarantine and isolation strategies. In this paper optimal control theory is applied to a system of ordinary differential equation describing a two-strain avian influenza transmission via the Pontryagin's Maximum Principle. To this end, a pair of control variables representing the isolation strategies for individuals with avian and mutant strains were incorporated into the transmission model. The infection averted ratio (IAR) and the incremental cost-effectiveness ratio (ICER) were calculated to investigate the cost-effectiveness of all possible combinations of the control strategies. The simulation results show that the implementation of the combination strategy during the epidemic is the most cost-effective strategy for avian influenza transmission. This is followed by the control strategy involving isolation of individuals with the mutant strain. Also observed was the fact that low mutating and more virulent virus results in an increased control effort of isolating individuals with the avian strain; and high mutating with more virulent virus results in increased efforts in isolating individuals with the mutant strain.

  12. A cost-effective high-throughput digital system for observation and acquisition of animal behavioral data.

    PubMed

    Farrimond, Jonathan A; Hill, Andrew J; Jones, Nicholas A; Stephens, Gary J; Whalley, Benjamin J; Williams, Claire M

    2009-05-01

    We have designed and implemented a low-cost digital system using closed-circuit television cameras coupled to a digital acquisition system for the recording of in vivo behavioral data in rodents and for allowing observation and recording of more than 10 animals simultaneously at a reduced cost, as compared with commercially available solutions. This system has been validated using two experimental rodent models: one involving chemically induced seizures and one assessing appetite and feeding. We present observational results showing comparable or improved levels of accuracy and observer consistency between this new system and traditional methods in these experimental models, discuss advantages of the presented system over conventional analog systems and commercially available digital systems, and propose possible extensions to the system and applications to nonrodent studies.

  13. A telerobotic digital controller system

    NASA Technical Reports Server (NTRS)

    Brown, Richard J.

    1992-01-01

    This system is a network of joint mounted dual axes digital servo-controllers (DDSC), providing control of various joints and end effectors of different robotic systems. This report provides description of and user required information for the Digital Controller System Network (DSCN) and, in particular, the DDSC, Model DDSC-2, developed to perform the controller functions. The DDSC can control 3 phase brushless or brush type DC motors, requiring up to 8 amps. Only four wires, two for power and 2 for serial communication, are required, except for local sensor and motor connections. This highly capable, very flexible, programmable servo-controller, contained on a single, compact printed circuit board measuring only 4.5 x 5.1 inches, is applicable to control systems of all types from sub-arc second precision pointing to control of robotic joints and end effectors. This document concentrates on the robotic applications for the DDSC.

  14. Is Surgery for Displaced, Midshaft Clavicle Fractures in Adults Cost-Effective? Results Based on a Multicenter Randomized Controlled Trial

    PubMed Central

    2010-01-01

    Objectives To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults. Design Formal cost-effectiveness analysis based on a prospective, randomized controlled trial. Setting Eight hospitals in Canada (seven university affiliated and one community hospital) Patients/Participants 132 adults with acute, completely displaced, midshaft clavicle fractures Intervention Clavicle ORIF versus nonoperative treatment Main Outcome Measurements Utilities derived from SF-6D Results The base-case cost per quality adjusted life year (QALY) gained for ORIF was $65,000. Cost-effectiveness improved to $28,150/QALY gained when the functional benefit from ORIF was assumed to be permanent, with cost per QALY gained falling below $50,000 when the functional advantage persisted for 9.3 years or more. In other sensitivity analyses, the cost per QALY gained for ORIF fell below $50,000 when ORIF cost less than $10,465 (base case cost $13,668) or the long-term utility difference between nonoperative treatment and ORIF was greater than 0.034 (base-case difference 0.014). Short-term disutility associated with fracture healing also affected cost-effectiveness, with the cost per QALY gained for ORIF falling below $50,000 when the utility of a fracture treated nonoperatively prior to union was less than 0.617 (base-case utility 0.706) or when nonoperative treatment increased the time to union by 20 weeks (base-case difference 12 weeks). Conclusions The cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared to nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had favorable value compared with many accepted health interventions. PMID:20577073

  15. Digital Controller For Acoustic Levitation

    NASA Technical Reports Server (NTRS)

    Tarver, D. Kent

    1989-01-01

    Acoustic driver digitally controls sound fields along three axes. Allows computerized acoustic levitation and manipulation of small objects for such purposes as containerless processing and nuclear-fusion power experiments. Also used for controlling motion of vibration-testing tables in three dimensions.

  16. Plant breeding to control zinc deficiency in India: how cost-effective is biofortification?

    PubMed

    Stein, Alexander J; Nestel, Penelope; Meenakshi, J V; Qaim, Matin; Sachdev, H P S; Bhutta, Zulfiqar A

    2007-05-01

    To estimate the potential impact of zinc biofortification of rice and wheat on public health in India and to evaluate its cost-effectiveness compared with alternative interventions and international standards. The burden of zinc deficiency (ZnD) in India was expressed in disability-adjusted life years (DALYs) lost. Current zinc intakes were derived from a nationally representative household food consumption survey (30-day recall) and attributed to household members based on adult equivalent weights. Using a dose-response function, projected increased zinc intakes from biofortified rice and wheat were translated into potential health improvements for pessimistic and optimistic scenarios. After estimating the costs of developing and disseminating the new varieties, the cost-effectiveness of zinc biofortification was calculated for both scenarios and compared with alternative micronutrient interventions and international reference standards. India. Representative household survey (n = 119 554). The calculated annual burden of ZnD in India is 2.8 million DALYs lost. Zinc biofortification of rice and wheat may reduce this burden by 20-51% and save 0.6-1.4 million DALYs each year, depending on the scenario. The cost for saving one DALY amounts to $US 0.73-7.31, which is very cost-effective by standards of the World Bank and the World Health Organization, and is lower than that of most other micronutrient interventions. Not only may zinc biofortification save lives and prevent morbidity among millions of people, it may also help accommodate the need to economise and to allocate resources more efficiently. Further research is needed to corroborate these findings.

  17. Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin.

    PubMed

    Klarenbach, Scott; Cameron, Chris; Singh, Sumeet; Ur, Ehud

    2011-11-08

    Metformin is widely accepted as first-line pharmacotherapy for patients with type 2 diabetes mellitus when glycemic control cannot be achieved by lifestyle interventions alone. However, uncertainty exists regarding the optimal second-line therapy for patients whose diabetes is inadequately controlled by metformin monotherapy. Increased use of newer, more costly agents, along with the rising incidence of type 2 diabetes, carries significant budgetary implications for health care systems. We conducted this analysis to determine the relative costs, benefits and cost-effectiveness of options for second-line treatment of type 2 diabetes. We used the United Kingdom Prospective Diabetes Study Outcomes Model to forecast diabetes-related complications, quality-adjusted life-years and costs of alternative second-line therapies available in Canada for adults with type 2 diabetes inadequately controlled by metformin. We obtained clinical data from a systematic review and mixed treatment comparison meta-analysis, and we obtained information on costs and utilities from published sources. We performed extensive sensitivity analyses to test the robustness of results to variation in inputs and assumptions. Sulphonylureas, when added to metformin, were associated with the most favourable cost-effectiveness estimate, with an incremental cost of $12 757 per quality-adjusted life-year gained, relative to continued metformin monotherapy. Treatment with other agents, including thiazolidinediones and dipeptidyl peptidase-4 inhibitors, had unfavourable cost-effectiveness estimates compared with sulphonylureas. These results were robust to extensive sensitivity analyses. For most patients with type 2 diabetes that is inadequately controlled with metformin monotherapy, the addition of a sulphonylurea represents the most cost-effective second-line therapy.

  18. Cost-effective control of nitrogen loadings in Long Island Sound

    NASA Astrophysics Data System (ADS)

    Bennett, Lynne L.; Thorpe, Steven G.; Guse, A. Joseph

    2000-12-01

    Long Island Sound is plagued by conditions of severe hypoxia (low levels of dissolved oxygen) during the summer months because of the existence of excessive amounts of nitrogen. A new proposal that would allow sewage treatment plants to buy or sell nitrogen discharge credits is currently being evaluated by the states of Connecticut and New York. Existing theory suggests that a trading program for nitrogen emissions would be a cost-effective means of addressing the problem. We estimate the costs associated with several trading scenarios and find that the potential for cost savings is substantial and that cost savings rise as the scope of trading expands.

  19. Cost-Effectiveness of Group and Internet Cognitive Behavioral Therapy for Insomnia in Adolescents: Results from a Randomized Controlled Trial

    PubMed Central

    De Bruin, Eduard J.; van Steensel, Francisca J.A.; Meijer, Anne Marie

    2016-01-01

    Study Objectives: To investigate cost-effectiveness of adolescent cognitive behavioral therapy for insomnia (CBTI) in group- and Internet-delivered formats, from a societal perspective with a time horizon of 1 y Methods: Costs and effects data up to 1-y follow-up were obtained from a randomized controlled trial (RCT) comparing Internet CBTI to face-to-face group CBTI. The study was conducted at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam, and the academic youth mental health care center UvAMinds in Amsterdam. Sixty-two participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for insomnia were randomized to face-to-face group CBTI (GT; n = 31, age = 15.6 y ± 1.8, 71.0% girls) or individual Internet CBTI (IT; n = 31, age = 15.4 y ± 1.5, 83.9% girls). The intervention consisted of six weekly sessions and a 2-mo follow up booster-session of CBTI, consisting of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT sessions were held in groups of six to eight adolescents guided by two trained sleep therapists. IT consisted of individual Internet therapy with preprogrammed content similar to GT, and guided by trained sleep therapists. Results: Outcome measures were subjective sleep efficiency (SE) ≥ 85%, and quality-adjusted life-years (QALY). Analyses were conducted from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling, and presented in cost-effectiveness planes. Primary analysis showed costs over 1 y were higher for GT but effects were similar for IT and GT. Bootstrapped ICERs demonstrated there is a high probability of IT being cost-effective compared to GT. Secondary analyses confirmed robustness of results. Conclusions: Internet CBTI is a cost-effective treatment compared to group CBTI for adolescents, although

  20. Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children.

    PubMed Central

    Frick, K. D.; Lietman, T. M.; Holm, S. O.; Jha, H. C.; Chaudhary, J. S.; Bhatta, R. C.

    2001-01-01

    OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal. METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma. Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used. The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole. FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child. However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households. CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences. Less expensive targeting methods are required in order to make targeted household treatment more cost-effective. PMID:11285663

  1. Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat

    PubMed Central

    Dan, Yock Young; Sim, Joe; Lim, Jeremy; Hsu, Li Yang; Chow, Wai Leng; Fisher, Dale A.; Wong, Yue Sie; Ho, Khek Yu

    2009-01-01

    The outbreak of influenza A pandemic (H1N1) 2009 prompted many countries in Asia, previously strongly affected by severe acute respiratory syndrome (SARS), to respond with stringent measures, particularly in preventing outbreaks in hospitals. We studied actual direct costs and cost-effectiveness of different response measures from a hospital perspective in tertiary hospitals in Singapore by simulating outbreaks of SARS, pandemic (H1N1) 2009, and 1918 Spanish influenza. Protection measures targeting only infected patients yielded lowest incremental cost/death averted of $23,000 (US$) for pandemic (H1N1) 2009. Enforced protection in high-risk areas (Yellow Alert) and full protection throughout the hospital (Orange Alert) averted deaths but came at an incremental cost of up to $2.5 million/death averted. SARS and Spanish influenza favored more stringent measures. High case-fatality rates, virulence, and high proportion of atypical manifestations impacted cost-effectiveness the most. A calibrated approach in accordance with viral characteristics and community risks may help refine responses to future epidemics. PMID:19961669

  2. Determining the cost effectiveness of a smoke alarm give-away program using data from a randomized controlled trial.

    PubMed

    Ginnelly, Laura; Sculpher, Mark; Bojke, Chris; Roberts, Ian; Wade, Angie; Diguiseppi, Carolyn

    2005-10-01

    In 2001, 486 deaths and 17,300 injuries occurred in domestic fires in the UK. Domestic fires represent a significant cost to the UK economy, with the value of property loss alone estimated at pounds 375 million in 1999. In 2001 in the US, there were 383 500 home fires, resulting in 3110 deaths, 15,200 injuries and dollar 5.5 billion in direct property damage. A cluster RCT was conducted to determine whether a smoke alarm give-away program, directed to an inner-city UK population, is effective and cost-effective in reducing the risk of fire-related deaths/injuries. Forty areas were randomized to the give-away or control group. The number of injuries/deaths and the number of fires in each ward were collected prospectively. Cost-effectiveness analysis was undertaken to relate the number of deaths/injuries to resource use (damage, fire service, healthcare and give-away costs). Analytical methods were used which reflected the characteristics of the trial data including the cluster design of the trial and a large number of zero costs and effects. The mean cost for a household in a give-away ward, including the cost of the program, was pounds 12.76, compared to pounds 10.74 for the control ward. The total mean number of deaths and injuries was greater in the intervention wards then the control wards, 6.45 and 5.17. When an injury/death avoided is valued at pounds 1000, a smoke alarm give-away has a probability of being cost effective of 0.15. A smoke alarm give-away program, as administered in the trial, is unlikely to represent a cost-effective use of resources.

  3. Reducing disability in community-dwelling frail older people: cost-effectiveness study alongside a cluster randomised controlled trial.

    PubMed

    Metzelthin, Silke F; van Rossum, Erik; Hendriks, Marike R C; De Witte, Luc P; Hobma, Sjoerd O; Sipers, Walther; Kempen, Gertrudis I J M

    2015-05-01

    although proactive primary care, including early detection and treatment of community-dwelling frail older people, is a part of the national healthcare policy in several countries, little is known about its cost-effectiveness. to evaluate the cost-effectiveness of a proactive primary care approach in community-dwelling frail older people. embedded in a cluster randomised trial among 12 Dutch general practitioner practices, an economic evaluation was performed from a societal perspective with a time horizon of 24 months. frail older people in the intervention group received an in-home assessment and interdisciplinary care based on a tailor-made treatment plan and regular evaluation and follow-up. Practices in the control group delivered usual care. The primary outcome for the cost-effectiveness and cost-utility analysis was disability and health-related quality of life, respectively. multilevel analyses among 346 frail older people showed no significant differences between the groups regarding disability and health-related quality of life at 24 months. People in the intervention group used, as expected, more primary care services, but there was no decline in more expensive hospital and long-term care. Total costs over 24 months tended to be higher in the intervention group than in the control group (€26,503 versus €20,550, P = 0.08). the intervention under study led to an increase in healthcare utilisation and related costs without providing any beneficial effects. This study adds to the scarce amount of evidence of the cost-effectiveness of proactive primary care in community-dwelling frail older people. Current Controlled Trials, ISRCTN 31954692. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Digital Control For Remote Manipulators

    NASA Technical Reports Server (NTRS)

    Bejczy, Antal K.; Dotson, Ronald S.

    1987-01-01

    Multiple microprocessors enable large separations between controllers and manipulators. Controller for remote manipulator requires no direct mechanical connection between slave arm and master arm moved by human operator. Employs two-way digital data transmission rather than mechanical linkage between master and slave. Manipulator a considerable distance from operator. Software for controller distributed between master and slave locations. Organized into modules. Hardware and software for system demonstrated in laboratory model.

  5. Development and Design of Cost-Effective, Real-Time Implementable Sediment and Contaminant Release Controls

    SciTech Connect

    Hampson, Steve

    2007-08-01

    Alternative design options for integrated storm water and sediment control systems were developed and evaluated for Outfalls 008, 011 and 015 of the Paducah Gaseous Diffusion Plant. The remedial options were required to be cost effective and implementable in a relatively short timeframe. Additionally, construction activities were to minimize earth disturbance, especially with respect to excavation. The current database for storm water and effluent sediment oncentration was assessed for the three outfalls. It was concluded that there was a significant lack of data and recommendations for monitoring equipment were provided to initiate a comprehensive surface water and sediment data acquisition system. Modeling was completed for current conditions. Peak flow, runoff volume, peak sediment concentration and storm sediment load were modeled for storm events, ranging from 0.5 inches (12.7mm) to 3.0 inches (6.2mm). Predicted peak flows ranged from 2.5 cfs (0.071 m3/s) for Outfall 011 and a 0.5 inches (12.7mm) storm to 210 cfs (5.95 m3/s) for Outfall 008 and a 3.0 inches (76.2mm) storm. Additionally, the 100-yr 24-hr NRCS Type II storm was modeled. Storm sediment loads, for the corresponding outfalls and storm events, ranged from 0.1 to 9.0 tons (8.18 tonnes). Retention ponds were designed and evaluated for each of the three outfalls. The ponds had a dual function; 1) contain the storm runoff volume for smaller storm events and 2) passively treat and discharge runoff that was in excess of the pond’s storage capacity. Stored runoff was transferred to alternative secondary treatment systems. The expected performance of these treatment systems was evaluated. The performance of the outfall ponds was evaluated for storm events ranging from 0.5 inches (12.7mm) to 4.0 inches (101.6mm). Outfall 011 has a watershed of 33.3 acres. Pond 011 (Outfall 011) has the largest storage capacity of the three outfalls, and therefore the highest potential for effective treatment. The predicted

  6. [Cost-effectiveness analysis of mechanical and manual soil-buried methods for Oncomelania hupensis control].

    PubMed

    Jiang, Neng-ming; Ye, Xiao-dong; Huang, Li-lan; Wang, Song-bo; Zheng, Shou-gui

    2014-06-01

    To explore a high molluscicidal efficient method in special Oncomelania hupensis snail environments. In 2005 and 2006, in large special environments (rubble creek beaches and seepage barren hills with snails), the mechanical soil-buried method (excavator digging to bury deep snails) and manual soil-buried method were used respectively, and the results were compared for the cost-effectiveness. With the mechanical soil-buried method in 2006, the investment was 0.78 yuan/m2, and the compression rate of snail areas was 100%; with the manual soil-buried method in 2005, the investment was 1.34 yuan/m2, and the compression rate of snail areas was 20.26%. The former was much better than the latter. In the large special environments with snails, the mechanical soil-buried method is superior to manual soil-buried method.

  7. Digitally controlled sonars

    NASA Technical Reports Server (NTRS)

    Hansen, G. R.

    1983-01-01

    Sonars are usually designed and constructed as stand alone instruments. That is, all elements or subsystems of the sonar are provided: power conditioning, displays, intercommunications, control, receiver, transmitter, and transducer. The sonars which are a part of the Advanced Ocean Test Development Platform (AOTDP) represent a departure from this manner of implementation and are configured more like an instrumentation system. Only the transducer, transmitter, and receiver which are unique to a particular sonar function; Up, Down, Side Scan, exist as separable subsystems. The remaining functions are reserved to the AOTDP and serve all sonars and other instrumentation in a shared manner. The organization and functions of the common AOTDP elements were described and then the interface with the sonars discussed. The techniques for software control of the sonar parameters were explained followed by the details of the realization of the sonar functions and some discussion of the performance of the side scan sonars.

  8. Digitally controlled sonars

    NASA Technical Reports Server (NTRS)

    Hansen, G. R.

    1983-01-01

    Sonars are usually designed and constructed as stand alone instruments. That is, all elements or subsystems of the sonar are provided: power conditioning, displays, intercommunications, control, receiver, transmitter, and transducer. The sonars which are a part of the Advanced Ocean Test Development Platform (AOTDP) represent a departure from this manner of implementation and are configured more like an instrumentation system. Only the transducer, transmitter, and receiver which are unique to a particular sonar function; Up, Down, Side Scan, exist as separable subsystems. The remaining functions are reserved to the AOTDP and serve all sonars and other instrumentation in a shared manner. The organization and functions of the common AOTDP elements were described and then the interface with the sonars discussed. The techniques for software control of the sonar parameters were explained followed by the details of the realization of the sonar functions and some discussion of the performance of the side scan sonars.

  9. Direct Digital Control Study.

    DTIC Science & Technology

    1985-02-01

    please attach additional pages to answer this question. 6. What is the "rule of thumb" used to calculate the number of DDC control loops and 1/0 points...I ’ : ’ ~ 2’, . Vkt ; .nw]i.<[[I’ S, ,ten,m Service Company would like to receive a copy of i I ication. Should additional information be required

  10. Atmospheric nitrogen deposition loadings to the Chesapeake Bay: An initial analysis of the cost effectiveness of control options

    SciTech Connect

    1996-12-31

    The purpose of this project was to examine whether programs to control regional airborne oxides of nitrogen (NOx) are cost-effective ways to reduce nitrogen loads to the Bay compared with other management scenarios. Regional control programs considered in this analysis include: the Low Emission Vehicle (LEV) program of the Ozone Transport Commission (OTC), and a 0.15 pounds (lbs) per million British thermal unit (MMBtu) NOx emission limit applied to large fuel combustors in the Northeast Ozone Transport Region (OTC) States. The effect of extending the OTR programs to wider areas of the country - whose emissions also influence the Bay - was also examined.

  11. 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.

  12. Cost-effectiveness of cognitive behavioral therapy for insomnia comorbid with depression: Analysis of a randomized controlled trial.

    PubMed

    Watanabe, Norio; Furukawa, Toshiaki A; Shimodera, Shinji; Katsuki, Fujika; Fujita, Hirokazu; Sasaki, Megumi; Sado, Mitsuhiro; Perlis, Michael L

    2015-06-01

    Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual (TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years (QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY (P = 0.002) than the TAU-alone group with an incremental value of 0.019 (SD 0.006), and had non-significantly higher costs with an incremental value of 254 (SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: -5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  13. Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation.

    PubMed

    Robotham, Julie V; Graves, Nicholas; Cookson, Barry D; Barnett, Adrian G; Wilson, Jennie A; Edgeworth, Jonathan D; Batra, Rahul; Cuthbertson, Brian H; Cooper, Ben S

    2011-10-05

    To assess the cost effectiveness of screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus (MRSA) in intensive care units. Economic evaluation based on a dynamic transmission model. England and Wales. Population Theoretical population of patients on an intensive care unit. Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost effectiveness ratios for alternative strategies, and net monetary benefits. All decolonisation strategies improved health outcomes and reduced costs. Although universal decolonisation (regardless of MRSA status) was the most cost effective in the short term, strategies using screening to target MRSA carriers may be preferred owing to the reduced risk of selecting for resistance. Among such targeted strategies, universal admission and weekly screening with polymerase chain reaction coupled with decolonisation using nasal mupirocin was the most cost effective. This finding was robust to the size of intensive care units, prevalence of MRSA on admission, proportion of patients classified as high risk, and precise value of willingness to pay for health benefits. All strategies using isolation but not decolonisation improved health outcomes but costs were increased. When the prevalence of MRSA on admission to the intensive care unit was 5% and the willingness to pay per QALY gained was between £20,000 (€23,000; $32,000) and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or after identification by admission and weekly screening for MRSA using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction based detection of MRSA coupled with isolation was unlikely to be cost effective unless prevalence was high (10% of patients colonised with MRSA on admission). MRSA control strategies that use decolonisation are likely to be cost saving in an intensive care unit

  14. Cost-Effectiveness of Group and Internet Cognitive Behavioral Therapy for Insomnia in Adolescents: Results from a Randomized Controlled Trial.

    PubMed

    De Bruin, Eduard J; van Steensel, Francisca J A; Meijer, Anne Marie

    2016-08-01

    To investigate cost-effectiveness of adolescent cognitive behavioral therapy for insomnia (CBTI) in group- and Internet-delivered formats, from a societal perspective with a time horizon of 1 y. Costs and effects data up to 1-y follow-up were obtained from a randomized controlled trial (RCT) comparing Internet CBTI to face-to-face group CBTI. The study was conducted at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam, and the academic youth mental health care center UvAMinds in Amsterdam. Sixty-two participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for insomnia were randomized to face-to-face group CBTI (GT; n = 31, age = 15.6 y ± 1.8, 71.0% girls) or individual Internet CBTI (IT; n = 31, age = 15.4 y ± 1.5, 83.9% girls). The intervention consisted of six weekly sessions and a 2-mo follow up booster-session of CBTI, consisting of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT sessions were held in groups of six to eight adolescents guided by two trained sleep therapists. IT consisted of individual Internet therapy with preprogrammed content similar to GT, and guided by trained sleep therapists. Outcome measures were subjective sleep efficiency (SE) ≥ 85%, and quality-adjusted life-years (QALY). Analyses were conducted from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling, and presented in cost-effectiveness planes. Primary analysis showed costs over 1 y were higher for GT but effects were similar for IT and GT. Bootstrapped ICERs demonstrated there is a high probability of IT being cost-effective compared to GT. Secondary analyses confirmed robustness of results. Internet CBTI is a cost-effective treatment compared to group CBTI for adolescents, although effects were largely similar for both formats

  15. Digital Breast Tomosynthesis in Addition to Conventional 2DMammography Reduces Recall Rates and is CostEffective.

    PubMed

    Pozz, Agostino; Corte, Angelo Della; Lakis, Mustapha A El; Jeong, HeonJae

    2016-01-01

    Digital breast tomosynthesis (DBT) as a breast cancer screening modality, through generation of three dimensional images during standard mammographic compression, can reduce interference from breast tissue overlap, increasing conspicuity of invasive cancers while concomitantly reducing falsepositive results. We here conducted a systematic review on previous studies to synthesize the evidence of DBT efficacy, eventually 18 articles being included in the analysis. The most commonly emerging topics were advantages of DBT screening tool in terms of recall rates, cancer detection rates and costeffectiveness, preventing unnecessary burdens on women and the healthcare system. Further research is needed to evaluate the potential impact of DBT on longerterm outcomes, such as interval cancer rates and mortality, to better understand the broader clinical and economic implications of its adoption.

  16. Reablement in community-dwelling older adults: a cost-effectiveness analysis alongside a randomized controlled trial.

    PubMed

    Kjerstad, Egil; Tuntland, Hanne Kristin

    2016-12-01

    In the face of a growing number of older adults in the population, policy-makers in high-income countries are seeking new ways to reduce the expected growth in long-term care expenditure. Research shows that disability is an important determinant of long-term care utilization. In this context, reablement has received increased attention. Reablement is a form of home-based rehabilitation, which focuses on improving independent functioning in daily activities perceived as important by the older adult. To evaluate the cost-effectiveness of reablement. The economic evaluation is based on data from a randomized controlled trial in which all participants were assessed at baseline and after 3 and 9 months. The intervention group participated in reablement, while the control group received usual care. The Canadian Occupational Performance Measure (COPM) was used to measure self-perceived activity performance and satisfaction with performance. Cost data were based on daily registrations of usage of home-based care personnel during a period of 9 months. Reablement was found to be more cost-effective than usual care. The assessments of performance and satisfaction regarding daily activities were significantly higher in the reablement group compared with the control group and this was achieved at lower cost. Importantly too, in the post-trial period, the intervention group requested significantly fewer home visits which were, on average, of significantly shorter duration compared with the control group. Expenditure on home visits was significantly lower for the reablement group. Reablement is a more cost-effective intervention compared with usual care. Reablement has a potentially large effect on the demand for compensating home-based care services. Policy-makers should therefore consider implementing reablement on a larger scale.

  17. Self management, joint protection and exercises in hand osteoarthritis: a randomised controlled trial with cost effectiveness analyses

    PubMed Central

    2011-01-01

    Background There is limited evidence for the clinical and cost effectiveness of occupational therapy (OT) approaches in the management of hand osteoarthritis (OA). Joint protection and hand exercises have been proposed by European guidelines, however the clinical and cost effectiveness of each intervention is unknown. This multicentre two-by-two factorial randomised controlled trial aims to address the following questions: • Is joint protection delivered by an OT more effective in reducing hand pain and disability than no joint protection in people with hand OA in primary care? • Are hand exercises delivered by an OT more effective in reducing hand pain and disability than no hand exercises in people with hand OA in primary care? • Which of the four management approaches explored within the study (leaflet and advice, joint protection, hand exercise, or joint protection and hand exercise combined) provides the most cost-effective use of health care resources Methods/Design Participants aged 50 years and over registered at three general practices in North Staffordshire and Cheshire will be mailed a health survey questionnaire (estimated mailing sample n = 9,500). Those fulfilling the eligibility criteria on the health survey questionnaire will be invited to attend a clinical assessment to assess for the presence of hand or thumb base OA using the ACR criteria. Eligible participants will be randomised to one of four groups: leaflet and advice; joint protection (looking after your joints); hand exercises; or joint protection and hand exercises combined (estimated n = 252). The primary outcome measure will be the OARSI/OMERACT responder criteria combining hand pain and disability (measured using the AUSCAN) and global improvement, 6 months post-randomisation. Secondary outcomes will also be collected for example pain, functional limitation and quality of life. Outcomes will be collected at baseline and 3, 6 and 12 months post-randomisation. The main analysis will

  18. A novel cost-effective medium for the production of Bacillus thuringiensis subsp. israelensis for mosquito control.

    PubMed

    Poopathi, Subbiah; Archana, B

    2012-03-01

    Bacillus thuringiensis subsp. israelensis (Bti) has been used for mosquito-control programmes the world-wide. Indeed, the large-scale production of Bti for mosquito control is very expensive due to the high cost of its culture. In the present study, we attempted to widen the scope in developing cost-effective culture medium for Bti production, based on the raw materials available on the biosphere, including coconut cake powder, CCP (Cocos nucifera), neem cake powder, NCP (Azadirachta indica) and groundnut cake powder, GCP (Arachis hypogea). Among these raw materials, the biomass production of Bti, sporulation and toxin synthesizing from 'CCP' in combination with mineral salt (MnCl(2)) was comfortably satisfactory. Bioassays with mosquito species (Culex quinquefasciatus, Anopheles stephensi and Aedes aegypti) and field trials were also satisfactory. The present investigation suggests that coconut cake-based culture medium can be used as an alternative for industrial production of Bti in mosquito-control programme. Therefore, the study is very important from the point of effective production of Bti from cost-effective culture medium for the control of mosquito vectors.

  19. 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.

  20. 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.

  1. Cost-effectiveness of routine immunization to control Japanese encephalitis in Shanghai, China.

    PubMed Central

    Ding, Ding; Kilgore, Paul E.; Clemens, John D.; Wei, Liu; Zhi-Yi, Xu

    2003-01-01

    OBJECTIVE: To assess the cost-effectiveness of inactivated and live attenuated Japanese encephalitis (JE) vaccines given to infants and children in Shanghai. METHODS: A decision-analytical model was constructed in order to compare costs and outcomes for three hypothetical cohorts of 100,000 children followed from birth in 1997 to the age of 30 years who received either no JE vaccine, inactivated JE vaccine (P3), or live attenuated JE vaccine (SA 14-14-2). Cumulative incidences of JE from birth to 30 years of age in the pre-immunization era, i.e. before 1968, were used to estimate expected rates of JE in the absence of vaccination. The economic consequences were measured as cost per case, per death, and per disability-adjusted life year (DALY) averted for the two JE immunization programmes. FINDINGS: In comparison with no JE immunization, a programme using the P3 vaccine would prevent 420 JE cases and 105 JE deaths and would save 6456 DALYs per 100,000 persons; the use of the SA 14-14-2 vaccine would prevent 427 cases and 107 deaths and would save 6556 DALYs per 100,000 persons. Both kinds of immunization were cost saving but the SA 14-14-2 vaccine strategy resulted in a saving that was 47% greater (512,456 US dollars) than that obtained with the P3 vaccine strategy (348,246 US dollars). CONCLUSION: Both JE immunization strategies resulted in cost savings in comparison with no JE immunization. This provides a strong economic rationale for vaccinating against JE in Shanghai and suggests that vaccination against JE might be economically justifiable in other parts of China and in certain other developing countries of Asia where the disease is endemic. PMID:12856051

  2. Digital electronic engine control history

    NASA Technical Reports Server (NTRS)

    Putnam, T. W.

    1984-01-01

    Full authority digital electronic engine controls (DEECs) were studied, developed, and ground tested because of projected benefits in operability, improved performance, reduced maintenance, improved reliability, and lower life cycle costs. The issues of operability and improved performance, however, are assessed in a flight test program. The DEEC on a F100 engine in an F-15 aircraft was demonstrated and evaluated. The events leading to the flight test program are chronicled and important management and technical results are identified.

  3. Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention.

    PubMed

    Yamagishi, Kazumasa; Sato, Shinichi; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Tanigawa, Takeshi; Ohira, Tetsuya; Imano, Hironori; Kondo, Masahide; Okubo, Ichiro; Ishikawa, Yoshinori; Shimamoto, Takashi; Iso, Hiroyasu

    2012-09-01

    The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

  4. Cost effectiveness analysis of elementary school-located vaccination against influenza – Results from a randomized controlled trial

    PubMed Central

    Yoo, Byung-Kwang; Humiston, Sharon G.; Szilagyi, Peter G.; Schaffer, Stanley J.; Long, Christine; Kolasa, Maureen

    2015-01-01

    School-located vaccination against influenza (SLV-I) has been suggested to help meet the need for annual vaccination of large numbers of school-aged children with seasonal influenza vaccine. However, little is known about the cost and cost-effectiveness of SLV-I. We conducted a cost-analysis and a cost-effectiveness analysis based on a randomized controlled trial (RCT) of an SLV-I program implemented in Monroe County, New York during the 2009–2010 vaccination season. We hypothesized that SLV-I is more cost effective, or less-costly, compared to a conventional, office-located influenza vaccination delivery. First and second SLV-I clinics were offered in 21 intervention elementary schools (n=9,027 children) with standard of care (no SLV-I) in 11 control schools (n=4,534 children). The direct costs, to purchase and administer vaccines, were estimated from our RCT. The effectiveness measure, receipt of ≥1 dose of influenza vaccine, was 13.2 percentage points higher in SLV-I schools than control schools. The school costs ($9.16/dose in 2009 dollars) plus project costs ($23.00/dose) plus vendor costs excluding vaccine purchase ($19.89/dose) was higher in direct costs ($52.05/dose) than the previously reported mean/median cost [$38.23/$21.44 per dose] for providing influenza vaccination in pediatric practices. However SLV-I averted parent costs to visit medical practices ($35.08 per vaccine). Combining direct and averted costs through Monte Carlo Simulation, SLV-I costs were $19.26/dose in net costs, which is below practice-based influenza vaccination costs. The incremental cost-effectiveness ratio (ICER) was estimated to be $92.50 or $38.59 (also including averted parent costs). When additionally accounting for the costs averted by disease prevention (i.e., both reduced disease transmission to household members and reduced loss of productivity from caring for a sick child), the SLV-I model appears to be cost-saving to society, compared to “no vaccination”. Our

  5. Cost effectiveness analysis of elementary school-located vaccination against influenza--results from a randomized controlled trial.

    PubMed

    Yoo, Byung-Kwang; Humiston, Sharon G; Szilagyi, Peter G; Schaffer, Stanley J; Long, Christine; Kolasa, Maureen

    2013-04-19

    School-located vaccination against influenza (SLV-I) has been suggested to help meet the need for annual vaccination of large numbers of school-aged children with seasonal influenza vaccine. However, little is known about the cost and cost-effectiveness of SLV-I. We conducted a cost-analysis and a cost-effectiveness analysis based on a randomized controlled trial (RCT) of an SLV-I program implemented in Monroe County, New York during the 2009-2010 vaccination season. We hypothesized that SLV-I is more cost effective, or less-costly, compared to a conventional, office-located influenza vaccination delivery. First and second SLV-I clinics were offered in 21 intervention elementary schools (n=9027 children) with standard of care (no SLV-I) in 11 control schools (n=4534 children). The direct costs, to purchase and administer vaccines, were estimated from our RCT. The effectiveness measure, receipt of ≥1 dose of influenza vaccine, was 13.2 percentage points higher in SLV-I schools than control schools. The school costs ($9.16/dose in 2009 dollars) plus project costs ($23.00/dose) plus vendor costs excluding vaccine purchase ($19.89/dose) was higher in direct costs ($52.05/dose) than the previously reported mean/median cost [$38.23/$21.44 per dose] for providing influenza vaccination in pediatric practices. However SLV-I averted parent costs to visit medical practices ($35.08 per vaccine). Combining direct and averted costs through Monte Carlo Simulation, SLV-I costs were $19.26/dose in net costs, which is below practice-based influenza vaccination costs. The incremental cost-effectiveness ratio (ICER) was estimated to be $92.50 or $38.59 (also including averted parent costs). When additionally accounting for the costs averted by disease prevention (i.e., both reduced disease transmission to household members and reduced loss of productivity from caring for a sick child), the SLV-I model appears to be cost-saving to society, compared to "no vaccination". Our findings

  6. 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

  7. The B-747 flight control system maintenance and reliability data base for cost effectiveness tradeoff studies

    NASA Technical Reports Server (NTRS)

    1982-01-01

    Primary and automatic flight controls are combined for a total flight control reliability and maintenance cost data base using information from two previous reports and additional cost data gathered from a major airline. A comparison of the current B-747 flight control system effects on reliability and operating cost with that of a B-747 designed for an active control wing load alleviation system is provided.

  8. Cost-Effectiveness of a Biodegradable Compared to a Titanium Fixation System in Maxillofacial Surgery: A Multicenter Randomized Controlled Trial

    PubMed Central

    van Bakelen, N. B.; Vermeulen, K. M.; Buijs, G. J.; Jansma, J.; de Visscher, J. G. A. M.; Hoppenreijs, Th. J. M.; Bergsma, J. E.; Stegenga, B.; Bos, R. R. M.

    2015-01-01

    Background Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. Aim The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery. Materials and Methods This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS). Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER) were bone healing (8 weeks) and plate removal (2 years). Results In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-)analysis and a Treatment-Received (TR-) analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group. Conclusion and Discussion The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO’s, Le Fort-I osteotomies and bimaxillary osteotomies. Trial Registration Controlled

  9. Cost-effectiveness of life-review for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial.

    PubMed

    Korte, Jojanneke; Cristina Majo, M; Bohlmeijer, Ernst T; Westerhof, Gerben J; Smit, Filip

    2015-08-01

    Life-review has been established as an evidence-based treatment of depression in later life. This study investigates the cost-effectiveness of life-review compared to care-as-usual. An economic evaluation alongside a randomized controlled trial was carried out, comparing life-review (n=100) to care-as-usual (n=102). Individuals of 55 years and over, with moderate depressive symptomatology, were included. Treatment response was defined as a statistically reliable reduction of depressive symptoms on the Center for Epidemiologic Studies Depression scale. Total per-participant costs encompassed intervention costs, costs of receiving other treatments, participants' out-of-pocket expenses, and costs stemming from production losses, and were expressed in (2009) euros (€). At 6-month follow-up, treatment response was 54.0% and 27.5% in the life-review and usual-care conditions, respectively. The difference in effectiveness was statistically significant at p=.001 (2-tailed). In the respective conditions the costs were €5550 and €3162, with the higher costs in the intervention arm of the trial. The incremental cost-effectiveness was €8675 (US$10,227) per improved participant. The findings suggest that offering life-review rather than care-as-usual almost doubles the likelihood of a favorable outcome. However, the better clinical outcomes are achieved at greater costs. The conclusion that life-review offers good value for money is sensitive to the willingness to pay for a favorable treatment response. It is recommended that life-review is delivered by a single therapist and in larger groups as this may improve the cost-effectiveness of this intervention. Copyright © 2015. Published by Elsevier Inc.

  10. Centralized digital control of accelerators

    SciTech Connect

    Melen, R.E.

    1983-09-01

    In contrasting the title of this paper with a second paper to be presented at this conference entitled Distributed Digital Control of Accelerators, a potential reader might be led to believe that this paper will focus on systems whose computing intelligence is centered in one or more computers in a centralized location. Instead, this paper will describe the architectural evolution of SLAC's computer based accelerator control systems with respect to the distribution of their intelligence. However, the use of the word centralized in the title is appropriate because these systems are based on the use of centralized large and computationally powerful processors that are typically supported by networks of smaller distributed processors.

  11. Digital Controller For Emergency Beacon

    NASA Technical Reports Server (NTRS)

    Ivancic, William D.

    1990-01-01

    Prototype digital controller intended for use in 406-MHz emergency beacon. Undergoing development according to international specifications, 406-MHz emergency beacon system includes satellites providing worldwide monitoring of beacons, with Doppler tracking to locate each beacon within 5 km. Controller turns beacon on and off and generates binary codes identifying source (e.g., ship, aircraft, person, or vehicle on land). Codes transmitted by phase modulation. Knowing code, monitor attempts to communicate with user, monitor uses code information to dispatch rescue team appropriate to type and locations of carrier.

  12. Digital adaptive flight controller development

    NASA Technical Reports Server (NTRS)

    Kaufman, H.; Alag, G.; Berry, P.; Kotob, S.

    1974-01-01

    A design study of adaptive control logic suitable for implementation in modern airborne digital flight computers was conducted. Two designs are described for an example aircraft. Each of these designs uses a weighted least squares procedure to identify parameters defining the dynamics of the aircraft. The two designs differ in the way in which control law parameters are determined. One uses the solution of an optimal linear regulator problem to determine these parameters while the other uses a procedure called single stage optimization. Extensive simulation results and analysis leading to the designs are presented.

  13. Digital electrospray for controlled deposition.

    PubMed

    Deng, Weiwei; Waits, C Mike; Gomez, Alessandro

    2010-03-01

    Many novel functional structures are now fabricated by controlled deposition as a maskless, bottom-up fabrication technique. These applications require rapid and precise deposition of minute amounts of solutions/suspensions or their ultimate particle products in predefined patterns. The electrospray is a promising alternative to the commonly used inkjet printing because it can easily handle highly viscous liquid, avoid high shear rates, and has low risk of clogging. We demonstrate a proof-of-concept digital electrospray. This system consists of a 61-nozzle array microfabricated in silicon and a 61-element digital extractor fabricated using flexible polyimide substrates. "Digital" refers to the state of each electrospray source that can be tuned either on or off independently and responsively. We showed a resolution of 675 mum and a response frequency up to 100 Hz. With similar design and industry standard fabrication procedures, it is feasible to scale up the system to O(1000) sources with spatial resolution better than 250 mum and a O(kHz) response frequency. The latter is controlled by the viscous damping time.

  14. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Sarah R. Nuss-Warren

    2007-02-01

    The objective of this project is to identify, develop, test, and commercialize emissions control and monitoring technologies that can be implemented by exploration and production (E&P) operators to significantly lower the cost of environmental compliance and expedite project permitting. The project team takes considerable advantage of the emissions control research and development efforts and practices that have been underway in the gas pipeline industry for the last 12 years. These efforts and practices are expected to closely interface with the E&P industry to develop cost-effective options that apply to widely-used field and gathering engines, and which can be readily commercialized. The project is separated into two phases. Phase 1 work establishes an E&P industry liaison group, develops a frequency distribution of installed E&P field engines, and identifies and assesses commercially available and emerging engine emissions control and monitoring technologies. Current and expected E&P engine emissions and monitoring requirements are reviewed, and priority technologies are identified for further development. The identified promising technologies are tested on a laboratory engine to confirm their generic viability. In addition, a full-scale field test of prototype emissions controls will be conducted on at least ten representative field engine models with challenging emissions profiles. Emissions monitoring systems that are integrated with existing controls packages will be developed. Technology transfer/commercialization is expected to be implemented through compressor fleet leasing operators, engine component suppliers, the industry liaison group, and the Petroleum Technology Transfer Council. This topical report discusses work completed during Phase 1 of the project Cost Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines. In this report information, data, and results are compiled and summarized from quarterly

  15. Cost-effectiveness of the use of vector control and mass drug administration, separately or in combination, against lymphatic filariasis.

    PubMed

    Krishnamoorthy, K; Rajendran, R; Sunish, I P; Reuben, R

    2002-12-01

    The costs and effects of two intervention strategies for the control of bancroftian filariasis-annual mass drug administrations (MDA) with a combination of diethylcarbamazine and ivermectin, with or without integrated vector control (VC)-were estimated in rural villages in South India. The aim was to compare the cost-effectiveness of MDA alone with that of MDA plus VC. Control of the local vector, Culex quinquefasciatus, was based on the application of polystyrene beads to cesspits, the treatment of drains with larvicidal Bacillus sphaericus and the stocking of wells with larvivorous fish. An itemized cost menu was used to cost MDA and MDA + VC, retrospectively. The annual transmission potential was used to assess the direct outcome of the disease-control methods, whereas the prevalence and intensity of microfilaraemia were used as indicators of the impact of each method. The per-capita costs were 1.49 U.S. dollars for two rounds of MDA, 1.70 U.S. dollars for 2 years of VC and, therefore, 3.19 U.S. dollars for 2 years of MDA + VC. Integration of VC with MDA did not appear to be cost-effective: it cost an estimated 1.80 U.S. dollars to stop an infective mosquito biting a villager using MDA alone but 3.32 U.S. dollars to achieve the same result using MDA + VC. Similarly, the cost to reduce the prevalence of microfilaraemia in a three-village group by 1% was only 96.62 U.S. dollars for MDA alone but 201.16 U.S. dollars when vector control was integrated. The implications of these results for the control and elimination of filariasis in Indian village communities, and the options for sharing and minimizing costs, are discussed.

  16. The OPTIMIST study: optimisation of cost effectiveness through individualised FSH stimulation dosages for IVF treatment. A randomised controlled trial

    PubMed Central

    2012-01-01

    Background Costs of in vitro fertilisation (IVF) are high, which is partly due to the use of follicle stimulating hormone (FSH). FSH is usually administered in a standard dose. However, due to differences in ovarian reserve between women, ovarian response also differs with potential negative consequences on pregnancy rates. A Markov decision-analytic model showed that FSH dose individualisation according to ovarian reserve is likely to be cost-effective in women who are eligible for IVF. However, this has never been confirmed in a large randomised controlled trial (RCT). The aim of the present study is to assess whether an individualised FSH dose regime based on an ovarian reserve test (ORT) is more cost-effective than a standard dose regime. Methods/Design Multicentre RCT in subfertile women indicated for a first IVF or intracytoplasmic sperm injection cycle, who are aged < 44 years, have a regular menstrual cycle and no major abnormalities at transvaginal sonography. Women with polycystic ovary syndrome, endocrine or metabolic abnormalities and women undergoing IVF with oocyte donation, will not be included. Ovarian reserve will be assessed by measuring the antral follicle count. Women with a predicted poor response or hyperresponse will be randomised for a standard versus an individualised FSH regime (150 IU/day, 225-450 IU/day and 100 IU/day, respectively). Participants will undergo a maximum of three stimulation cycles during maximally 18 months. The primary study outcome is the cumulative ongoing pregnancy rate resulting in live birth achieved within 18 months after randomisation. Secondary outcomes are parameters for ovarian response, multiple pregnancies, number of cycles needed per live birth, total IU of FSH per stimulation cycle, and costs. All data will be analysed according to the intention-to-treat principle. Cost-effectiveness analysis will be performed to assess whether the health and associated economic benefits of individualised treatment of

  17. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial

    PubMed Central

    Bos, Ingeborg B C Korthals-de; Hoving, Jan L; van Tulder, Maurits W; Mölken, Maureen P M H Rutten-van; Adèr, Herman J; de Vet, Henrica C W; Koes, Bart W; Vondeling, Hindrik; Bouter, Lex M

    2003-01-01

    Objective To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. Design Economic evaluation alongside a randomised controlled trial. Setting Primary care. Participants 183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilisation), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counselling, education, and drugs). Main outcome measures Clinical outcomes were perceived recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques. Results The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy (€447; £273; $402) were around one third of the costs of physiotherapy (€1297) and general practitioner care (€1379). These differences were significant: P<0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care. Conclusions Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner. What is already known on this topicThe cost of treating neck pain is considerableMany conservative interventions are available, such as prescription drugs, yet their cost effectiveness has not been

  18. Cost effective analysis of recall methods for cervical cancer screening in Selangor--results from a prospective randomized controlled trial.

    PubMed

    Rashid, Rima Marhayu Abdul; Ramli, Sophia; John, Jennifer; Dahlui, Maznah

    2014-01-01

    Cervical cancer screening in Malaysia is by opportunistic Pap smear which contributes to the low uptake rate. To overcome this, a pilot project called the SIPPS program (translated as information system of Pap smear program) had been introduced whereby women aged 20-65 years old are invited for Pap smear and receive recall to repeat the test. This study aimed at determining which recall method is most cost-effective in getting women to repeat Pap smear. A randomised control trial was conducted where one thousand women were recalled for repeat smear either by registered letter, phone messages, phone call or the usual postal letter. The total cost applied for cost-effectiveness analysis includes the cost of sending letter for first invitation, cost of the recall method and cost of two Pap smears. Cost-effective analysis (CEA) of Pap smear uptake by each recall method was then performed. The uptake of Pap smear by postal letter, registered letters, SMS and phone calls were 18.8%, 20.0%, 21.6% and 34.4%, respectively (p<0.05). The CER for the recall method was lowest by phone call compared to other interventions; RM 69.18 (SD RM 0.14) compared to RM 106.53 (SD RM 0.13), RM 134.02 (SD RM 0.15) and RM 136.38 (SD RM 0.11) for SMS, registered letter and letter, respectively. ICER showed that it is most cost saving if the usual method of recall by postal letter be changed to recall by phone call. The possibility of letter as a recall for repeat Pap smear to reach the women is higher compared to sending SMS or making phone call. However, getting women to do repeat Pap smear is better with phone call which allows direct communication. Despite the high cost of the phone call as a recall method for repeat Pap smear, it is the most cost-effective method compared to others.

  19. Optimal digital redesign of cascaded analogue controllers

    NASA Technical Reports Server (NTRS)

    Shieh, L. S.; Decrocq, B. B.; Zhang, J. L.

    1991-01-01

    This paper presents a new, optimal digital redesign technique for finding an optimal cascaded digital controller from the given continuous-time counterpart by minimizing a quadratic performance index. The control gains can be obtained by solving a set of Liapunov equations. The developed optimal cascaded digital controller enables the state and/or outputs of the digitally controlled closed-loop sampled-data system to optimally match those of the original continuous-time closed-loop system at any instant between sampling periods. The developed control law can be implemented using inexpensive and reliable digital electronics with a relatively long sampling period.

  20. Evaluation of active control technology for short haul aircraft. [cost effectiveness

    NASA Technical Reports Server (NTRS)

    Renshaw, J. H.; Bennett, J. A.; Harris, O. C.; Honrath, J. F.; Patterson, R. W.

    1975-01-01

    An evaluation of the economics of short-haul aircraft designed with active controls technology and low wing-loading to achieve short field performance with good ride quality is presented. Results indicate that for such a system incorporating gust load alleviation and augmented stability the direct operating cost is better than for aircraft without active controls.

  1. Cost-Effective Control Systems for Colleges and Universities: A New Paradigm.

    ERIC Educational Resources Information Center

    Hubbell, Loren Loomis; Dougherty, Jennifer Dowling

    This report addresses the issue of maintaining adequate controls within a streamlined or restructured financial affairs environment at an institution of higher education. It presents a new paradigm for control structures designed to more effectively meet administrators' needs--both in terms of cost and risk management. The first section: (1)…

  2. Cost effective malaria risk control using remote sensing and environmental data

    NASA Astrophysics Data System (ADS)

    Rahman, Md. Z.; Roytman, Leonid; Kadik, Abdel Hamid

    2012-06-01

    Malaria transmission in many part of the world specifically in Bangladesh and southern African countries is unstable and epidemic. An estimate of over a million cases is reported annually. Malaria is heterogeneous, potentially due to variations in ecological settings, socio-economic status, land cover, and agricultural practices. Malaria control only relies on treatment and supply of bed networks. Drug resistance to these diseases is widespread. Vector control is minimal. Malaria control in those countries faces many formidable challenges such as inadequate accessibility to effective treatment, lack of trained manpower, inaccessibility of endemic areas, poverty, lack of education, poor health infrastructure and low health budgets. Health facilities for malaria management are limited, surveillance is inadequate, and vector control is insufficient. Control can only be successful if the right methods are used at the right time in the right place. This paper aims to improve malaria control by developing malaria risk maps and risk models using satellite remote sensing data by identifying, assessing, and mapping determinants of malaria associated with environmental, socio-economic, malaria control, and agricultural factors.

  3. Cost-effectiveness of therapist-delivered online cognitive-behavioural therapy for depression: randomised controlled trial.

    PubMed

    Hollinghurst, Sandra; Peters, Tim J; Kaur, Surinder; Wiles, Nicola; Lewis, Glyn; Kessler, David

    2010-10-01

    Therapist-delivered online cognitive-behavioural therapy (CBT) has been found to be effective for depression in primary care. To determine the cost-effectiveness of online CBT compared with usual care. Economic evaluation at 8 months alongside a randomised controlled trial. Cost to the National Health Service (NHS), personal costs, and the value of lost productivity, each compared with outcomes based on the Beck Depression Inventory and quality-adjusted life-years (QALYs). Incremental analysis indicated the NHS cost per QALY gain. Online CBT was more expensive than usual care, although the outcomes for the CBT group were better. Cost per QALY gain based on complete case data was £17,173, and £10,083 when missing data were imputed. Online CBT delivered by a therapist in real time is likely to be cost-effective compared with usual care if society is willing to pay at least £20,000 per QALY; it could be a useful alternative to face-to-face CBT.

  4. Efficacy and cost-effectiveness of nutritional intervention in elderly after hip fracture: design of a randomized controlled trial

    PubMed Central

    2010-01-01

    Background Hip fracture patients often have an impaired nutritional status at the time of fracture, which can result in a higher complication rate, prolonged rehabilitation time and increased mortality. A study was designed to evaluate the effect of nutritional intervention on nutritional status, functional status, total length of stay, postoperative complications and cost-effectiveness. Methods Open-labelled, multi-centre, randomized controlled trial in hip fracture patients aged 55 years and above. The intervention group receives dietetic counselling (by regular home visits and telephone calls) and oral nutritional supplementation for three months after surgery. The control group receives usual dietetic care as provided by the hospital. Outcome assessment is performed at three and six months after hip fracture. Discussion Patient recruitment has started in July 2007 and has ended in December 2009. First results are expected in 2011. Trial registration ClinicalTrials.gov NCT00523575 PMID:20423469

  5. A Decision Support System for Cost-Effectiveness Analysis for Control and Security of Computer Systems.

    DTIC Science & Technology

    1985-09-01

    Support System for Cost- Master’s Thesis Effectiveness Analysis for Control and September 1985 Security of Computer Systems 6. PERFORMING ORG . REPORT...F )3010 >~T .0 0 Find directory U Figulre 8. i reaFlw iara fies.obe ->~Ne8 DrbelExoue Controls Inc z W &Z ,~L. UJ. LiL La CA CC 449 -*LA- D. P Erase

  6. COST EFFECTIVE CONTROL OF HEXAVALENT CHROMIUM AIR EMISSIONS FROM FUNCTIONAL CHROMIUM ELECTROPLATING

    EPA Science Inventory

    This paper will summrize thie pollution prevention (p2) method to control stack emissions from hard chromium plating operations performed by the USEPA's National Risk Management Research Laboratory (NRMRL) over the last four years. During literature research and user surveys, it...

  7. COST EFFECTIVE CONTROL OF HEXAVALENT CHROMIUM AIR EMISSIONS FROM FUNCTIONAL CHROMIUM ELECTROPLATING

    EPA Science Inventory

    This paper will summrize thie pollution prevention (p2) method to control stack emissions from hard chromium plating operations performed by the USEPA's National Risk Management Research Laboratory (NRMRL) over the last four years. During literature research and user surveys, it...

  8. Aircraft digital control design methods

    NASA Technical Reports Server (NTRS)

    Powell, J. D.; Parsons, E.; Tashker, M. G.

    1976-01-01

    Variations in design methods for aircraft digital flight control are evaluated and compared. The methods fall into two categories; those where the design is done in the continuous domain (or s plane) and those where the design is done in the discrete domain (or z plane). Design method fidelity is evaluated by examining closed loop root movement and the frequency response of the discretely controlled continuous aircraft. It was found that all methods provided acceptable performance for sample rates greater than 10 cps except the uncompensated s plane design method which was acceptable above 20 cps. A design procedure based on optimal control methods was proposed that provided the best fidelity at very slow sample rates and required no design iterations for changing sample rates.

  9. Cost effective development of a Shuttle-based astronomical instrument control system

    NASA Technical Reports Server (NTRS)

    Parise, R. A.; Blum, A.; Budney, T. J.; Stone, R. W.

    1982-01-01

    The high level language FORTH is used for the electronic control of the Space Shuttle-based Ultraviolet Imaging Telescope, in a flight computer system which minimizes costs. The greater part of the breadboard version of the flight computer is assembled from commercially available components, reducing novel circuit design features and permitting simultaneous development of both hardware and software. The commercial boards are then refabricated on aluminum core heat conducting stock, using high reliability parts to produce the flight versions of the system. The system's ground support equipment employs a MINC-25 minicomputer which performs such functions as flight computer software development, PROM programming, test and integration support, and flight operations support. The implementation of these concepts in flight computer telescope controls is described.

  10. Cost effective development of a Shuttle-based astronomical instrument control system

    NASA Technical Reports Server (NTRS)

    Parise, R. A.; Blum, A.; Budney, T. J.; Stone, R. W.

    1982-01-01

    The high level language FORTH is used for the electronic control of the Space Shuttle-based Ultraviolet Imaging Telescope, in a flight computer system which minimizes costs. The greater part of the breadboard version of the flight computer is assembled from commercially available components, reducing novel circuit design features and permitting simultaneous development of both hardware and software. The commercial boards are then refabricated on aluminum core heat conducting stock, using high reliability parts to produce the flight versions of the system. The system's ground support equipment employs a MINC-25 minicomputer which performs such functions as flight computer software development, PROM programming, test and integration support, and flight operations support. The implementation of these concepts in flight computer telescope controls is described.

  11. Cost effective development of a Shuttle-based astronomical instrument control system

    NASA Astrophysics Data System (ADS)

    Parise, R. A.; Blum, A.; Budney, T. J.; Stone, R. W.

    1982-10-01

    The high level language FORTH is used for the electronic control of the Space Shuttle-based Ultraviolet Imaging Telescope, in a flight computer system which minimizes costs. The greater part of the breadboard version of the flight computer is assembled from commercially available components, reducing novel circuit design features and permitting simultaneous development of both hardware and software. The commercial boards are then refabricated on aluminum core heat conducting stock, using high reliability parts to produce the flight versions of the system. The system's ground support equipment employs a MINC-25 minicomputer which performs such functions as flight computer software development, PROM programming, test and integration support, and flight operations support. The implementation of these concepts in flight computer telescope controls is described.

  12. A Cost Effectiveness Study of a Consolidated Corrosion Control Work Center.

    DTIC Science & Technology

    1976-09-01

    States Air Force, many maintenance work centers are required by directives such as Air Force Manual 66-1, Maintenance Management, or equipment...technical manuals to perform work on equipment to control or prevent corrosion (38:1.1; 43:3.1; 44:3.1; 45:3.1). On any given Air Force base possessing...preventive activities might logically be a part of their primary functions. Air Force Manual (AFM) 39-1, Airman Classification Manual , which

  13. Design of a multicentered randomized controlled trial on the clinical and cost effectiveness of schema therapy for personality disorders

    PubMed Central

    2012-01-01

    Background Despite international guidelines describing psychotherapy as first choice for people with personality disorders (PDs), well-designed research on the effectiveness and cost-effectiveness of psychotherapy for PD is scarce. Schema therapy (ST) is a specific form of psychological treatment that proved to be effective for borderline PD. Randomized controlled studies on the effectiveness of ST for other PDs are lacking. Another not yet tested new specialized treatment is Clarification Oriented Psychotherapy (COP). The aim of this project is to perform an effectiveness study as well as an economic evaluation study (cost effectiveness as well as cost-utility) comparing ST versus COP versus treatment as usual (TAU). In this study, we focus on avoidant, dependent, obsessive-compulsive, paranoid, histrionic and narcissistic PD. Methods/Design In a multicentered randomized controlled trial, ST, and COP as an extra experimental condition, are compared to TAU. Minimal 300 patients are recruited in 12 mental health institutes throughout the Netherlands, and receive an extensive screening prior to enrolment in the study. When eligible, they are randomly assigned to one of the intervention groups. An economic evaluation and a qualitative research study on patient and therapist perspectives on ST are embedded in this trial. Outcome assessments (both for clinical effectiveness and economic evaluation) take place at 6,12,18,24 and 36 months after start of treatment. Primary outcome is recovery from PD; secondary measures include general psychopathological complaints, social functioning and quality of life. Data for the cost-effectiveness and cost-utility analyses are collected by using a retrospective cost interview. Information on patient and therapist perspectives is gathered using in-depth interviews and focus groups, and focuses on possible helpful and impeding aspects of ST. Discussion This trial is the first to compare ST and COP head-to-head with TAU for people with

  14. Burner modifications for very cost effective NO{sub x} control

    SciTech Connect

    Melick, T.A.; Hensley, M.E.; Gustafson, D.A.

    1996-12-31

    The development of commercial Low NO{sub x} Burners has provided Energy and Environmental Research Corporation (EER) with the expertise to modify existing burner equipment to provide the controlled fuel/air mixing conditions required for low NO{sub x} combustion. This approach represents a viable alternative to a full burner retrofit for many applications. EER has modified burners to lower NO{sub x} emissions at Louisville Gas & Electric`s (LG&E) Cane Run Station and at Jamestown Board of Public Utilities (JBPU). This paper will discuss the method and results of these burner modifications.

  15. Burner modifications for very cost effective NO{sub x} control

    SciTech Connect

    Melick, T.A.; Hensley, M.E.; Gustafson, D.A.

    1996-12-31

    The development of commercial Low NO{sub x} Burners has provided Energy and Environmental Research Corporation (EER) with the expertise to modify existing burner equipment to provide the controlled fuel/air mixing conditions required for low NO{sub x} combustion. This approach represents a viable alternative to a full burner retrofit for many applications. EER has modified burners to lower NO{sub x} emissions at Louisville Gas and Electric`s (LG and E) Cane Run Station and at Jamestown Board of Public Utilities (JBPU). This paper will discuss the method and results of these burner modifications.

  16. Adaptive Control, Learning, and Cost-Effective Sensor Systems for Robotics or Advanced Automation Systems.

    DTIC Science & Technology

    1985-12-31

    31 DEC 05 p NCLASSIFIED CSDL-R-1829GNSMB4- 3 --B7 F/G 6/4 NL 22 40 2= 1111Q2 El- MICROCOPY RESOLUTION TEST CHART Nvon i m , nr DA~)S 163- irI CSDL-R...and detection, pattern recognition , hypothesis testing, control theory, as well as the conventional expert system’s rules and heuristics. The general...done in the automatic interpretation of electrocardiograms using statistical pattern recognition methods( 29 ). However, these systems are generally not

  17. Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne.

    PubMed

    Ozolins, M; Eady, E A; Avery, A; Cunliffe, W J; O'Neill, C; Simpson, N B; Williams, H C

    2005-01-01

    To determine the relative efficacy and cost-effectiveness of five of the most commonly used antimicrobial preparations for treating mild to moderate facial acne in the community; the propensity of each regimen to give rise to local and systemic adverse events; whether pre-existing bacterial resistance to the prescribed antibiotic resulted in reduced efficacy; and whether some antimicrobial regimens were less likely to give rise to resistant propionibacterial strains. This was a parallel group randomised assessor-blind controlled clinical trial. It was a pragmatic design with intention-to-treat analysis. All treatments were given for 18 weeks, after a 4-week treatment free period. Outcomes were measured at 0, 6, 12 and 18 weeks. Primary care practices and colleges in and around Nottingham and Leeds, and one practice in Stockton-on-Tees, England. Participants were 649 people aged 12--39 years, all with mild to moderate inflammatory acne of the face. Study participants were randomised into one of five groups: 500 mg oral oxytetracycline (non-proprietary) twice daily (b.d.) + topical vehicle control b.d.; 100 mg oral Minocin MR (minocycline) once daily (o.d.) + topical vehicle control b.d.; topical Benzamycin (3% erythromycin + 5% benzoyl peroxide) b.d. + oral placebo o.d.; topical Stiemycin (2% erythromycin) o.d. + topical Panoxyl Aquagel (5% benzoyl peroxide) o.d. + oral placebo o.d., and topical Panoxyl Aquagel (5% benzoyl peroxide) b.d. + oral placebo o.d. (the active comparator group). The two primary outcome measures were: (1) the proportion of patients with at least moderate self-assessed improvement as recorded on a six-point Likert scale, and (2) change in inflamed lesion count (red spots). The best response rates were seen with two of the topical regimens (erythromycin plus benzoyl peroxide administered separately o.d. or in a combined proprietary formulation b.d.), compared with benzoyl peroxide alone, oxytetracycline (500 mg b.d.) and minocycline (100 mg o

  18. Is control through utilization a cost effective Prosopis juliflora management strategy?

    PubMed

    Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

    2016-03-01

    The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control

  19. Cost-effectiveness of early detection of atrial fibrillation via remote control of implanted devices.

    PubMed

    Lorenzoni, Giulia; Folino, Franco; Soriani, Nicola; Iliceto, Sabino; Gregori, Dario

    2014-10-01

    Atrial fibrillation (AF) is an independent risk factor for stroke, and its incidence is high in patients implanted with pacemakers (PMs) and implantable cardioverter defibrillators (ICDs). The aim of our study is to evaluate the potential benefit of remote control (RC) on the incidence of stroke related to AF in patients with new-onset AF implanted with PMs and ICDs and to evaluate the impact of RC on the consumption of medical resources. The study consisted of two cohorts of patients: group AMB (patients attending ambulatory care clinics from August to October 2013) and group RC (patients followed remotely). All detected cases of new-onset AF were confirmed by the electrogram stored in the device's memory or by standard electrocardiogram recording. Monte Carlo simulations were performed in order to evaluate the potential risk reduction of stroke related to AF. The costs were estimated from the perspectives of the hospital, the patients and the National Health Service. We enrolled 223 patients in group RC and 359 in group AMB. We detected 20 new-onset cases of AF, and the median time to AF detection was 2 days in the RC and 78 days in the ambulatory care clinic control. Management of patients was more efficient with RC, with an average savings in direct costs of €40.88 per year per patient. Through the use of Monte Carlo simulations, we showed that the early detection of new-onset AF may provide a relative risk reduction of 94.3% for stroke in PM-implanted patients older than 55 years. RC potentially provides a risk reduction for stroke because it allows an early detection of new-onset AF. Moreover, it is also a cost-saving means of follow-up. © 2014 John Wiley & Sons, Ltd.

  20. The Cost Effectiveness of Docetaxel and Active Symptom Control versus Active Symptom Control Alone for Refractory Oesophagogastric Adenocarcinoma: Economic Analysis of the COUGAR-02 Trial.

    PubMed

    Meads, David M; Marshall, Andrea; Hulme, Claire T; Dunn, Janet A; Ford, Hugo E R

    2016-01-01

    The COUGAR-02 trial recently showed survival and quality-of-life benefits of docetaxel and active symptom control (DXL + ASC) over active symptom control (ASC) alone in patients with refractory oesophagogastric adenocarcinoma. The aim of this study was to conduct an economic evaluation conforming to National Institute for Health and Care Excellence (NICE) technology appraisal guidance to evaluate the cost effectiveness of DXL + ASC versus ASC from the perspective of the English National Health Service (NHS). Cost-utility analyses were conducted using trial data. Utility values were captured using the EQ-5D completed by patients at 3- and 6-weekly intervals, while resource use was captured using nurse-completed report forms and patient reports. Incremental cost-effectiveness ratios (ICERs) were calculated and the main outcome was cost per incremental quality-adjusted life-year (QALY). Nonparametric bootstrapping was conducted to capture sampling uncertainty and to generate a cost-effectiveness acceptability curve (CEAC). The analysis horizon was the trial period (median follow-up 12 months) and no modelling or discounting of future costs and benefits was conducted. Average costs were £9352 and £6218 for DXL + ASC and ASC, respectively, and average QALYs were 0.302 and 0.186, respectively. This yielded an ICER of £27,180 for DXL + ASC. DXL + ASC had a 24 % chance of being cost effective at a £20,000 QALY threshold (lambda) and a mean net monetary benefit of -£821; this rose to 59 % and £332 when the threshold was raised to £30,000. If NICE end-of-life criteria are applied, the probability of cost effectiveness increases to 90 % (at lambda = £50,000). Results were robust to sensitivity analyses. DXL + ASC is likely to be cost effective if an end-of-life premium is applied. Further research should determine the impact of different utility measurement strategies and different chemotherapy delivery modes on estimates of cost effectiveness.

  1. Effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement for osteoarthritis: study protocol for a randomised controlled trial.

    PubMed

    Wylde, Vikki; Artz, Neil; Marques, Elsa; Lenguerrand, Erik; Dixon, Samantha; Beswick, Andrew D; Burston, Amanda; Murray, James; Parwez, Tarique; Blom, Ashley W; Gooberman-Hill, Rachael

    2016-06-13

    Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the

  2. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E & P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Sarah R. Nuss-Warren

    2006-09-30

    Continuing work in controlled testing uses a one cylinder Ajax DP-115 (a 13.25 in bore x 16 in stroke, 360 rpm engine) to assess a sequential analysis and evaluation of a series of engine upgrades. As with most of the engines used in the natural gas industry, the Ajax engine is a mature engine with widespread usage throughout the gas gathering industry. The end point is an assessment of these technologies that assigns a cost per unit reduction in NO{sub X} emissions. Technologies including one pre-combustion chamber, in-cylinder sensors, the means to adjust the air-to-fuel ratio, and modification of the air filter housing have been evaluated in previous reports. Current work tests non-production, prototype, mid-pressure fuel valves and begins analysis of these tests. This analysis reveals questions which must be answered before coming to any firm conclusions about the use of the180 psig fuel valve. The research team plans to continue with the remaining pre-combustion chamber tests in the coming quarter. By using the Ajax DP-115 these tests are completed in a low-cost and efficient manner. The various technologies can be quickly exchanged with different hardware, and it is inexpensive to run the engine. Progress in moving toward field testing is discussed, and a change in strategy is suggested. Although field engines are available to test, it is suggested that the final field testing be put on hold due to information from outside publications during this last quarter. Instead, KSU would focus on related field-testing and characterization in an outside project that will close an apparent technology gap. The results of this characterization will give a more solid footing to the field testing that will complete this project.

  3. Cost effective CD control for DUV implant layers using the Archer MPX focus-exposure monitor

    NASA Astrophysics Data System (ADS)

    Hannon, Sean; Eichelberger, Brad; Nelson, Chris; Dinu, Berta; Kennemer, Harold; Monahan, Kevin

    2005-05-01

    CD control is one of the main parameters for IC product performances and a major contributor to yield performance. Traditional SEM metrology can be a challenge on particular layers due to normal process variation and has not proven to provide sufficient focus monitoring ability. This in turn causes false positives resulting in unnecessary rework, but more importantly missed focus excursions resulting in yield loss. Alexander Starikov, Intel Corporation, alludes to the fact that focus and exposure "knobs" account for greater than 80% of CD correctible variance1. Spansion F25 is evaluating an alternative technology using an optical method for the indirect monitoring of the CD on the implant layer. The optical method utilizes a dual tone line-end-shortening (LES) target which is measured on a standard optical overlay tool. The dual tone technology enables the ability to separate the contributions of the focus and exposure resulting in a more accurate characterization of the two parameters on standard production wafers. Ultimately by keeping focus and exposure within acceptable limits it can be assumed that the CD will be within acceptable limits as well without the unnecessary rework caused by process variation. By using designed experiments this paper will provide characterization of the LES technique on the implant layer showing its ability to separate focus-exposure errors vs. the traditional SEM metrology. Actual high volume production data will be used to compare the robustness and sensitivity of the two technologies in a real life production environment. An overall outline of the production implementation will be documented as well.

  4. Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial.

    PubMed Central

    Creed, F.; Mbaya, P.; Lancashire, S.; Tomenson, B.; Williams, B.; Holme, S.

    1997-01-01

    OBJECTIVE: To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN: Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING: Teaching hospital in an inner city area. SUBJECTS: 179 patients with acute psychiatric illness referred for admission who were suitable for random allocation to day hospital or inpatient treatment. 77 (43%) patients had schizophrenia. INTERVENTIONS: Routine inpatient or day hospital treatment. MAIN OUTCOME MEASURES: Direct and indirect costs over 12 months, clinical symptoms, social functioning, and burden on relatives over the follow up period. RESULTS: Clinical and social outcomes were similar at 12 months, except that inpatients improved significantly faster than day patients and burden on relatives was significantly less in the day hospital group at one year. Median direct costs to the hospital were 1923 pounds (95% confidence interval 750 pounds to 3174 pounds) per patient less for day hospital treatment than inpatient treatment. Indirect costs were greater for day patients; when these were included, overall day hospital treatment was 2165 pounds cheaper than inpatient treatment (95% confidence interval of median difference 737 pounds to 3593 pounds). Including costs to informants when appropriate meant that day hospital treatment was 1994 pounds per patient cheaper (95% confidence interval 600 pounds to 3543 pounds). CONCLUSIONS: Day patient treatment is cheaper for the 30-40% of potential admissions that can be treated in this way. Carers of day hospital patients may bear additional costs. Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission, but day hospital treatment leads to less burden on carers in the long term. PMID:9161310

  5. Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study).

    PubMed

    Koek, Mayke B G; Sigurdsson, Vigfús; van Weelden, Huib; Steegmans, Paul H A; Bruijnzeel-Koomen, Carla A F M; Buskens, Erik

    2010-04-20

    To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). Secondary care, provided by a dermatologist in the Netherlands. 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (>/=50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were euro800 for home treatment and euro752 for outpatient treatment, showing an incremental cost per patient of euro48 (95% CI euro-77 to euro174). The average total costs by one year after the end of phototherapy were euro1272 and euro1148 respectively (difference euro124, 95% CI euro-155 to euro403). Cost utility analyses revealed that patients experienced equal health benefits-that is, a gain of 0

  6. Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study)

    PubMed Central

    Sigurdsson, Vigfús; van Weelden, Huib; Steegmans, Paul H A; Bruijnzeel-Koomen, Carla A F M; Buskens, Erik

    2010-01-01

    Objective To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Design Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). Setting Secondary care, provided by a dermatologist in the Netherlands. Participants 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. Interventions Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). Main outcome measures Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (≥50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). Results Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were €800 for home treatment and €752 for outpatient treatment, showing an incremental cost per patient of €48 (95% CI €−77 to €174). The average total costs by one year after the end of phototherapy were €1272 and €1148 respectively (difference €124, 95% CI €−155 to €403). Cost utility analyses revealed

  7. COST-EFFECTIVE CONTROL OF NOx WITH INTEGRATED ULTRA LOW-NOx BURNERS AND SNCR

    SciTech Connect

    Hamid Farzan; Jennifer Sivy; Alan Sayre; John Boyle

    2003-07-01

    Under sponsorship of the Department of Energy's National Energy Technology Laboratory (NETL), McDermott Technology, Inc. (MTI), the Babcock & Wilcox Company (B&W), and Fuel Tech teamed together to investigate an integrated solution for NOx control. The system was comprised of B&W's DRB-4Z{trademark} low-NO{sub x} pulverized coal (PC) burner technology and Fuel Tech's NO{sub x}OUT{reg_sign}, a urea-based selective non-catalytic reduction (SNCR) technology. The technology's emission target is achieving 0.15 lb NO{sub x}/10{sup 6} Btu for full-scale boilers. Development of the low-NOx burner technology has been a focus in B&W's combustion program. The DRB-4Z{trademark} burner (see Figure 1.1) is B&W's newest low-NO{sub x} burner capable of achieving very low NO{sub x}. The burner is designed to reduce NO{sub x} by diverting air away from the core of the flame, which reduces local stoichiometry during coal devolatilization and, thereby, reduces initial NO{sub x} formation. Figure 1.2 shows the historical NO{sub x} emission levels from different B&W burners. Figure 1.2 shows that based on three large-scale commercial installations of the DRB-4Z{trademark} burners in combination with OFA ports, using Western subbituminous coal, the NO{sub x} emissions ranged from 0.16 to 0.18 lb/10{sup 6} Btu. It appears that with continuing research and development the Ozone Transport Rule (OTR) emission level of 0.15 lb NO{sub x}/10{sup 6} Btu is within the reach of combustion modification techniques for boilers using western U.S. subbituminous coals. Although NO{sub x} emissions from the DRB-4Z{trademark} burner are nearing OTR emission level with subbituminous coals, the utility boiler owners that use bituminous coals can still benefit from the addition of an SNCR and/or SCR system in order to comply with the stringent NO{sub x} emission levels facing them.

  8. Modified natural cycle versus controlled ovarian hyperstimulation IVF: a cost-effectiveness evaluation of three simulated treatment scenarios.

    PubMed

    Groen, Henk; Tonch, Nino; Simons, Arnold H M; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A

    2013-12-01

    Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a cost-effective alternative for one cycle of COH with strict application of single embryo transfer (SET). MNC is cheaper per cycle than COH but also less effective in terms of live birth rate (LBR). However, strict application of SET in COH cycles reduces effectiveness and up to three MNC cycles can be performed at the same costs as one COH cycle. The cost-effectiveness of MNC versus COH was evaluated in three simulated treatment scenarios: three cycles of MNC versus one cycle of COH with SET or double embryo transfer (DET) and subsequent transfer of cryopreserved embryos (Scenario 1); six cycles of MNC versus one cycle of COH with strictly SET and subsequent transfer of cryopreserved embryos (Scenario 2); six cycles of MNC with minimized medication (hCG ovulation trigger only) versus one cycle of COH with SET or DET and subsequent transfer of cryopreserved embryos (Scenario 3). We used baseline data obtained from two retrospective cohorts of consecutive patients (2005-2008) undergoing MNC in the University Medical Center Groningen (n = 499, maximum six cycles per patient) or their first COH cycle with subsequent transfer of cryopreserved embryos in the Academic Medical Center Amsterdam (n = 392). Data from 1994 MNC cycles (958 MNC-IVF and 1036 MNC-ICSI) and 392 fresh COH cycles (one per patient, 196 COH-IVF and 196 COH-ICSI) with subsequent transfer of cryopreserved embryos (n = 72 and n = 94 in MNC and COH cycles, respectively) in ovulatory, subfertile women <36 years of age served as baseline for the three simulated scenarios. To compare the scenarios, the incremental cost-effectiveness ratio (ICER) was calculated, defined as the ratio of the difference in IVF costs up to 6 weeks postpartum to the

  9. Effectiveness and Cost-Effectiveness of Different Weekly Frequencies of Pilates for Chronic Low Back Pain: Randomized Controlled Trial.

    PubMed

    Miyamoto, Gisela Cristiane; Moura, Katherinne Ferro; Franco, Yuri Rafael dos Santos; Oliveira, Naiane Teixeira Bastos de; Amaral, Diego Diulgeroglo Vicco; Branco, Amanda Nery Castelo; Silva, Maria Liliane da; Lin, Christine; Cabral, Cristina Maria Nunes

    2016-03-01

    The Pilates method has been recommended to patients with low back pain, but the evidence on effectiveness is inconclusive. In addition, there is still no evidence for the cost-effectiveness of this method or for the ideal number of sessions to achieve the highest effectiveness. The aim of this study will be to investigate the effectiveness and cost-effectiveness of the Pilates method with different weekly frequencies in the treatment of patients with nonspecific low back pain. This is a randomized controlled trial with blinded assessor. This study will be conducted at a physical therapy clinic in São Paulo, Brazil. Two hundred ninety-six patients with nonspecific low back pain between the ages of 18 and 80 years will be assessed and randomly allocated to 4 groups (n=74 patients per group). All groups will receive an educational booklet. The booklet group will not receive additional exercises. Pilates group 1 will follow a Pilates-based program once a week, Pilates group 2 will follow the same program twice a week, and Pilates group 3 will follow the same program 3 times a week. The intervention will last 6 weeks. A blinded assessor will evaluate pain, quality-adjusted life-years, general and specific disability, kinesiophobia, pain catastrophizing, and global perceived effect 6 weeks, 6 months, and 12 months after randomization. Therapists and patients will not be blinded. This will be the first study to investigate different weekly frequencies of treatment sessions for nonspecific low back pain. The results of this study will contribute to a better definition of treatment programs for this population. © 2016 American Physical Therapy Association.

  10. Schistosomiais and Soil-Transmitted Helminth Control in Niger: Cost Effectiveness of School Based and Community Distributed Mass Drug Administration

    PubMed Central

    Leslie, Jacqueline; Garba, Amadou; Oliva, Elisa Bosque; Barkire, Arouna; Tinni, Amadou Aboubacar; Djibo, Ali; Mounkaila, Idrissa; Fenwick, Alan

    2011-01-01

    Background In 2004 Niger established a large scale schistosomiasis and soil-transmitted helminths control programme targeting children aged 5–14 years and adults. In two years 4.3 million treatments were delivered in 40 districts using school based and community distribution. Method and Findings Four districts were surveyed in 2006 to estimate the economic cost per district, per treatment and per schistosomiasis infection averted. The study compares the costs of treatment at start up and in a subsequent year, identifies the allocation of costs by activity, input and organisation, and assesses the cost of treatment. The cost of delivery provided by teachers is compared to cost of delivery by community distributers (CDD). The total economic cost of the programme including programmatic, national and local government costs and international support in four study districts, over two years, was US$ 456,718; an economic cost/treatment of $0.58. The full economic delivery cost of school based treatment in 2005/06 was $0.76, and for community distribution was $0.46. Including only the programme costs the figures are $0.47 and $0.41 respectively. Differences at sub-district are more marked. This is partly explained by the fact that a CDD treats 5.8 people for every one treated in school. The range in cost effectiveness for both direct and direct and indirect treatments is quantified and the need to develop and refine such estimates is emphasised. Conclusions The relative cost effectiveness of school and community delivery differs by country according to the composition of the population treated, the numbers targeted and treated at school and in the community, the cost and frequency of training teachers and CDDs. Options analysis of technical and implementation alternatives including a financial analysis should form part of the programme design process. PMID:22022622

  11. Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial

    PubMed Central

    Rainer, Timothy H; Jacobs, Philip; Ng, Y C; Cheung, N K; Tam, Michael; Lam, Peggo K W; Wong, Robert; Cocks, Robert A

    2000-01-01

    Objectives To investigate the cost effectiveness of intravenous ketorolac compared with intravenous morphine in relieving pain after blunt limb injury in an accident and emergency department. Design Double blind, randomised, controlled study and cost consequences analysis. Setting Emergency department of a university hospital in the New Territories of Hong Kong. Participants 148 adult patients with painful isolated limb injuries (limb injuries without other injuries). Main outcome measures Primary outcome measure was a cost consequences analysis comparing the use of ketorolac with morphine; secondary outcome measures were pain relief at rest and with limb movement, adverse events, patients' satisfaction, and time spent in the emergency department. Results No difference was found in the median time taken to achieve pain relief at rest between the group receiving ketorolac and the group receiving morphine, but with movement the median reduction in pain score in the ketorolac group was 1.09 per hour (95% confidence interval 1.05 to 2.02) compared with 0.87 (0.84 to 1.06) in the morphine group (P=0.003). The odds of experiencing adverse events was 144.2 (41.5 to 501.6) times more likely with morphine than with ketorolac. The median time from the initial delivery of analgesia to the participant leaving the department was 20 (4.0 to 39.0) minutes shorter in the ketorolac group than in the morphine group (P=0.02). The mean cost per person was $HK44 (£4; $5.6) in the ketorolac group and $HK229 in the morphine group (P<0.0001). The median score for patients' satisfaction was 6.0 for ketorolac and 5.0 for morphine (P<0.0001). Conclusion Intravenous ketorolac is a more cost effective analgesic than intravenous morphine in the management of isolated limb injury in an emergency department in Hong Kong, and its use may be considered as the dominant strategy. PMID:11082083

  12. Searching for the most cost-effective strategy for controlling epidemics spreading on regular and small-world networks

    PubMed Central

    Kleczkowski, Adam; Oleś, Katarzyna; Gudowska-Nowak, Ewa; Gilligan, Christopher A.

    2012-01-01

    We present a combined epidemiological and economic model for control of diseases spreading on local and small-world networks. The disease is characterized by a pre-symptomatic infectious stage that makes detection and control of cases more difficult. The effectiveness of local (ring-vaccination or culling) and global control strategies is analysed by comparing the net present values of the combined cost of preventive treatment and illness. The optimal strategy is then selected by minimizing the total cost of the epidemic. We show that three main strategies emerge, with treating a large number of individuals (global strategy, GS), treating a small number of individuals in a well-defined neighbourhood of a detected case (local strategy) and allowing the disease to spread unchecked (null strategy, NS). The choice of the optimal strategy is governed mainly by a relative cost of palliative and preventive treatments. If the disease spreads within the well-defined neighbourhood, the local strategy is optimal unless the cost of a single vaccine is much higher than the cost associated with hospitalization. In the latter case, it is most cost-effective to refrain from prevention. Destruction of local correlations, either by long-range (small-world) links or by inclusion of many initial foci, expands the range of costs for which the NS is most cost-effective. The GS emerges for the case when the cost of prevention is much lower than the cost of treatment and there is a substantial non-local component in the disease spread. We also show that local treatment is only desirable if the disease spreads on a small-world network with sufficiently few long-range links; otherwise it is optimal to treat globally. In the mean-field case, there are only two optimal solutions, to treat all if the cost of the vaccine is low and to treat nobody if it is high. The basic reproduction ratio, R0, does not depend on the rate of responsive treatment in this case and the disease always invades (but

  13. Searching for the most cost-effective strategy for controlling epidemics spreading on regular and small-world networks.

    PubMed

    Kleczkowski, Adam; Oleś, Katarzyna; Gudowska-Nowak, Ewa; Gilligan, Christopher A

    2012-01-07

    We present a combined epidemiological and economic model for control of diseases spreading on local and small-world networks. The disease is characterized by a pre-symptomatic infectious stage that makes detection and control of cases more difficult. The effectiveness of local (ring-vaccination or culling) and global control strategies is analysed by comparing the net present values of the combined cost of preventive treatment and illness. The optimal strategy is then selected by minimizing the total cost of the epidemic. We show that three main strategies emerge, with treating a large number of individuals (global strategy, GS), treating a small number of individuals in a well-defined neighbourhood of a detected case (local strategy) and allowing the disease to spread unchecked (null strategy, NS). The choice of the optimal strategy is governed mainly by a relative cost of palliative and preventive treatments. If the disease spreads within the well-defined neighbourhood, the local strategy is optimal unless the cost of a single vaccine is much higher than the cost associated with hospitalization. In the latter case, it is most cost-effective to refrain from prevention. Destruction of local correlations, either by long-range (small-world) links or by inclusion of many initial foci, expands the range of costs for which the NS is most cost-effective. The GS emerges for the case when the cost of prevention is much lower than the cost of treatment and there is a substantial non-local component in the disease spread. We also show that local treatment is only desirable if the disease spreads on a small-world network with sufficiently few long-range links; otherwise it is optimal to treat globally. In the mean-field case, there are only two optimal solutions, to treat all if the cost of the vaccine is low and to treat nobody if it is high. The basic reproduction ratio, R(0), does not depend on the rate of responsive treatment in this case and the disease always invades

  14. Highly integrated digital electronic control: Digital flight control, aircraft model identification, and adaptive engine control

    NASA Technical Reports Server (NTRS)

    Baer-Riedhart, Jennifer L.; Landy, Robert J.

    1987-01-01

    The highly integrated digital electronic control (HIDEC) program at NASA Ames Research Center, Dryden Flight Research Facility is a multiphase flight research program to quantify the benefits of promising integrated control systems. McDonnell Aircraft Company is the prime contractor, with United Technologies Pratt and Whitney Aircraft, and Lear Siegler Incorporated as major subcontractors. The NASA F-15A testbed aircraft was modified by the HIDEC program by installing a digital electronic flight control system (DEFCS) and replacing the standard F100 (Arab 3) engines with F100 engine model derivative (EMD) engines equipped with digital electronic engine controls (DEEC), and integrating the DEEC's and DEFCS. The modified aircraft provides the capability for testing many integrated control modes involving the flight controls, engine controls, and inlet controls. This paper focuses on the first two phases of the HIDEC program, which are the digital flight control system/aircraft model identification (DEFCS/AMI) phase and the adaptive engine control system (ADECS) phase.

  15. Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.

    PubMed

    Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A

    2016-09-01

    To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.

  16. Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial.

    PubMed

    Hunter, Ruth F; Brennan, Sarah F; Tang, Jianjun; Smith, Oliver J; Murray, Jennifer; Tully, Mark A; Patterson, Chris; Longo, Alberto; Hutchinson, George; Prior, Lindsay; French, David P; Adams, Jean; McIntosh, Emma; Kee, Frank

    2016-07-22

    Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions. This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability

  17. Research in digital adaptive flight controllers

    NASA Technical Reports Server (NTRS)

    Kaufman, H.

    1976-01-01

    A design study of adaptive control logic suitable for implementation in modern airborne digital flight computers was conducted. Both explicit controllers which directly utilize parameter identification and implicit controllers which do not require identification were considered. Extensive analytical and simulation efforts resulted in the recommendation of two explicit digital adaptive flight controllers. Interface weighted least squares estimation procedures with control logic were developed using either optimal regulator theory or with control logic based upon single stage performance indices.

  18. The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial.

    PubMed

    Burn, Edward; Marshall, Alison L; Miller, Yvette D; Barnett, Adrian G; Fjeldsoe, Brianna S; Graves, Nicholas

    2015-04-29

    To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. This study considers the cost-effectiveness of MobileMums in Queensland, Australia. A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. Australian Clinical Trials Registry; ACTRN12611000481976. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. A cluster randomised controlled trial to investigate the effectiveness and cost effectiveness of the 'Girls Active' intervention: a study protocol.

    PubMed

    Edwardson, C L; Harrington, D M; Yates, T; Bodicoat, D H; Khunti, K; Gorely, T; Sherar, L B; Edwards, R T; Wright, C; Harrington, K; Davies, M J

    2015-06-04

    Despite the health benefits of physical activity, data from the UK suggest that a large proportion of adolescents do not meet the recommended levels of moderate-to-vigorous physical activity (MVPA). This is particularly evident in girls, who are less active than boys across all ages and may display a faster rate of decline in physical activity throughout adolescence. The 'Girls Active' intervention has been designed by the Youth Sport Trust to target the lower participation rates observed in adolescent girls. 'Girls Active' uses peer leadership and marketing to empower girls to influence decision making in their school, develop as role models and promote physical activity to other girls. Schools are provided with training and resources to review their physical activity, sport and PE provision, culture and practices to ensure they are relevant and attractive to adolescent girls. This study is a two-arm cluster randomised controlled trial (RCT) aiming to recruit 20 secondary schools. Clusters will be randomised at the school level (stratified by school size and proportion of Black and Minority Ethnic (BME) pupils) to receive either the 'Girls Active' intervention or carry on with usual practice (1:1). The 20 secondary schools will be recruited from state secondary schools within the Midlands area. We aim to recruit 80 girls aged 11-14 years in each school. Data will be collected at three time points; baseline and seven and 14 months after baseline. Our primary aim is to investigate whether 'Girls Active' leads to higher objectively measured (GENEActiv) moderate-to-vigorous physical activity in adolescent girls at 14 months after baseline assessment compared to the control group. Secondary outcomes include other objectively measured physical activity variables, adiposity, physical activity-related psychological factors and the cost-effectiveness of the 'Girls Active' intervention. A thorough process evaluation will be conducted during the course of the intervention

  20. The (cost) effectiveness of an online intervention for pregnant women with affective symptoms: protocol of a randomised controlled trial.

    PubMed

    Heller, Hanna M; van Straten, Annemieke; de Groot, Christianne J M; Honig, Adriaan

    2014-08-14

    Women in pregnancy and postpartum have an increased vulnerability to develop an affective disorder. Affective disorders in pregnancy are associated with an increased risk of prematurity, dysmaturity (foetal weight below the 10th percentile as determined by ultrasound) and the development of postpartum depressive disorder. Untreated affective disorders and their complications may also result in considerable costs. Recent meta-analyses showed that interventions during pregnancy are less effective than postpartum interventions probably because of high attrition due to the barriers pregnant women experience with attending sessions outside their homes. An internet-based self-help intervention may overcome these barriers as it can be followed at home, and also in one's own time. Such internet interventions showed to be effective for decreasing affective symptoms in general.This randomised clinical trial examines whether an internet-based self-help intervention is effective in the reduction of affective symptoms in pregnancy and postpartum and results in an improvement of the perinatal outcome. We will also determine the cost-effectiveness of the intervention. We will investigate the effectiveness of a 6 week internet-based self-help problem solving treatment (PST) for affective symptoms in pregnancy. We aim to include 286 women with mild to severe affective symptoms who will be randomly assigned to the internet-based intervention or a waiting list control group. Primary outcome measures are affective symptoms and the perinatal outcome. Secondary outcome measures are quality of life, and economic costs. All assessments are based on self-report and will take place at baseline (T0), 10 weeks later (after completion of the intervention (T1), 4 weeks before the expected day of birth (T2), and 6 weeks after delivery (T3). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. If shown (cost) effective

  1. Cost-Effectiveness Analysis of Fluticasone vs. Montelukast in Children with Mild-Moderate Persistent Asthma in the Pediatric Asthma Controller Trial

    PubMed Central

    Wang, Li; Hollenbeak, Christopher S.; Mauger, David T.; Zeiger, Robert S.; Paul, Ian M.; Sorkness, Christine A.; Lemanske, Robert F.; Martinez, Fernando D.; Strunk, Robert C.; Szefler, Stanley J.; Taussig, Lynn M.

    2011-01-01

    Background Cost-effectiveness analyses of asthma controller regimens for adults exist, but similar evaluations exclusively for children are few. Objective To compare the cost-effectiveness of two commonly used asthma controllers, fluticasone and montelukast, with data from the Pediatric Asthma Controller Trial. Methods We compared the cost-effectiveness of low-dose fluticasone with montelukast in a randomized controlled multi-center clinical trial in children with mild-moderate persistent asthma. Analyses were also conducted on subgroups based on phenotypic factors. Effectiveness measures included a) the number of asthma-control days, b) the percentage of participants with an increase over baseline of FEV1≥12%, and c) the number of exacerbations avoided. Costs were analyzed from both a US health care payer's perspective and a societal perspective. Results For all cost-effectiveness measures studied, fluticasone cost less and was more effective than montelukast; e.g., fluticasone treatment cost $430 less in mean direct cost (P<0.01) and had 40 more asthma control days (P<0.01) during the 48 week study period. Considering sampling uncertainty, fluticasone cost less and was more effective at least 95% of the time. For the high eNO phenotypic subgroup (eNO≥25ppb) and more responsive PC20 subgroup (PC20<2 mg/mL), fluticasone was cost-effective compared with montelukast for all cost-effectiveness measures; whereas not all the effectiveness measures were statistically different for the other two phenotypic subgroups. Conclusion For children with mild-moderate persistent asthma, low dose fluticasone had lower cost and higher effectiveness compared with montelukast, especially in those with more airway inflammation as indicated by elevated levels of eNO and more responsivity to methacholine. PMID:21211651

  2. Tonsillectomy: a cost-effective option for childhood sore throat? Further analysis of a randomized controlled trial.

    PubMed

    Wilson, Janet A; Steen, I Nick; Lock, Catherine A; Eccles, Martin P; Carrie, Sean; Clarke, Ray; Kubba, Haytham; Raine, Chris H; Zarod, Andrew; Bond, John

    2012-01-01

    To compare the estimated cost-effectiveness of childhood (adeno)tonsillectomy vs medical therapy for recurrent sore throats from the intention-to-treat (ITT) analysis of a randomized controlled trial (RCT) with that modeled on the recorded timing of surgical interventions as observed in all participants irrespective of their original group allocation. A pragmatic RCT (trial) with a parallel nonrandomized patient preference group (cohort) of (adeno)tonsillectomy vs medical therapy. Five secondary care UK otolaryngology departments. Eligible children, aged 4 to 15 years, were enrolled to the trial (268) or cohort (461) groups. Outcomes included sore throat diaries, quality of life, and general practice consultations. The RCT protocol ITT analysis was compared with an as-treated analysis incorporating the cohort group, modeled to reflect the timing of tonsillectomy and the differential switch rates among the original groups. In the RCT ITT analysis, tonsillectomy saved 3.5 sore throats, whereas the as-treated model suggested an average reduction of more than 8 sore throats in 2 years for surgery within 10 weeks of consultation, falling to only 3.5 twelve months later due to the spontaneous improvement in the medical therapy group. In eligible UK school-age children, tonsillectomy can save up to 8 sore throats at a reasonable cost, if performed promptly. Further prospective data collection, accounting for baseline and per-trial preferences and choice, is urgently needed.

  3. Cost-effective control of a quarantine disease: a quantitative exploration using "design of experiments" methodology and bio-economic modeling.

    PubMed

    Breukers, Annemarie; van der Werf, Wopke; Kleijnen, Jack P C; Mourits, Monique; Lansink, Alfons Oude

    2007-08-01

    ABSTRACT An integrated approach to control of quarantine diseases at the level of the plant production chain is complicated. The involved actors have different interests and the system is complex. Consequently, control policies may not be cost effective. By means of a bio-economic model for brown rot in the Dutch potato production chain, the efficacy of different control options was quantitatively analyzed. An impact analysis was performed using the methodology of "design of experiments" to quantify the effect of factors in interaction on incidence and costs of brown rot. Factors can be grouped as policy, sector, economic, and exogenous factors. Results show that brown rot incidence and economic consequences are determined predominantly by policy and sector factors and, to a lesser extent, by economic and exogenous factors. Scenario studies were performed to elucidate how the government and sector can optimize the cost-effectiveness of brown rot control. Optimal cost-effectiveness of control requires cooperation of the sector and government, in which case brown rot incidence can be reduced by 75% and the costs of control can be reduced by at least 2 million euros per year. This study demonstrates quantitatively the potential contribution of an integrated approach to cost-effective disease control at chain level.

  4. Cost-Effective Control of Plant Disease When Epidemiological Knowledge Is Incomplete: Modelling Bahia Bark Scaling of Citrus

    PubMed Central

    Neri, Franco M.; DeSimone, R. Erik; Gilligan, Christopher A.

    2014-01-01

    A spatially-explicit, stochastic model is developed for Bahia bark scaling, a threat to citrus production in north-eastern Brazil, and is used to assess epidemiological principles underlying the cost-effectiveness of disease control strategies. The model is fitted via Markov chain Monte Carlo with data augmentation to snapshots of disease spread derived from a previously-reported multi-year experiment. Goodness-of-fit tests strongly supported the fit of the model, even though the detailed etiology of the disease is unknown and was not explicitly included in the model. Key epidemiological parameters including the infection rate, incubation period and scale of dispersal are estimated from the spread data. This allows us to scale-up the experimental results to predict the effect of the level of initial inoculum on disease progression in a typically-sized citrus grove. The efficacies of two cultural control measures are assessed: altering the spacing of host plants, and roguing symptomatic trees. Reducing planting density can slow disease spread significantly if the distance between hosts is sufficiently large. However, low density groves have fewer plants per hectare. The optimum density of productive plants is therefore recovered at an intermediate host spacing. Roguing, even when detection of symptomatic plants is imperfect, can lead to very effective control. However, scouting for disease symptoms incurs a cost. We use the model to balance the cost of scouting against the number of plants lost to disease, and show how to determine a roguing schedule that optimises profit. The trade-offs underlying the two optima we identify—the optimal host spacing and the optimal roguing schedule—are applicable to many pathosystems. Our work demonstrates how a carefully parameterised mathematical model can be used to find these optima. It also illustrates how mathematical models can be used in even this most challenging of situations in which the underlying epidemiology is ill

  5. A cost-effectiveness analysis of online, radio and print tobacco control advertisements targeting 25-39 year-old males.

    PubMed

    Clayforth, Cassandra; Pettigrew, Simone; Mooney, Katie; Lansdorp-Vogelaar, Iris; Rosenberg, Michael; Slevin, Terry

    2014-06-01

    To assess the relative cost-effectiveness of various non-television advertising media in encouraging 25-39 year-old male smokers to respond to a cessation-related call to action. Information about how new electronic media compare in effectiveness is important to inform the implementation of future tobacco control media campaigns. Two testimonial advertisements featuring members of the target group were developed for radio, press and online media. Multiple waves of media activity were scheduled over a period of seven weeks, including an initial integrated period that included all three media and subsequent single media phases that were interspersed with a week of no media activity. The resulting Quit website hits, Quitline telephone calls, and registrations to online and telephone counselling services were compared to advertising costs to determine the relative cost-effectiveness of each media in isolation and the integrated approach. The online-only campaign phase was substantially more cost-effective than the other phases, including the integrated approach. This finding is contrary to the current assumption that the use of a consistent message across multiple media simultaneously is the most cost-effective way of reaching and affecting target audiences. Online advertising may be a highly cost-effective channel for low-budget tobacco control media campaigns. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

  6. Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)

    PubMed Central

    Gray, Alastair; Raikou, Maria; McGuire, Alistair; Fenn, Paul; Stevens, Richard; Cull, Carole; Stratton, Irene; Adler, Amanda; Holman, Rury; Turner, Robert

    2000-01-01

    Objective To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Design Incremental cost effectiveness analysis alongside randomised controlled trial. Setting 23 UK hospital clinic based study centres. Participants 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Interventions Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Main outcome measures Incremental cost per event-free year gained within the trial period. Results Intensive glucose control increased trial treatment costs by £695 (95% confidence interval £555 to £836) per patient but reduced the cost of complications by £957 (£233 to £1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was £478 (−£275 to £1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was £1166 (costs and effects discounted at 6% a year) and £563 (costs discounted at 6% a year and effects not discounted). Conclusions Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications. PMID:10818026

  7. Digital flight control actuation system study

    NASA Technical Reports Server (NTRS)

    Rossing, R.; Hupp, R.

    1974-01-01

    Flight control actuators and feedback sensors suitable for use in a redundant digital flight control system were examined. The most appropriate design approach for an advanced digital flight control actuation system for development and use in a fly-by-wire system was selected. The concept which was selected consisted of a PM torque motor direct drive. The selected system is compatible with concurrent and independent development efforts on the computer system and the control law mechanizations.

  8. Cost-effectiveness of a distance lifestyle counselling programme among overweight employees from a company perspective, ALIFE@Work: a randomized controlled trial.

    PubMed

    Gussenhoven, A H M; van Wier, M F; Bosmans, J E; Dekkers, J C; van Mechelen, W

    2013-01-01

    The objective of this study was to determine whether a lifestyle intervention with individual counselling was cost-effective for reducing body weight compared with usual care from a company perspective. Overweight employees were recruited and randomly assigned to the intervention groups, either phone or Internet, or the control group. The intervention was based on a cognitive behavioural approach and addressed physical activity and diet. Self-reported body weight was collected at baseline and 12 months follow-up. Intervention costs and costs of sick leave days based on gross and net lost productivity days (GLPDs/NLPDs) obtained from the participating companies were calculated. Missing data were imputed using multiple imputation techniques. Uncertainty surrounding the differences in costs and the incremental cost-effectiveness ratios (ICER) was estimated by bootstrapping techniques, and presented on cost-effectiveness planes and cost-effectiveness acceptability curves. No statistically significant differences in total costs were found between the intervention groups and control group, though mean total costs in both intervention groups tended to be higher than those in the control group. The ICER of the Internet group compared with the control group was €59 per kilogram of weight loss based on GLPD costs. The probability of cost effectiveness of the Internet intervention was 45% at a willingness-to-pay of €0 per extra kilogram weight loss and 75% at a willingness-to-pay of €1500 per extra kilogram body weight loss. Comparable results were found for the phone intervention. The intervention was not cost effective in comparison with usual care from the company perspective. Due to the large amount of missing data, it is not possible to draw firm conclusions.

  9. Cost-effectiveness of early interventions for non-specific low back pain: a randomized controlled study investigating medical yoga, exercise therapy and self-care advice.

    PubMed

    Aboagye, Emmanuel; Karlsson, Malin Lohela; Hagberg, Jan; Jensen, Irene

    2015-02-01

    To evaluate the cost-effectiveness of medical yoga as an early intervention compared with evidence-based exercise therapy and self-care advice for non-specific low back pain. Randomized controlled trial with a cost-effectiveness analysis. A total of 159 participants randomized into the medical yoga group (n = 52), the exercise therapy group (n = 52) and the self-care advice group (n = 55). The health outcome measure EQ-5D was applied to measure quality of life data combined with cost data collected from treatment groups from baseline to 12 months follow-up. Outcome measure was health-related quality of life (HRQL). Incremental cost per quality adjusted life year (QALY) was also calculated. Cost-effectiveness analysis was conducted primarily from the societal and employer perspectives. Medical yoga is cost-effective compared with self-care advice if an employer considers the significant improvement in the HRQL of an employee with low back pain justifies the additional cost of treatment (i.e. in this study EUR 150). From a societal perspective, medical yoga is a cost-effective treatment compared with exercise therapy and self-care advice if an additional QALY is worth EUR 11,500. Sensitivity analysis suggests that medical yoga is more cost-effective than its alternatives. Six weeks of uninterrupted medical yoga thera-py is a cost-effective early intervention for non-specific low back pain, when treatment recommendations are adhered to.

  10. Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial

    PubMed Central

    Barnett, Paul G.; Wong, Wynnie; Jeffers, Abra; Hall, Sharon M.; Prochaska, Judith J.

    2016-01-01

    Objective We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients. Method Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically-verified abstinence from cigarettes were assessed during 18-months of follow-up. Trial findings were combined with literature on changes in smoking status and the age and gender adjusted effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness during a lifetime horizon. Results Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (p < 0.001). At the end of follow-up, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (p <0.05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional Quality Adjusted Life Years (QALYs), an incremental cost-effectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates. Conclusions A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness. PMID:26528651

  11. Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial.

    PubMed

    Orgeta, Vasiliki; Leung, Phuong; Yates, Lauren; Kang, Sujin; Hoare, Zoe; Henderson, Catherine; Whitaker, Chris; Burns, Alistair; Knapp, Martin; Leroi, Iracema; Moniz-Cook, Esme D; Pearson, Stephen; Simpson, Stephen; Spector, Aimee; Roberts, Steven; Russell, Ian T; de Waal, Hugo; Woods, Robert T; Orrell, Martin

    2015-08-01

    Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based, carer-led cognitive stimulation interventions is limited. To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers, compared with treatment as usual (TAU). A multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point). Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. A total of 356 caregiving dyads were recruited and 273 completed the trial. iCST consisted of structured cognitive stimulation sessions for people with dementia, completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms, activities of daily living, depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions), mood symptoms, resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference -0.55, 95% confidence interval (CI) -2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference -0.02, 95% CI -1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental/physical health for carers. People with dementia in the iCST group experienced better

  12. Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial.

    PubMed Central

    Orgeta, Vasiliki; Leung, Phuong; Yates, Lauren; Kang, Sujin; Hoare, Zoe; Henderson, Catherine; Whitaker, Chris; Burns, Alistair; Knapp, Martin; Leroi, Iracema; Moniz-Cook, Esme D; Pearson, Stephen; Simpson, Stephen; Spector, Aimee; Roberts, Steven; Russell, Ian T; de Waal, Hugo; Woods, Robert T; Orrell, Martin

    2015-01-01

    BACKGROUND Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based, carer-led cognitive stimulation interventions is limited. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers, compared with treatment as usual (TAU). DESIGN A multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point). SETTING Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. PARTICIPANTS A total of 356 caregiving dyads were recruited and 273 completed the trial. INTERVENTION iCST consisted of structured cognitive stimulation sessions for people with dementia, completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. MAIN OUTCOME MEASURES Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms, activities of daily living, depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions), mood symptoms, resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. RESULTS There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference -0.55, 95% confidence interval (CI) -2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference -0.02, 95% CI -1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental

  13. Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial

    PubMed Central

    Simkiss, D E; Snooks, H A; Stallard, N; Kimani, P K; Sewell, B; Fitzsimmons, D; Anthony, R; Winstanley, S; Wilson, L; Phillips, C J; Stewart-Brown, S

    2013-01-01

    Objective To evaluate the effectiveness and cost utility of a universally provided early years parenting programme. Design Multicentre randomised controlled trial with cost-effectiveness analysis. Setting Early years centres in four deprived areas of South Wales. Participants Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control. Intervention The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions. Main outcome measures Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures. Results There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With ‘+’ indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI −1.90 to 3.69); in supportive parenting, +0.17 (95%CI −0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485–46 578) over 5 years and £18 954 (range 11 664–25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up. Conclusions Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains. Trial registration The trial is registered with Current Controlled Trials ISRCTN13919732. PMID:23906953

  14. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Sarah R. Nuss-Warren

    2006-12-31

    This report highlights work done on a project intended to lower the cost of environmental compliance and expedite project permitting for Exploration and Production (E&P) operators by identifying, developing, testing, and commercializing emissions control and monitoring technologies. Promising technologies have already been identified and developed. Current work focuses on testing these promising technologies. Specifically, several technologies are being tested in the laboratory for application to lean-burn engines or fully characterized on-site for use with rich-burn engines. Upon completion of these tests, the most cost-effective and robust technologies will be tested in the field and commercialization will ensue. During this quarter, progress in laboratory testing for lean-burn engines was limited by maintenance issues on the KSU Ajax DP-115. The difficulties that required maintenance to be performed will likely require that the 180 psig prototype valve be tested in the future, if possible. The maintenance was performed, and it is expected that the Ajax will be available for testing in the coming quarter. Although laboratory testing was slowed as a result of maintenance issues, progress in experimental characterization of technologies has been significant. NSCR systems will be characterized as applied to rich-burn engines on-site. This characterization will ensure high-quality data in final field testing on rich-burn engines and is considered to be essential, despite that the work requires the delay of official field testing until 2008. Many preliminary and administrative tasks have been completed, including initial site selection, official proposal submittal, and beginning a process to approve necessary changes to installed field engines.

  15. Muslim communities learning about second-hand smoke: a pilot cluster randomised controlled trial and cost-effectiveness analysis.

    PubMed

    Shah, Sarwat; Ainsworth, Hannah; Fairhurst, Caroline; Tilbrook, Helen; Sheikh, Aziz; Amos, Amanda; Parrott, Steve; Torgerson, David; Thompson, Heather; King, Rebecca; Mir, Ghazala; Siddiqi, Kamran

    2015-08-27

    In the United Kingdom, men of Bangladeshi and Pakistani origin have higher smoking rates than the general population. This makes non-smokers in their households more vulnerable to second-hand smoke (SHS) exposure than the general population. The aim of this study was to investigate the feasibility of implementing and pilot testing the effectiveness and cost-effectiveness of a 'Smoke-free Homes' (SFH) intervention in Islamic religious settings to encourage families of Bangladeshi and Pakistani origin to apply smoking restrictions in their homes. We allocated Islamic religious settings (clusters) to either receive SFH-an educational intervention-or to a control arm. Within each cluster, we recruited households with at least one smoker and one non-smoker. SHS exposure among non-smokers was measured using salivary cotinine. Seven (50%) clusters were randomised to each trial arm. A total of 468 households were assessed for eligibility and 62% (n=289) were eligible, of which 74% (n=213) agreed to participate in the trial. Six of the seven intervention clusters delivered the intervention, and all clusters were retained throughout the trial. In all, 81% (n=172) of households provided data at follow-up. No evidence of a difference in log cotinine level was observed (adjusted mean difference -0.02, 95% confidence interval (CI) -1.28-1.23, P=0.97) between the two trial arms. The direct mean cost of delivering the intervention was £18.18 per household (range £3.55-42.20). It was possible to recruit, randomise and retain Islamic religious settings and participant households. However, some of the original assumptions, in particular our ability to collect primary outcome data, need to be revisited before a definitive trial.

  16. Cost-Effectiveness of a Long-Term Internet-Delivered Worksite Health Promotion Programme on Physical Activity and Nutrition: A Cluster Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Robroek, Suzan J. W.; Polinder, Suzanne; Bredt, Folef J.; Burdorf, Alex

    2012-01-01

    This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the unit of randomization. The intervention was compared with a…

  17. Cost-Effectiveness of a Long-Term Internet-Delivered Worksite Health Promotion Programme on Physical Activity and Nutrition: A Cluster Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Robroek, Suzan J. W.; Polinder, Suzanne; Bredt, Folef J.; Burdorf, Alex

    2012-01-01

    This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the unit of randomization. The intervention was compared with a…

  18. A Cost-Effectiveness Tool to Guide the Prioritization of Interventions for Rheumatic Fever and Rheumatic Heart Disease Control in African Nations

    PubMed Central

    Lubinga, Solomon J.; Mayosi, Bongani; Babigumira, Joseph B.

    2016-01-01

    Background Rheumatic heart disease (RHD) prevalence and mortality rates remain especially high in many parts of Africa. While effective prevention and treatment exist, coverage rates of the various interventions are low. Little is known about the comparative cost-effectiveness of different RHD interventions in limited resource settings. We developed an economic evaluation tool to assist ministries of health in allocating resources and planning RHD control programs. Methodology/Principal Findings We constructed a Markov model of the natural history of acute rheumatic fever (ARF) and RHD, taking transition probabilities and intervention effectiveness data from previously published studies and expert opinion. Our model estimates the incremental cost-effectiveness of scaling up coverage of primary prevention (PP), secondary prevention (SP) and heart valve surgery (VS) interventions for RHD. We take a healthcare system perspective on costs and measure outcomes as disability-adjusted life-years (DALYs), discounting both at 3%. Univariate and probabilistic sensitivity analyses are also built into the modeling tool. We illustrate the use of this model in a hypothetical low-income African country, drawing on available disease burden and cost data. We found that, in our hypothetical country, PP would be cost saving and SP would be very cost-effective. International referral for VS (e.g., to a country like India that has existing surgical capacity) would be cost-effective, but building in-country VS services would not be cost-effective at typical low-income country thresholds. Conclusions/Significance Our cost-effectiveness analysis tool is designed to inform priorities for ARF/RHD control programs in Africa at the national or subnational level. In contrast to previous literature, our preliminary findings suggest PP could be the most efficient and cheapest approach in poor countries. We provide our model for public use in the form of a Supplementary File. Our research has

  19. Effectiveness and cost-effectiveness of telehealthcare for chronic obstructive pulmonary disease: study protocol for a cluster randomized controlled trial.

    PubMed

    Udsen, Flemming Witt; Lilholt, Pernille Heyckendorff; Hejlesen, Ole; Ehlers, Lars Holger

    2014-05-21

    Several feasibility studies show promising results of telehealthcare on health outcomes and health-related quality of life for patients suffering from chronic obstructive pulmonary disease, and some of these studies show that telehealthcare may even lower healthcare costs. However, the only large-scale trial we have so far - the Whole System Demonstrator Project in England - has raised doubts about these results since it conclude that telehealthcare as a supplement to usual care is not likely to be cost-effective compared with usual care alone. The present study is known as 'TeleCare North' in Denmark. It seeks to address these doubts by implementing a large-scale, pragmatic, cluster-randomized trial with nested economic evaluation. The purpose of the study is to assess the effectiveness and the cost-effectiveness of a telehealth solution for patients suffering from chronic obstructive pulmonary disease compared to usual practice. General practitioners will be responsible for recruiting eligible participants (1,200 participants are expected) for the trial in the geographical area of the North Denmark Region. Twenty-six municipality districts in the region define the randomization clusters. The primary outcomes are changes in health-related quality of life, and the incremental cost-effectiveness ratio measured from baseline to follow-up at 12 months. Secondary outcomes are changes in mortality and physiological indicators (diastolic and systolic blood pressure, pulse, oxygen saturation, and weight). There has been a call for large-scale clinical trials with rigorous cost-effectiveness assessments in telehealthcare research. This study is meant to improve the international evidence base for the effectiveness and cost-effectiveness of telehealthcare to patients suffering from chronic obstructive pulmonary disease by implementing a large-scale pragmatic cluster-randomized clinical trial. Clinicaltrials.gov, http://NCT01984840, November 14, 2013.

  20. Evaluation of the cost effectiveness of exenatide versus insulin glargine in patients with sub-optimally controlled Type 2 diabetes in the United Kingdom

    PubMed Central

    Woehl, Anette; Evans, Mark; Tetlow, Anthony P; McEwan, Philip

    2008-01-01

    Objective Exenatide belongs to a new therapeutic class in the treatment of diabetes (incretin mimetics), allowing glucose-dependent glycaemic control in Type 2 diabetes. Randomised controlled trial data suggest that exenatide is as effective as insulin glargine at reducing HbA1c in combination therapy with metformin and sulphonylureas; with reduced weight but higher incidence of adverse gastrointestinal events. The objective of this study is to evaluate the cost effectiveness of exenatide versus insulin glargine using RCT data and a previously published model of Type 2 diabetes disease progression that is based on the United Kingdom Prospective Diabetes Study; the perspective of the health-payer of the United Kingdom National Health Service. Methods The study used a discrete event simulation model designed to forecast the costs and health outcome of a cohort of 1,000 subjects aged over 40 years with sub-optimally-controlled Type 2 diabetes, following initiation of either exenatide, or insulin glargine, in addition to oral hypoglycaemic agents. Sensitivity analysis for a higher treatment discontinuation rate in exenatide patients was applied to the cohort in three different scenarios; (1) either ignored or (2) exenatide-failures excluded or (3) exenatide-failures switched to insulin glargine. Analyses were undertaken to evaluate the price sensitivity of exenatide in terms of relative cost effectiveness. Baseline cohort profiles and effectiveness data were taken from a published randomised controlled trial. Results The relative cost-effectiveness of exenatide and insulin glargine was tested under a variety of conditions, in which insulin glargine was dominant in all cases. Using the most conservative of assumptions, the cost-effectiveness ratio of exenatide vs. insulin glargine at the current UK NHS price was -£29,149/QALY (insulin glargine dominant) and thus exenatide is not cost-effective when compared with insulin glargine, at the current UK NHS price. Conclusion

  1. A cost effectiveness analysis within a randomised controlled trial of post-acute care of older people in a community hospital

    PubMed Central

    O'Reilly, Jacqueline; Lowson, Karin; Young, John; Forster, Anne; Green, John; Small, Neil

    2006-01-01

    Objective To assess the cost effectiveness of post-acute care for older people in a locality based community hospital compared with a department for care of elderly people in a district general hospital, which admits patients aged over 76 years with acute medical conditions. Design Cost effectiveness analysis within a randomised controlled trial. Setting Community hospital and district general hospital in Yorkshire, England. Participants 220 patients needing rehabilitation after an acute illness for which they required admission to hospital. Interventions Multidisciplinary care in the district general hospital or prompt transfer to the community hospital. Main outcome measures EuroQol EQ-5D scores transformed into quality adjusted life years (QALYs), and health and social service costs over six months from randomisation. Results The mean QALY score for the community hospital group was marginally non-significantly higher than that for the district general hospital group (0.38 v 0.35) at six months after recruitment. The mean (standard deviation) costs per patient of the health and social services resources used were similar for both groups: community hospital group £7233 (euros 10 567; $13 341) (£5031), district general hospital group £7351 (£6229), and these findings were robust to several sensitivity analyses. The incremental cost effectiveness ratio for community hospital care dominated. A cost effectiveness acceptability curve, based on bootstrapped simulations, suggests that at a willingness to pay threshold of £10 000 per QALY, 51% of community hospital cases will be cost effective, which rises to 53% of cases when the threshold is £30 000 per QALY. Conclusion Post-acute care for older people in a locality based community hospital is of similar cost effectiveness to that of an elderly care department in a district general hospital. PMID:16861254

  2. Novel oral anticoagulants versus warfarin therapy at various levels of anticoagulation control in atrial fibrillation--a cost-effectiveness analysis.

    PubMed

    You, Joyce H S

    2014-03-01

    The decision as to whether to use more expensive novel oral anticoagulants (NOACs) or invest resources for quality improvement of warfarin therapy requires input from both clinical and economic analyses. Cost-effectiveness of NOACs compared to warfarin therapy at various levels of patient-time in therapeutic range (TTR) in patients with atrial fibrillation was examined, from the healthcare provider's perspective. A Markov model was used to compare life-long economic and treatment outcomes of warfarin and NOACs in a hypothetical cohort of 65-year-old atrial fibrillation patients with CHADS2 scores of 2 or above. Model inputs were derived from clinical trials published in the literature. The outcome measure was incremental cost per quality-adjusted life-year (QALY) gained (ICER). Using United States Dollar (USD) 50,000 as the threshold of willingness-to-pay per QALY, NOACs therapy was cost-effective when TTR of warfarin therapy was 60 % or below, or monthly cost of warfarin management increased by two-fold or more to achieve 70 % TTR. Warfarin therapy was cost-effective when TTR of warfarin was 70 % with up to a 1.5-fold increment in monthly cost of care, or when TTR reached 75 % with monthly cost of warfarin care increased up to three-fold. At TTR 60 %, 70 % and 75 %, NOACs was cost-effective when monthly drug cost was < USD 200, < USD 122-185 and < USD 85-145, respectively. 10,000 Monte Carlo simulations showed NOACs to be cost-effective 83.6 %, 50.7 % and 32.7 % of the time at TTR of 60 %, 70 % and 75 %, respectively. The acceptance of NOACs as cost-effective was highly dependent upon drug cost, anticoagulation control for warfarin, and anticoagulation service cost.

  3. Digital control system for space structural dampers

    NASA Technical Reports Server (NTRS)

    Haviland, J. K.

    1984-01-01

    Digital control systems for space structural dampers, also referred to as inertia or proof-mass dampers are investigated. A damper concept is improved by adding a small taper to the proof-mass, and using a proximeter to determine position. Another damper using a three inch stroke rather than the standard one inch stroke is described. Provisions are made for a relative velocity feedback. In one approach, the digital controller is modified to accept the signal from a linear velocity transducer. In the other, the velocity feedback is included in the digital program. An overall system concept for the use of the dampers is presented.

  4. The cost-effectiveness analysis of JinQi Jiangtang tablets for the treatment on prediabetes: a randomized, double-blind, placebo-controlled, multicenter design.

    PubMed

    Sun, Xiao; Guo, Liping; Shang, Hongcai; Ren, Ming; Wang, Yue; Huo, Da; Lei, Xiang; Wang, Hui; Zhai, Jingbo

    2015-11-03

    At present, diabetes is a chronic disease of great cost and heavy burdens. The International Diabetes Federation has repeatedly warned that by 2025, the global number of diabetics would rise to 333 million from 194 million in 2003. Although the occurrence of diabetes in developing countries is lower, China has a large population, so that the number of cases is increased. At the same time, more people have prediabetes, a growing health concern where a large percentage of the patients develop full type 2 diabetes. In addition, the patients of diabetes easily incur complications such as blindness, kidney failure, and cardiovascular diseases that can seriously affect the patients' quality of life and cause great economic burdens to family and society. Therefore, effective interventions for prediabetes are needed to prevent or delay the occurrence and development of diabetes. A randomized controlled trial that was assessed with pharmacoeconomic methods was undertaken in this study. The study term was 24 months (12 months for the intervention and 12 months for follow up). Four hundred participants, recruited from four cities in China: Beijing, Tianjin, Xian, and Naning, were randomized to the treatment group (JQJT tablets) and the control group (placebo). Participants included in this study had been diagnosed with prediabetes according to the criteria for western medicine and Traditional Chinese Medicine (TCM). The end-point effectiveness indexes included the incidence of diabetes and the reversion rate. The drug costs and lifestyle intervention costs were included in the total costs. The study used the cost-effectiveness analysis to discuss the economic advantage of the JQJT tablets. The outcomes of the study contained 2 sections,namely clinical outcomes and cost-effectiveness analysis outcomes. The clinical outcomes: the treatment group and control group had no significant statistical difference P> 0.05) on the baseline of situation; Jinqi Jiangtang tablet effectively

  5. Evaluating Multi-Input/Multi-Output Digital Control Systems

    NASA Technical Reports Server (NTRS)

    Pototzky, Anthony S.; Wieseman, Carol D.; Hoadley, Sherwood T.; Mukhopadhyay, Vivek

    1994-01-01

    Controller-performance-evaluation (CPE) methodology for multi-input/multi-output (MIMO) digital control systems developed. Procedures identify potentially destabilizing controllers and confirm satisfactory performance of stabilizing ones. Methodology generic and used in many types of multi-loop digital-controller applications, including digital flight-control systems, digitally controlled spacecraft structures, and actively controlled wind-tunnel models. Also applicable to other complex, highly dynamic digital controllers, such as those in high-performance robot systems.

  6. Evaluation of the clinical and cost effectiveness of intermediate care clinics for diabetes (ICCD): a multicentre cluster randomised controlled trial.

    PubMed

    Wilson, Andrew; O'Hare, Joseph Paul; Hardy, Ainsley; Raymond, Neil; Szczepura, Ala; Crossman, Ric; Baines, Darrin; Khunti, Kamlesh; Kumar, Sudhesh; Saravanan, Ponnusamy

    2014-01-01

    Configuring high quality care for the rapidly increasing number of people with type 2 diabetes (T2D) is a major challenge worldwide for both providers and commissioners. In the UK, about two thirds of people with T2D are managed entirely in primary care, with wide variation in management strategies and achievement of targets. Pay for performance, introduced in 2004, initially resulted in improvements but disparities exist in ethnic minorities and the improvements are levelling off. Community based, intermediate care clinics for diabetes (ICCDs) were considered one solution and are functioning across the UK. However, there is no randomised trial evidence for the effectiveness of such clinics. This is a cluster-randomised trial, involving 3 primary care trusts, with 49 general practices randomised to usual care (n=25) or intervention (ICCDs; n=24). All eligible adult patients with T2D were invited; 1997 were recruited and 1280 followed-up after 18-months intervention. achievement of all three of the NICE targets [(HbA1c ≤ 7.0%/53 mmol/mol; Blood Pressure <140/80 mmHg; cholesterol <154 mg/dl (4 mmol/l)]. PRIMARY OUTCOME was achieved in 14.3% in the intervention arm vs. 9.3% in the control arm (p=0.059 after adjustment for covariates). The odds ratio (95% CI) for achieving primary outcome in the intervention group was 1.56 (0.98, 2.49). Primary care and community clinic costs were significantly higher in the intervention group, but there were no significant differences in hospital costs or overall healthcare costs. An incremental cost-effectiveness ratio (ICER) of +£7,778 per QALY gained, indicated ICCD was marginally more expensive at producing health gain. Intermediate care clinics can contribute to improving target achievement in patients with diabetes. Further work is needed to investigate the optimal scale and organisational structure of ICCD services and whether, over time, their role may change as skill levels in primary care increase. ClinicalTrials.gov NCT

  7. Universal test, treat, and keep: improving ART retention is key in cost-effective HIV control in Uganda.

    PubMed

    McCreesh, Nicky; Andrianakis, Ioannis; Nsubuga, Rebecca N; Strong, Mark; Vernon, Ian; McKinley, Trevelyan J; Oakley, Jeremy E; Goldstein, Michael; Hayes, Richard; White, Richard G

    2017-05-03

    With ambitious new UNAIDS targets to end AIDS by 2030, and new WHO treatment guidelines, there is increased interest in the best way to scale-up ART coverage. We investigate the cost-effectiveness of various ART scale-up options in Uganda. Individual-based HIV/ART model of Uganda, calibrated using history matching. 22 ART scale-up strategies were simulated from 2016 to 2030, comprising different combinations of six single interventions (1. increased HIV testing rates, 2. no CD4 threshold for ART initiation, 3. improved ART retention, 4. increased ART restart rates, 5. improved linkage to care, 6. improved pre-ART care). The incremental net monetary benefit (NMB) of each intervention was calculated, for a wide range of different willingness/ability to pay (WTP) per DALY averted (health-service perspective, 3% discount rate). For all WTP thresholds above $210, interventions including removing the CD4 threshold were likely to be most cost-effective. At a WTP of $715 (1 × per-capita-GDP) interventions to improve linkage to and retention/re-enrolment in HIV care were highly likely to be more cost-effective than interventions to increase rates of HIV testing. At higher WTP (> ~ $1690), the most cost-effective option was 'Universal Test, Treat, and Keep' (UTTK), which combines interventions 1-5 detailed above. Our results support new WHO guidelines to remove the CD4 threshold for ART initiation in Uganda. With additional resources, this could be supplemented with interventions aimed at improving linkage to and/or retention in HIV care. To achieve the greatest reductions in HIV incidence, a UTTK policy should be implemented.

  8. Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain: A Randomized Controlled Trial.

    PubMed

    Kemani, Mike K; Olsson, Gunnar L; Lekander, Mats; Hesser, Hugo; Andersson, Erik; Wicksell, Rikard K

    2015-11-01

    To date, few studies have compared Acceptance and Commitment Therapy (ACT) for longstanding pain with established treatments. Only 1 study has evaluated the cost-effectiveness of ACT. The aim of the current study was to evaluate the efficacy and cost-effectiveness of ACT and applied relaxation (AR) for adults with unspecific, longstanding pain. On the basis of the inclusion criteria 60 consecutive patients received 12 weekly group sessions of ACT or AR. Data were collected pretreatment, midtreatment, and posttreatment, as well as at 3- and 6-month follow-up. Growth curve modeling was used to analyze treatment effects on pain disability, pain intensity, health-related quality of life (physical domain), anxiety, depression, and acceptance. Significant improvements were seen across conditions (pretreatment to follow-up assessment) on all outcome measures. Pain disability decreased significantly in ACT relative to AR from preassessment to postassessment. A corresponding decrease in pain disability was seen in AR between postassessment and 6-month follow-up. Pain acceptance increased only in ACT, and this effect was maintained at 6-month follow-up. Approximately 20% of the participants achieved clinically significant change after treatment. Health economic analyses showed that ACT was more cost-effective than AR at post and 3-month follow-up assessment, but not at 6-month follow-up. More studies investigating moderators and mediators of change are needed. The present study is one of few that have evaluated the cost-effectiveness of ACT and AR and compared ACT with an established behavioral intervention, and the results provide additional support for behavioral interventions for longstanding pain.

  9. Percutaneous Cryoablation of Metastatic Renal Cell Carcinoma for Local Tumor Control: Feasibility, Outcomes, and Estimated Cost-effectiveness for Palliation

    PubMed Central

    Bang, Hyun J.; Littrup, Peter J.; Goodrich, Dylan J.; Currier, Brandt P.; Aoun, Hussein D.; Heilbrun, Lance K.; Vaishampayan, Ulka; Adam, Barbara; Goodman, Allen C.

    2013-01-01

    Purpose To assess complications, local tumor recurrences, overall survival (OS), and estimates of cost-effectiveness for multisite cryoablation (MCA) of oligometastatic renal cell carcinoma (RCC). Materials and Methods A total of 60 computed tomography- and/or ultrasound-guided percutaneous MCA procedures were performed on 72 tumors in 27 patients (three women and 24 men). Average patient age was 63 years. Tumor location was grouped according to common metastatic sites. Established surgical selection criteria graded patient status. Median OS was determined by Kaplan–Meier method and defined life-years gained (LYGs). Estimates of MCA costs per LYG were compared with established values for systemic therapies. Results Total number of tumors and cryoablation procedures for each anatomic site are as follows: nephrectomy bed, 11 and 11; adrenal gland, nine and eight; paraaortic, seven and six; lung, 14 and 13; bone, 13 and 13; superficial, 12 and nine; intraperitoneal, five and three; and liver, one and one. A mean of 2.2 procedures per patient were performed, with a median clinical follow-up of 16 months. Major complication and local recurrence rates were 2% (one of 60) and 3% (two of 72), respectively. No patients were graded as having good surgical risk, but median OS was 2.69 years, with an estimated 5-year survival rate of 27%. Cryoablation remained cost-effective with or without the presence of systemic therapies according to historical cost comparisons, with an adjunctive cost-effectiveness ratio of $28,312–$59,554 per LYG. Conclusions MCA was associated with very low morbidity and local tumor recurrence rates for all anatomic sites, with apparent increased OS. Even as an adjunct to systemic therapies, MCA appeared cost-effective for palliation of oligometastatic RCC. PMID:22538119

  10. A cost-effective approach to the development of printed materials: a randomized controlled trial of three strategies.

    PubMed

    Paul, C L; Redman, S; Sanson-Fisher, R W

    2004-12-01

    Printed materials have been a primary mode of communication in public health education. Three major approaches to the development of these materials--the application of characteristics identified in the literature, behavioral strategies and marketing strategies--have major implications for both the effectiveness and cost of materials. However, little attention has been directed towards the cost-effectiveness of such approaches. In the present study, three pamphlets were developed using successive addition of each approach: first literature characteristics only ('C' pamphlet), then behavioral strategies ('C + B' pamphlet) and then marketing strategies ('C + B + M' pamphlet). Each pamphlet encouraged women to join a Pap Test Reminder Service (PTRS). Each pamphlet was mailed to a randomly selected sample of 2700 women aged 50-69 years. Registrations with the PTRS were monitored and 420 women in each pamphlet group were surveyed by telephone. It was reported that the 'C + B' and 'C + B + M' pamphlets were significantly more effective than the 'C' pamphlet. The 'C + B' pamphlet was the most cost-effective of the three pamphlets. There were no significant differences between any of the pamphlet groups on acceptability, knowledge or attitudes. It was suggested that the inclusion of behavioral strategies is likely to be a cost-effective approach to the development of printed health education materials.

  11. Direct Digital Control Liquid Level Experiment.

    ERIC Educational Resources Information Center

    Adb-El-Bary, M. F.

    1983-01-01

    Describes an experiment to give students exposure to digital control widely used in industry but not given much attention in most undergraduate process control curricula. Students write their own control programs and experimentally determine the transfer functions for all system components. Also describes experimental apparatus used in the…

  12. Cost-effectiveness of tailored print communication, telephone motivational interviewing, and a combination of the two: results of an economic evaluation alongside the Vitalum randomized controlled trial

    PubMed Central

    2010-01-01

    Background The aim of the present study was to evaluate the cost-effectiveness of tailored print communication (TPC), telephone motivational interviewing (TMI), a combination of the two, and no intervention on two outcomes in adults aged 45 to 70, half of them having hypertension: increasing the number of public health guidelines met for three behaviors (physical activity and fruit and vegetable consumption), and impact on quality adjusted life years (QALYs). Methods Participants (n = 1,629) from 23 Dutch general practices were randomized into one of four groups, which received 4 TPCs, 4 TMIs, 2 of each (combined), or no intervention (control), respectively. The self-reported outcomes, measured at baseline and 73 weeks follow-up (7 months after the last intervention component), were difference in total number of guidelines met at follow-up compared to baseline, and number of QALYs experienced over 73 weeks. The costs of implementing the intervention were estimated using a bottom-up approach. Results At 73 weeks follow-up participants showed increased adherence with 0.62 (TPC), 0.40 (TMI), 0.50 (combined), and 0.26 (control) guidelines compared to baseline, and experienced 1.09, 1.08, 1.08, and 1.07 QALYs, respectively. The costs for the control group were considered to be zero. TMI was more expensive (€107 per person) than both the combined intervention (€80) and TPC (€57). The control condition was most cost-effective for lower ceiling ratios, while TPC had the highest probability of being most cost-effective for higher ceiling ratios (more than €160 per additional guideline met, and €2,851 for each individual QALY). Conclusions For low society's willingness to pay, the control group was most cost-effective for the number of QALYs experienced over 73 weeks. This also applied to the increase in the number of guidelines met at lower ceiling ratios, whereas at higher ceiling ratios, TPC had a higher probability of being more cost-effective than the TMI

  13. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.

    PubMed

    Isetta, Valentina; Negrín, Miguel A; Monasterio, Carmen; Masa, Juan F; Feu, Nuria; Álvarez, Ainhoa; Campos-Rodriguez, Francisco; Ruiz, Concepción; Abad, Jorge; Vázquez-Polo, Francisco J; Farré, Ramon; Galdeano, Marina; Lloberes, Patricia; Embid, Cristina; de la Peña, Mónica; Puertas, Javier; Dalmases, Mireia; Salord, Neus; Corral, Jaime; Jurado, Bernabé; León, Carmen; Egea, Carlos; Muñoz, Aida; Parra, Olga; Cambrodi, Roser; Martel-Escobar, María; Arqué, Meritxell; Montserrat, Josep M

    2015-11-01

    Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). NCT01716676. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  14. Assessment of the impact of fibrates and diet on survival and their cost-effectiveness: evidence from randomized, controlled trials in coronary heart disease and health economic evaluations.

    PubMed

    Montagne, O; Vedel, I; Durand-Zaleski, I

    1999-11-01

    The fibrates are one of several classes of lipid-reducing agents commonly prescribed to reduce hypercholesterolemia and prevent coronary heart disease. In today's evidence-based, cost-conscious health care environment, interventions promoted by policymakers must provide clear clinical benefits and economic value. We assessed the evidence regarding the impact of fibrates and diet on survival and the cost-effectiveness of these interventions. A literature search was conducted for randomized, controlled trials of diet, fibrates, and heart disease that were published after 1971; both primary and secondary prevention clinical trials were reviewed, and recent literature reviews and meta-analyses were searched. The evidence that diet alone improves survival is poor, although specifically increasing intake of polyunsaturated fatty acid (including n-3 fatty acids) relative to saturated fatty acid intake may provide some clinical benefit in the secondary prevention of coronary heart disease. The cost-effectiveness of dietary intervention is also questionable because compliance is extremely poor. There is no consistent evidence from primary or secondary prevention trials that fibrates improve survival; in fact, fibrates may increase the risk of death from noncoronary causes. No consistent data suggest that fibrates are a cost-effective therapy. Because diet and fibrates do not appear to improve survival or provide value, policymakers should promote the use of alternative drug interventions that have consistently been proved to reduce mortality and are cost-effective.

  15. Assessing the effectiveness and cost-effectiveness of audit and feedback on physician’s prescribing indicators: study protocol of a randomized controlled trial with economic evaluation

    PubMed Central

    2012-01-01

    Background Physician prescribing is the most frequent medical intervention with a highest impact on healthcare costs and outcomes. Therefore improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of two forms of conducting prescribing audit and feedback interventions and a printed educational material intervention in improving physician prescribing. Method/design A four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider’s perspective and incremental cost-effectiveness ratios will be calculated. Discussion This study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide. Trial registration Iranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07 PMID:23351564

  16. Assessing the effectiveness and cost-effectiveness of audit and feedback on physician's prescribing indicators: study protocol of a randomized controlled trial with economic evaluation.

    PubMed

    Soleymani, Fatemeh; Rashidian, Arash; Dinarvand, Rassoul; Kebriaeezade, Abbas; Hosseini, Mostafa; Abdollahi, Mohammad

    2012-12-06

    Physician prescribing is the most frequent medical intervention with a highest impact on healthcare costs and outcomes. Therefore improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of two forms of conducting prescribing audit and feedback interventions and a printed educational material intervention in improving physician prescribing. A four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider's perspective and incremental cost-effectiveness ratios will be calculated. This study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide. Iranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07.

  17. Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial.

    PubMed

    Hedman, Erik; Andersson, Erik; Ljótsson, Brjánn; Andersson, Gerhard; Rück, Christian; Lindefors, Nils

    2011-11-01

    Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n=64) or CBGT (n=62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care

    PubMed Central

    2012-01-01

    Background There is insufficient evidence to determine whether acupuncture is a cost-effective treatment for irritable bowel syndrome. The objective of this study is to assess the cost-effectiveness of acupuncture as an adjunct to usual care versus usual care alone for the treatment of Irritable Bowel Syndrome (IBS). Methods Cost-utility analysis conducted alongside a pragmatic, multicentre, randomised controlled trial. 233 patients with irritable bowel syndrome were randomly allocated to either acupuncture plus usual care, or usual care alone. Cost-effectiveness outcomes are expressed in terms of incremental cost per quality adjusted life year (QALY) at one year after randomisation. Costs were estimated from the UK National Health Service perspective for a time horizon of one year. Cost-utility ratios were estimated based on complete case analysis for the base case analysis, where only patients with available EQ-5D and cost data were included. Sensitivity analyses comprised a multiple imputation approach for missing data and a subgroup analysis for the more severe cases of IBS. Results The base case analysis showed acupuncture to be marginally more effective than usual care (gain of 0.0035 QALYs, 95% CI: -0.00395 to 0.0465) and more expensive (incremental cost of £218 per patient (95% CI: 55.87 to 492.87) resulting in an incremental cost-effectiveness ratio of approximately £62,500. Sensitivity analysis using multiple imputation for missing data resulted in acupuncture appearing less effective and more costly than usual care, so usual care is dominant. Subgroup analysis selecting the most severe cases of IBS (Symptom Severity Score of over 300) suggested that acupuncture may be a cost-effective treatment option for this group, with a cost-per-QALY of £6,500. Conclusions Acupuncture as an adjunct to usual care is not a cost-effective option for the whole IBS population; however it may be cost-effective for those with more severe irritable bowel syndrome. Trial

  19. Cost-Effectiveness of a Model Infection Control Program for Preventing Multi-Drug-Resistant Organism Infections in Critically Ill Surgical Patients.

    PubMed

    Jayaraman, Sudha P; Jiang, Yushan; Resch, Stephen; Askari, Reza; Klompas, Michael

    2016-10-01

    Interventions to contain two multi-drug-resistant Acinetobacter (MDRA) outbreaks reduced the incidence of multi-drug-resistant (MDR) organisms, specifically methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile in the general surgery intensive care unit (ICU) of our hospital. We therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of MDR organisms based on the practices used to control the MDRA outbreak. We created a model of a proactive infection control program based on the 2011 MDRA outbreak response. We built a decision analysis model and performed univariable and probabilistic sensitivity analyses to evaluate the cost-effectiveness of the proposed program compared with standard infection control practices to reduce transmission of these MDR organisms. The cost of a proactive infection control program would be $68,509 per year. The incremental cost-effectiveness ratio (ICER) was calculated to be $3,804 per aversion of transmission of MDR organisms in a one-year period compared with standard infection control. On the basis of probabilistic sensitivity analysis, a willingness-to-pay (WTP) threshold of $14,000 per transmission averted would have a 42% probability of being cost-effective, rising to 100% at $22,000 per transmission averted. This analysis gives an estimated ICER for implementing a proactive program to prevent transmission of MDR organisms in the general surgery ICU. To better understand the causal relations between the critical steps in the program and the rate reductions, a randomized study of a package of interventions to prevent healthcare-associated infections should be considered.

  20. Digital Control Of A Telescope In An Airplane

    NASA Technical Reports Server (NTRS)

    Mccormack, Ann C.; Snyder, Philip K.

    1991-01-01

    Options for design of aim-stabilizing system analyzed. Report discusses feasibility of digital control system stabilizing aim of 30-in. telescope aboard NASA C141 airplane known as Kuiper Atmospheric Observatory. Proposed digital compensator consists of input analog-to-digital converter, digital controller processor, and output digital-to-analog converter.

  1. Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV

    PubMed Central

    Ong, Jason J; Fairley, Christopher K; Carroll, Susan; Walker, Sandra; Chen, Marcus; Read, Tim; Grulich, Andrew; Bradshaw, Catriona; Kaldor, John; Clarke, Philip

    2016-01-01

    Introduction Anal cancer in men who have sex with men (MSM) living with HIV is an important issue but there are no consistent guidelines for how to screen for this cancer. In settings where screening with anal cytology is unavailable, regular anal examinations have been proposed in some guidelines but their cost-effectiveness is unknown. Methods Our objective was to estimate the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive MSM living in Australia using a probabilistic Markov model. Data sources were based on the medical literature and a clinical trial of HIV-positive MSM receiving an annual anal examination in Australia. The main outcome measures for calculating effectiveness were undiscounted and discounted (at 3%) lifetime costs, life years gained, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratio (ICER). Results Base-case analysis estimated the average cost of screening for and management of anal cancer ranged from $195 for no screening to $1,915 for lifetime annual screening of men aged ≥ 50. Screening of men aged ≥ 50 generated ICERs of $29,760 per QALY gained (for screening every four years), $32,222 (every three years) and $45,484 (every two years). Uncertainty for ICERs was mostly influenced by the cost (financially and decrease in quality of life) from a false-positive result, progression rate of anal cancer, specificity of the anal examination, the probability of detection outside a screening program and the discount rate. Conclusions Screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥ 50 is most likely to be cost-effective by conventional standards. Given that anal pap smears are not widely available yet in many clinical settings, regular anal exams for MSM living with HIV to detect anal cancer earlier should be implemented. PMID:26942721

  2. The effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial.

    PubMed

    Kuyken, Willem; Nuthall, Elizabeth; Byford, Sarah; Crane, Catherine; Dalgleish, Tim; Ford, Tamsin; Greenberg, Mark T; Ukoumunne, Obioha C; Viner, Russell M; Williams, J Mark G

    2017-04-26

    Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness or cost-effectiveness for young people. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of a mindfulness training (MT) programme to enhance mental health, wellbeing and social-emotional behavioural functioning in adolescence. To address this aim, the design will be a superiority, cluster randomised controlled, parallel-group trial in which schools offering social and emotional provision in line with good practice (Formby et al., Personal, Social, Health and Economic (PSHE) Education: A mapping study of the prevalent models of delivery and their effectiveness, 2010; OFSTED, Not Yet Good Enough: Personal, Social, Health and Economic Education in schools, 2013) will be randomised to either continue this provision (control) or include MT in this provision (intervention). The study will recruit and randomise 76 schools (clusters) and 5700 school students aged 12 to 14 years, followed up for 2 years. The study will contribute to establishing if MT is an effective and cost-effective approach to promoting mental health in adolescence. International Standard Randomised Controlled Trials, identifier: ISRCTN86619085 . Registered on 3 June 2016.

  3. Cost-Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infection in Long-Term Care Facilities: Economic Evaluation with a Randomized Controlled Trial

    PubMed Central

    van den Hout, Wilbert B; Caljouw, Monique A A; Putter, Hein; Cools, Herman J M; Gussekloo, Jacobijn

    2014-01-01

    Objectives To investigate whether the preventive use of cranberry capsules in long-term care facility (LTCF) residents is cost-effective depending on urinary tract infection (UTI) risk. Design Economic evaluation with a randomized controlled trial. Setting Long-term care facilities. Participants LTCF residents (N = 928, 703 female, median age 84), stratified according to UTI risk. Measurements UTI incidence (clinically or strictly defined), survival, quality of life, quality-adjusted life years (QALYs), and costs. Results In the weeks after a clinical UTI, participants showed a significant but moderate deterioration in quality of life, survival, care dependency, and costs. In high-UTI-risk participants, cranberry costs were estimated at €439 per year (1.00 euro = 1.37 U.S. dollar), which is €3,800 per prevented clinically defined UTI (95% confidence interval = €1,300–infinity). Using the strict UTI definition, the use of cranberry increased costs without preventing UTIs. Taking cranberry capsules had a 22% probability of being cost-effective compared with placebo (at a willingness to pay of €40,000 per QALY). In low-UTI-risk participants, use of cranberry capsules was only 3% likely to be cost-effective. Conclusion In high-UTI-risk residents, taking cranberry capsules may be effective in preventing UTIs but is not likely to be cost-effective in the investigated dosage, frequency, and setting. In low-UTI-risk LTCF residents, taking cranberry capsules twice daily is neither effective nor cost-effective. PMID:25180379

  4. Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial

    PubMed Central

    Stokes, E A; Wordsworth, S; Bargo, D; Pike, K; Rogers, C A; Brierley, R C M; Angelini, G D; Murphy, G J; Reeves, B C

    2016-01-01

    Objective To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery. Design A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK. Setting 17 specialist cardiac surgery centres in UK NHS hospitals. Participants 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL. Interventions Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery. Main outcome measures Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). Results The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is −£182, 95% CI −£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI −0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained. Conclusions We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery. Trial registration number ISRCTN70923932; Results. PMID:27481621

  5. Post-acute care for older people in community hospitals--a cost-effectiveness analysis within a multi-centre randomised controlled trial.

    PubMed

    O'Reilly, Jacqueline; Lowson, Karin; Green, John; Young, John B; Forster, Anne

    2008-09-01

    to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care. cost-effectiveness study embedded within a randomised controlled trial. seven community hospitals and five general hospitals at five centres in the midlands and north of England. 490 patients needing rehabilitation following hospital admission with an acute illness. multidisciplinary team care for older people in community hospitals. EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation. there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval -0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social services resources used were comparable for both groups: community hospital group 8,946 pounds ( 6,514 pounds); general hospital group 8,226 pounds ( 7,453 pounds). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was 16,324 pounds per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was 10,000 pounds, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to 30,000 pounds. the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.

  6. Digital control system for space structure dampers

    NASA Technical Reports Server (NTRS)

    Haviland, J. K.

    1985-01-01

    A digital controller was developed using an SKD-51 System Design Kit, which incorporates an 8031 microcontroller. The necessary interfaces were installed in the wire wrap area of the SKD-51 and a pulse width modulator was developed to drive the coil of the actuator. Also, control equations were developed, using floating-point arithmetic. The design of the digital control system is emphasized, and it is shown that, provided certain rules are followed, an adequate design can be achieved. It is recommended that the so-called w-plane design method be used, and that the time elapsed before output of the up-dated coil-force signal be kept as small as possible. However, the cycle time for the controller should be watched carefully, because very small values for this time can lead to digital noise.

  7. Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial.

    PubMed

    Murphy, Sean M; Campbell, Aimee N C; Ghitza, Udi E; Kyle, Tiffany L; Bailey, Genie L; Nunes, Edward V; Polsky, Daniel

    2016-04-01

    Substance misuse and excessive alcohol consumption are major public health issues. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for addressing barriers to access and supplementing existing care. This study examines cost-effectiveness in a multisite, randomized trial of an internet-based version of the community reinforcement approach (CRA) with contingency management (CM) known as the Therapeutic Education System (TES). Economic evaluation of the 12-week trial with follow-up at 24 and 36 weeks. 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs were recruited and randomized to either treatment as usual (TAU) or TES+TAU. Sub-analyses were completed on participants with a poorer prognosis (i.e., those not abstinent at study entry). From the provider's perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable. With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Cost-Effectiveness of an Internet-Delivered Treatment for Substance Abuse: Data from a Multisite Randomized Controlled Trial

    PubMed Central

    Murphy, Sean M.; Campbell, Aimee N. C.; Ghitza, Udi E.; Kyle, Tiffany L.; Bailey, Genie L.; Nunes, Edward V.; Polsky, Daniel

    2016-01-01

    Background Substance misuse and excessive alcohol consumption are major public health issues. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for addressing barriers to access and supplementing existing care. This study examines cost-effectiveness in a multisite, randomized trial of an internet-based version of the community reinforcement approach (CRA) with contingency management (CM) known as the Therapeutic Education System (TES). Methods Economic evaluation of the 12-week trial with follow-up at 24 and 36 weeks. 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs were recruited and randomized to either treatment as usual (TAU) or TES+TAU. Sub-analyses were completed on participants with a poorer prognosis (i.e., those not abstinent at study entry). Results From the provider’s perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable. Conclusions With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy. Clinical trial registration NCT01104805. PMID:26880594

  9. Study comparing "Kangaroo Ward Care" with "Intermediate Intensive Care" for improving the growth outcome and cost effectiveness: randomized control trial.

    PubMed

    Sharma, Deepak; Murki, Srinivas; Oleti, Tejo Pratap

    2017-08-02

    The aim of this study was to compare growth outcome and cost effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable infants with birth weight 1000 g to <1100 g. In this secondary analysis, we included 79 infants, with birth weight 1000 g to <1100 g. Thirty-eight were randomized to KWC and 41 to IIC group once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attained a weight of 1250 g before shifting to Kangaroo Ward. After shifting to Kangaroo ward, infants in the IIC group received equivalent care to KWC group infants. There was significant better weight gain post-randomization during hospital stay and better length gain till 40 weeks of gestational age in intervention arm. There was reduction of post-randomization hospital stay by 2 d in the KWC group. The infants in the KWC group were shifted 6 d earlier to Kangaroo ward from IIC when compared with the IIC group. The cost-effective analysis that used "top-down" and "bottom-up" accounting method showed significant reduction of hospital and parents expenditure in the KWC group (p < .001) with saving of 570 USD per patient in the KWC group. Early shifting of infants to Kangaroo ward with birth weight 1000 g to <1100 g leads to better growth and is cost effective (CTRI/2014/05/004625). Clinical trial registry of India CTRI/2014/05/004625.

  10. Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana.

    PubMed

    Pitt, Catherine; Tawiah, Theresa; Soremekun, Seyi; ten Asbroek, Augustinus H A; Manu, Alexander; Tawiah-Agyemang, Charlotte; Hill, Zelee; Owusu-Agyei, Seth; Kirkwood, Betty R; Hanson, Kara

    2016-01-01

    Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5-18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting. We prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI -12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20-60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates. In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to -7674) per newborn life saved, or $352 (95% CI 104 to -268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER

  11. Designing Digital Control Systems With Averaged Measurements

    NASA Technical Reports Server (NTRS)

    Polites, Michael E.; Beale, Guy O.

    1990-01-01

    Rational criteria represent improvement over "cut-and-try" approach. Recent development in theory of control systems yields improvements in mathematical modeling and design of digital feedback controllers using time-averaged measurements. By using one of new formulations for systems with time-averaged measurements, designer takes averaging effect into account when modeling plant, eliminating need to iterate design and simulation phases.

  12. Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)

    PubMed Central

    2012-01-01

    Abstract Background Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions Cryotherapy is more costly and no more effective than salicylic acid. Trial registration Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151. PMID:22369511

  13. Cost-effectiveness of an experimental caries-control regimen in a 3.4-yr randomized clinical trial among 11-12-yr-old Finnish schoolchildren.

    PubMed

    Hietasalo, Pauliina; Seppä, Liisa; Lahti, Satu; Niinimaa, Ahti; Kallio, Jouko; Aronen, Pasi; Sintonen, Harri; Hausen, Hannu

    2009-12-01

    The aim of this study was to assess the cost-effectiveness of an experimental caries-control regimen in a randomized clinical trial (RCT) conducted in Pori, Finland, in 2001-2005. Children (n = 497) who were 11-12 yr of age and had at least one active initial caries lesion at baseline were studied. The children in the experimental group (n = 250) were offered an individually designed patient-centered regimen for caries control. The children in the control group (n = 247) received standard dental care. Furthermore, the whole population was exposed to continuous community-level oral health promotion. Individual costs of treatment procedures and outcomes (DMFS increment score) for the follow-up period of 3.4 yr were calculated for each child in both groups. The incremental cost-effectiveness ratio was euro 34.07 per averted DMF surface. The experimental regimen was more effective, and also more costly. However, the total costs decreased year after year, and for the last 2 yr the experimental regimen was less expensive than the standard dental care. The experimental regimen would probably have been more cost-effective than standard dental care if the follow-up period had been longer, the regimen less comprehensive, and/or if dental nurses had conducted the preventive procedures.

  14. GMA200 ATEGG Digital Controls Demonstration.

    DTIC Science & Technology

    1979-10-01

    Technologyi Demonstrator Variable Cycle Engines Digital Controls Control Modes Turbine Engine Controls Signal Synthesis 20 A 8STRACI ’CantInue -n r.ct...Turbine Outlet Temperature TX Temperature at Station Location X UTC Universal Test Console VCE Variable Cycle Engine VG Variable Geometry W Flow WA...Definition of engine control variables - ATEGG is a variaole cycle engine with a multi-input, multi-output structure. The multi-input part of tna

  15. Clinical Impact and Cost-Effectiveness of an Education Program for PD Patients: A Randomized Controlled Trial

    PubMed Central

    Ory-Magne, Fabienne; Arcari, Céline; Mohara, Christine; Pourcel, Laure; Derumeaux, Hélène; Bérard, Emilie; Bourrel, Robert; Molinier, Laurent; Brefel-Courbon, Christine

    2016-01-01

    Background Parkinson’s disease (PD) is characterized by its impact on quality of life, constituting a substantial economic burden on society. Education programs implicating patients more in the management of their illness and complementing medical treatment may be a beneficial adjunct in PD. This study assessed the impact of an education program on quality of life and its cost-effectiveness in PD patients. Methods This single-center, prospective, randomized study assessed an education program consisting of individual and group sessions over a 12-month period. A total of 120 PD patients were assigned to either the Treated by Behavioral Intervention group (TTBI) or the no TTBI group. The primary outcome criterion was quality of life assessed using PDQ39. The Unified Parkinson’s Disease Rating Scale (UPDRS) and psychological status were collected. An economic evaluation was performed, including calculations of incremental cost-effectiveness ratios (ICERs). Results After 12 months of follow-up, changes recorded in the PDQ39 between the groups were not significantly different but better changes were observed in each dimension in the TTBI group compared to the no TTBI group. UPDRS I, II and total score were significantly improved in TTBI group compared to the no TTBI group. Mean annual costs did not differ significantly between the two groups. Conclusion This study suggested that the education program positively impacts the perceived health of PD patients without increasing medical costs. PMID:27685455

  16. Clinical Impact and Cost-Effectiveness of an Education Program for PD Patients: A Randomized Controlled Trial.

    PubMed

    Canivet, Cindy; Costa, Nadège; Ory-Magne, Fabienne; Arcari, Céline; Mohara, Christine; Pourcel, Laure; Derumeaux, Hélène; Bérard, Emilie; Bourrel, Robert; Molinier, Laurent; Brefel-Courbon, Christine

    Parkinson's disease (PD) is characterized by its impact on quality of life, constituting a substantial economic burden on society. Education programs implicating patients more in the management of their illness and complementing medical treatment may be a beneficial adjunct in PD. This study assessed the impact of an education program on quality of life and its cost-effectiveness in PD patients. This single-center, prospective, randomized study assessed an education program consisting of individual and group sessions over a 12-month period. A total of 120 PD patients were assigned to either the Treated by Behavioral Intervention group (TTBI) or the no TTBI group. The primary outcome criterion was quality of life assessed using PDQ39. The Unified Parkinson's Disease Rating Scale (UPDRS) and psychological status were collected. An economic evaluation was performed, including calculations of incremental cost-effectiveness ratios (ICERs). After 12 months of follow-up, changes recorded in the PDQ39 between the groups were not significantly different but better changes were observed in each dimension in the TTBI group compared to the no TTBI group. UPDRS I, II and total score were significantly improved in TTBI group compared to the no TTBI group. Mean annual costs did not differ significantly between the two groups. This study suggested that the education program positively impacts the perceived health of PD patients without increasing medical costs.

  17. Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial.

    PubMed

    McBain, Ryan K; Salhi, Carmel; Hann, Katrina; Salomon, Joshua A; Kim, Jane J; Betancourt, Theresa S

    2016-05-01

    One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product

  18. Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial

    PubMed Central

    McBain, Ryan K; Salhi, Carmel; Hann, Katrina; Salomon, Joshua A; Kim, Jane J; Betancourt, Theresa S

    2016-01-01

    Background: One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. Methods: The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15–24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An ‘ingredients approach’ estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. Results: Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers’ interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = −1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. Conclusions: The YRI is not cost-effective at a willingness

  19. Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial

    PubMed Central

    2013-01-01

    Background A recent HTA review concluded that there was a need for RCTs of exercise referral schemes (ERS) for people with a medical diagnosis who might benefit from exercise. Overall, there is still uncertainty as to the cost-effectiveness of ERS. Evaluation of public health interventions places challenges on conventional health economics approaches. This economic evaluation of a national public health intervention addresses this issue of where ERS may be most cost effective through subgroup analysis, particularly important at a time of financial constraint. Method This economic analysis included 798 individuals aged 16 and over (55% of the randomised controlled trial (RCT) sample) with coronary heart disease risk factors and/or mild to moderate anxiety, depression or stress. Individuals were referred by health professionals in a primary care setting to a 16 week national exercise referral scheme (NERS) delivered by qualified exercise professionals in local leisure centres in Wales, UK. Health-related quality of life, health care services use, costs per participant in NERS, and willingness to pay for NERS were measured at 6 and 12 months. Results The base case analysis assumed a participation cost of £385 per person per year, with a mean difference in QALYs between the two groups of 0.027. The incremental cost-effectiveness ratio was £12,111 per QALY gained. Probabilistic sensitivity analysis demonstrated an 89% probability of NERS being cost-effective at a payer threshold of £30,000 per QALY. When participant payments of £1 and £2 per session were considered, the cost per QALY fell from £12,111 (base case) to £10,926 and £9,741, respectively. Participants with a mental health risk factor alone or in combination with a risk of chronic heart disease generated a lower ICER (£10,276) compared to participants at risk of chronic heart disease only (£13,060). Conclusions Results of cost-effectiveness analyses suggest that NERS is cost saving in fully

  20. Cost-effective particulate control options at Potomac Electric Power Company's Dickerson Station: An integrated approach to current and future particulate limits

    SciTech Connect

    Christoffersen, S.W.; Rouse, G.T.; Krasnopoler, M.J.; Chapowski, J.A.

    1998-07-01

    The Dickerson Generating Station evaluated several particulate control options to identify the most cost-effective option. The study's goals were to: eliminate the particulate scrubber and its high maintenance costs, and incorporate flexibility for low-sulfur coal and possible stricter emission limits. Each of the three Dickerson 190 MW units has a small 37-year-old electrostatic precipitator and a wet particulate scrubber. The study evaluated alternatives to replace the scrubber and enhance ESP performance: Existing ESP alternatives--Extend height of existing ESP; Flue gas conditioning. Scrubber stream alternatives--Partial-flow ESP or pulse jet baghouse. Full-flow alternatives--Supplemental ESP; COHPAC baghouse; replacement ESP or baghouse. A technical and economic prescreening eliminated some of the options. Capital, operating, and life cycle costs were estimated for the remaining options to determine the most cost-effective alternative. This paper will present the technical and economic evaluations done for this study, including performance and costs.

  1. Digital system identification and its application to digital flight control

    NASA Technical Reports Server (NTRS)

    Kotob, S.; Kaufman, H.

    1974-01-01

    On-line system identification of linear discrete systems for implementation in a digital adaptive flight controller is considered by the conventional extended Kalman filter and a decoupling process in which the linear state estimation problem and the linear parameter identification problem are each treated separately and alternately. Input requirements for parameter identifiability are established using the standard conditions of observability for a time variant system. Experimental results for simulated linearized lateral aircraft motion are included along with the effect of different initialization and updating procedures for the priming trajectory used by the filter.

  2. Cost-effectiveness of silver dressings for paediatric partial thickness burns: An economic evaluation from a randomized controlled trial.

    PubMed

    Gee Kee, E; Stockton, K; Kimble, R M; Cuttle, L; McPhail, S M

    2017-06-01

    Partial thickness burns of up to 10% total body surface area (TBSA) in children are common injuries primarily treated in the outpatient setting using expensive silver-containing dressings. However, economic evaluations in the paediatric burns population are lacking to assist healthcare providers when choosing which dressing to use. The aim of this study was to conduct a cost-effectiveness analysis of three silver dressings for partial thickness burns ≤10% TBSA in children aged 0-15 years using days to full wound re-epithelialization as the health outcome. This study was a trial based economic evaluation (incremental cost effectiveness) conducted from a healthcare provider perspective. Ninety-six children participated in the trial investigating Acticoat™, Acticoat™ with Mepitel™ or Mepilex Ag™. Costs directly related to the management of partial thickness burns ≤10% TBSA were collected during the trial from March 2013 to July 2014 and for a one year after re-epithelialization time horizon. Incremental cost effectiveness ratios were estimated and dominance probabilities calculated from bootstrap resampling trial data. Sensitivity analyses were conducted to examine the potential effect of accounting for infrequent, but high cost, skin grafting surgical procedures. Costs (dressing, labour, analgesics, scar management) were considerably lower in the Mepilex Ag™ group (median AUD$94.45) compared to the Acticoat™ (median $244.90) and Acticoat™ with Mepitel™ (median $196.66) interventions. There was a 99% and 97% probability that Mepilex Ag™ dominated (cheaper and more effective than) Acticoat™ and Acticoat™ with Mepitel™, respectively. This pattern of dominance was consistent across raw cost and effects, after a priori adjustments, and sensitivity analyses. There was an 82% probability that Acticoat™ with Mepitel dominated Acticoat™ in the primary analysis, although this probability was sensitive to the effect of skin graft procedures. This

  3. Costs and cost-effectiveness of epidural steroids for acute lumbosacral radicular syndrome in general practice: an economic evaluation alongside a pragmatic randomized control trial.

    PubMed

    Spijker-Huiges, Antje; Vermeulen, Karin; Winters, Jan C; van Wijhe, Marten; van der Meer, Klaas

    2014-11-15

    A pragmatic, randomized, controlled, single-blinded trial in Dutch general practice. Assessing the costs and cost-effectiveness of adding segmental epidural steroid injections to care as usual in radiculopathy in general practice. Lumbosacral radicular syndrome (radiculopathy) is a benign, generally self-limiting but painful condition caused by a herniated lumbar intervertebral disc, which results in an inflammatory process around the nerve root. Segmental epidural steroid injections could lessen pain. Low back pain and sciatica form a large financial burden on national health care systems. Improving pain treatment could lower costs to society by diminishing loss of productivity. Patients with acute radiculopathy were included by general practitioners. All patients received usual care. Patients in the intervention group received one segmental epidural steroid injection containing 80 mg of triamcinolone as well. Follow-up was performed using postal questionnaires at 2, 4, 6, 13, 26, and 52 weeks. Main outcomes were pain, disability and costs. Economic evaluation was performed from a societal perspective with a time horizon of 1 year. Sixty-three patients were included in the analysis. Mean total costs were €4414 or $5985 in the intervention group and €5121 or $6943 in the control group. This difference was mostly due to loss of productivity. The point estimate for the incremental cost-effectiveness ratio was -€730 or -$990 (1-point diminishment on the numerical rating scale back pain score in 1 patient in the course of 1 yr would save €730 or $990). Bootstrapping showed a 95% confidence interval of -€4476 to €951 or -$6068 to $1289. The cost-effectiveness acceptability curve showed that without additional investment the probability that epidural steroids are cost-effective is more than 80%. The effect on pain and disability of epidural steroids in lumbosacral radicular syndrome is small but significant, and at lower costs with no reported complications

  4. Cost-effectiveness of an exercise intervention program in perimenopausal women: the Fitness League Against MENopause COst (FLAMENCO) randomized controlled trial.

    PubMed

    Carbonell-Baeza, Ana; Soriano-Maldonado, Alberto; Gallo, Francisco Javier; López del Amo, María Puerto; Ruiz-Cabello, Pilar; Andrade, Ana; Borges-Cosic, Milkana; Peces-Rama, Antonio Rubén; Spacírová, Zuzana; Álvarez-Gallardo, Inmaculada C; García-Mochón, Leticia; Segura-Jiménez, Víctor; Estévez-López, Fernando; Camiletti-Moirón, Daniel; Martín-Martín, Jose Jesús; Aranda, Pilar; Delgado-Fernández, Manuel; Aparicio, Virginia A

    2015-06-17

    The high prevalence of women that do not reach the recommended level of physical activity is worrisome. A sedentary lifestyle has negative consequences on health status and increases health care costs. The main objective of this project is to assess the cost-effectiveness of a primary care-based exercise intervention in perimenopausal women. The present study is a Randomized Controlled Trial. A total of 150 eligible women will be recruited and randomly assigned to either a 16-week exercise intervention (3 sessions/week), or to usual care (control) group. The primary outcome measure is the incremental cost-effectiveness ratio. The secondary outcome measures are: i) socio-demographic and clinical information; ii) body composition; iii) dietary patterns; iv) glycaemic and lipid profile; v) physical fitness; vi) physical activity and sedentary behaviour; vii) sleep quality; viii) quality of life, mental health and positive health; ix) menopause symptoms. All outcomes will be assessed at baseline and post intervention. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct a cost effectiveness analysis from a health system perspective. The intervention designed is feasible and if it proves to be clinically and cost effective, it can be easily transferred to other similar contexts. Consequently, the findings of this project might help the Health Systems to identify strategies for primary prevention and health promotion as well as to reduce health care requirements and costs. ClinicalTrials.gov Identifier: NCT02358109. Date of registration: 05/02/2015.

  5. Cost-effectiveness of blended vs. face-to-face cognitive behavioural therapy for severe anxiety disorders: study protocol of a randomized controlled trial.

    PubMed

    Romijn, Geke; Riper, Heleen; Kok, Robin; Donker, Tara; Goorden, Maartje; van Roijen, Leona Hakkaart; Kooistra, Lisa; van Balkom, Anton; Koning, Jeroen

    2015-12-12

    Anxiety disorders are among the most prevalent psychiatric conditions, and are associated with poor quality of life and substantial economic burden. Cognitive behavioural therapy is an effective treatment to reduce anxiety symptoms, but is also costly and labour intensive. Cost-effectiveness could possibly be improved by delivering cognitive behavioural therapy in a blended format, where face-to-face sessions are partially replaced by online sessions. The aim of this trial is to determine the cost-effectiveness of blended cognitive behavioural therapy for adults with anxiety disorders, i.e. panic disorder, social phobia or generalized anxiety disorder, in specialized mental health care settings compared to face-to-face cognitive behavioural therapy. In this paper, we present the study protocol. It is hypothesized that blended cognitive behavioural therapy for anxiety disorders is clinically as effective as face-to-face cognitive behavioural therapy, but that intervention costs may be reduced. We thus hypothesize that blended cognitive behavioural therapy is more cost-effective than face-to-face cognitive behavioural therapy. In a randomised controlled equivalence trial 156 patients will be included (n = 78 in blended cognitive behavioural therapy, n = 78 in face-to-face cognitive behavioural therapy) based on a power of 0.80, calculated by using a formula to estimate the power of a cost-effectiveness analysis: [Formula: see text]. Measurements will take place at baseline, midway treatment (7 weeks), immediately after treatment (15 weeks) and 12-month follow-up. At baseline a diagnostic interview will be administered. Primary clinical outcomes are changes in anxiety symptom severity as measured with the Beck Anxiety Inventory. An incremental cost-effectiveness ratio will be calculated to obtain the costs per quality-adjusted life years (QALYs) measured by the EQ-5D (5-level version). Health-economic outcomes will be explored from a societal and health care

  6. The Cost-Effectiveness of Two Forms of Case Management Compared to a Control Group for Persons with Dementia and Their Informal Caregivers from a Societal Perspective

    PubMed Central

    Eekhout, Iris; Joling, Karlijn J.; van Mierlo, Lisa D.; Meiland, Franka J. M.; van Hout, Hein P. J.; de Rooij, Sophia E.

    2016-01-01

    Objectives The objective of this article was to compare the costs and cost-effectiveness of the two most prominent types of case management in the Netherlands (intensive case management and linkage models) against no access to case management (control group) for people with already diagnosed dementia and their informal caregivers. Methods The economic evaluation was conducted from a societal perspective embedded within a two year prospective, observational, controlled, cohort study with 521 informal caregivers and community-dwelling persons with dementia. Case management provided within one care organization (intensive case management model, ICMM), case management where care was provided by different care organizations within one region (Linkage model, LM), and a group with no access to case management (control) were compared. The economic evaluation related incremental costs to incremental effects regarding neuropsychiatric symptoms (NPI), psychological health of the informal caregiver (GHQ-12), and quality adjusted life years (QALY) of the person with dementia and informal caregiver. Results Inverse-propensity-score-weighted models showed no significant differences in clinical or total cost outcomes between the three groups. Informal care costs were significantly lower in the ICMM group compared to both other groups. Day center costs were significantly lower in the ICMM group compared to the control group. For all outcomes, the probability that the ICMM was cost-effective in comparison with LM and the control group was larger than 0.97 at a threshold ratio of 0 €/incremental unit of effect. Conclusion This study provides preliminary evidence that the ICMM is cost-effective compared to the control group and the LM. However, the findings should be interpreted with caution since this study was not a randomized controlled trial. PMID:27655234

  7. Cost-effectiveness of scaling up mass drug administration for the control of soil-transmitted helminths: a comparison of cost function and constant costs analyses.

    PubMed

    Turner, Hugo C; Truscott, James E; Fleming, Fiona M; Hollingsworth, T Déirdre; Brooker, Simon J; Anderson, Roy M

    2016-07-01

    The coverage of mass drug administration (MDA) for neglected tropical diseases, such as the soil-transmitted helminths (STHs), needs to rapidly expand to meet WHO's 2020 targets. We aimed to compare use of a cost function to take into account economies of scale to the standard method of assuming a constant cost per treatment when investigating the cost and cost-effectiveness of scaling up a STH MDA programme targeting Ascaris lumbricoides. We fitted a cost function describing how the costs of MDA change with scale to empirical cost data and incorporated it into a STH transmission model. Using this cost function, we investigated the consequences of taking into account economies of scale on the projected cost-effectiveness of STH control, by comparison with the standard method of assuming a constant cost per treatment. The cost function was fitted to economic cost data collected as part of a school-based deworming programme in Uganda using maximum likelihood methods. We used the model to investigate the total reduction in the overall worm burden, the total number of prevalent infection case-years averted, and the total number of heavy infection case-years averted. For each year, we calculated the effectiveness as the difference between the worm burden or number of cases and the number in absence of treatment. When using the cost function, the cost-effectiveness of STH control markedly increased as the programme was scaled up. By contrast, the standard method (constant cost per treatment) undervalued this and generated misleading conclusions. For example, when scaling up control in the projected district from 10% to 75% coverage of at-risk school-age children, the cost-effectiveness in terms of prevention of heavy burden infections was projected to increase by over 70% when using the cost function, but decrease by 18% when assuming a constant cost per treatment. The current exclusion of economies of scale in most economic analyses must be addressed if the most cost-effective

  8. Towards practical implementation of biophotonics-based solutions for cost-effective monitoring of food quality control (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Meglinski, Igor; Popov, Alexey; Bykov, Alexander

    2017-03-01

    Biophotonics-based diagnostic and imaging modalities have been widely used in various applications associated with the non-invasive imaging of the internal structure of a range biological media from a range of cells cultures to biological tissues. With the fast growing interest in food securities there remains strong demand to apply reliable and cost effective biophotonics-based technologies for rapid screening of freshness, internal defects and quality of major agricultural products. In current presentation the results of application of optical coherence tomography (OCT) and encapsulated optical bio-sensors for quantitative assessment of freshness of agricultural products, such as meat and sea foods, are presented, and their further perspectives are discussed.

  9. Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol.

    PubMed

    Sanches, Sarita A; Swildens, Wilma E; van Busschbach, Jooske T; Stant, A Dennis; Feenstra, Talitha L; van Weeghel, Jaap

    2015-09-15

    People with Severe Mental Illness (SMI) frequently experience problems with regard to societal participation (i.e. work, education and daily activities outside the home), and require professional support in this area. The Boston University approach to Psychiatric Rehabilitation (BPR) is a comprehensive methodology that can offer this type of support. To date, several Randomised Controlled Trials (RCT's) investigating the effectiveness of BPR have yielded positive outcomes with regard to societal participation. However, information about the cost-effectiveness and budgetary impact of the methodology, which may be important for broader dissemination of the approach, is lacking. BPR may be more cost effective than Care As Usual (CAU) because an increase in participation and independence may reduce the costs to society. Therefore, the aim of this study is to investigate, from a societal perspective, the cost-effectiveness of BPR for people with SMI who wish to increase their societal participation. In addition, the budget impact of implementing BPR in the Dutch healthcare setting will be assessed by means of a budget impact analysis (BIA) after completion of the trial. In a multisite RCT, 225 adults (18-64 years of age) with SMI will be randomly allocated to the experimental (BPR) or the control condition (CAU). Additionally, a pilot study will be conducted with a group of 25 patients with severe and enduring eating disorders. All participants will be offered support aimed at personal rehabilitation goals, and will be monitored over a period of a year. Outcomes will be measured at baseline, and at 6 and 12 months after enrolment. Based on trial results, further analyses will be performed to assess cost-effectiveness and the budgetary impact of implementation scenarios. The trial results will provide insight into the cost-effectiveness of BPR in supporting people with SMI who would like to increase their level of societal participation. These results can be used to make

  10. SSME digital control design characteristics

    NASA Technical Reports Server (NTRS)

    Mitchell, W. T.; Searle, R. F.

    1985-01-01

    To protect against a latent programming error (software fault) existing in an untried branch combination that would render the space shuttle out of control in a critical flight phase, the Backup Flight System (BFS) was chartered to provide a safety alternative. The BFS is designed to operate in critical flight phases (ascent and descent) by monitoring the activities of the space shuttle flight subsystems that are under control of the primary flight software (PFS) (e.g., navigation, crew interface, propulsion), then, upon manual command by the flightcrew, to assume control of the space shuttle and deliver it to a noncritical flight condition (safe orbit or touchdown). The problems associated with the selection of the PFS/BFS system architecture, the internal BFS architecture, the fault tolerant software mechanisms, and the long term BFS utility are discussed.

  11. Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial.

    PubMed

    Ternent, Laura; Vale, Luke; Boachie, Charles; Burr, Jennifer M; Lois, Noemi

    2012-03-01

    To determine whether internal limiting membrane (ILM) peeling is cost-effective compared with no peeling for patients with an idiopathic stage 2 or 3 full-thickness macular hole. A cost-effectiveness analysis was performed alongside a randomised controlled trial. 141 participants were randomly allocated to receive macular-hole surgery, with either ILM peeling or no peeling. Health-service resource use, costs and quality of life were calculated for each participant. The incremental cost per quality-adjusted life year (QALY) gained was calculated at 6 months. At 6 months, the total costs were on average higher (£424, 95% CI -182 to 1045) in the No Peel arm, primarily owing to the higher reoperation rate in the No Peel arm. The mean additional QALYs from ILM peel at 6 months were 0.002 (95% CI 0.01 to 0.013), adjusting for baseline EQ-5D and other minimisation factors. A mean incremental cost per QALY was not computed, as Peeling was on average less costly and slightly more effective. A stochastic analysis suggested that there was more than a 90% probability that Peeling would be cost-effective at a willingness-to-pay threshold of £20,000 per QALY. Although there is no evidence of a statistically significant difference in either costs or QALYs between macular hole surgery with or without ILM peeling, the balance of probabilities is that ILM Peeling is likely to be a cost-effective option for the treatment of macular holes. Further long-term follow-up data are needed to confirm these findings.

  12. Automatic Exposure Control Device for Digital Mammography

    DTIC Science & Technology

    2004-08-01

    developing innovative approaches for controlling DM exposures. These approaches entail using the digital detector and an artificial neural network to...of interest that determine the exposure parameters for the fully exposed image; and (2) to use an artificial neural network to select exposure

  13. Automatic Exposure Control Device for Digital Mammography

    DTIC Science & Technology

    2001-08-01

    developing innovative approaches for controlling DM exposures. These approaches entail using the digital detector and an artificial neural network to...34 regions of interest that determine the exposure parameters for the fully exposed image; and (2) to use an artificial neural network to select exposure

  14. Digital control of highly augmented combat rotorcraft

    NASA Technical Reports Server (NTRS)

    Tischler, Mark B.

    1987-01-01

    Proposed concepts for the next generation of combat helicopters are to be embodied in a complex, highly maneuverable, multiroled vehicle with avionics systems. Single pilot and nap-of-the-Earth operations require handling qualities which minimize the involvement of the pilot in basic stabilization tasks. To meet these requirements will demand a full authority, high-gain, multimode, multiply-redundant, digital flight-control system. The gap between these requirements and current low-authority, low-bandwidth operational rotorcraft flight-control technology is considerable. This research aims at smoothing the transition between current technology and advanced concept requirements. The state of the art of high-bandwidth digital flight-control systems are reviewed; areas of specific concern for flight-control systems of modern combat are exposed; and the important concepts are illustrated in design and analysis of high-gain, digital systems with a detailed case study involving a current rotorcraft system. Approximate and exact methods are explained and illustrated for treating the important concerns which are unique to digital systems.

  15. Digital electronic engine control F-15 overview

    NASA Technical Reports Server (NTRS)

    Kock, B.

    1984-01-01

    A flight test evaluation of the digital elctronic engine control (DEEC) system was conducted. An overview of the flight program is presented. The roles of the participating parties, the system, and the flight program objectives are described. The test program approach is discussed, and the engine performance benefits are summarized. A description of the follow-on programs is included.

  16. Aircraft digital flight control technical review

    NASA Technical Reports Server (NTRS)

    Davenport, Otha B.; Leggett, David B.

    1993-01-01

    The Aircraft Digital Flight Control Technical Review was initiated by two pilot induced oscillation (PIO) incidents in the spring and summer of 1992. Maj. Gen. Franklin (PEO) wondered why the Air Force development process for digital flight control systems was not preventing PIO problems. Consequently, a technical review team was formed to examine the development process and determine why PIO problems continued to occur. The team was also to identify the 'best practices' used in the various programs. The charter of the team was to focus on the PIO problem, assess the current development process, and document the 'best practices.' The team reviewed all major USAF aircraft programs with digital flight controls, specifically, the F-15E, F-16C/D, F-22, F-111, C-17, and B-2. The team interviewed contractor, System Program Office (SPO), and Combined Test Force (CTF) personnel on these programs. The team also went to NAS Patuxent River to interview USN personnel about the F/A-18 program. The team also reviewed experimental USAF and NASA systems with digital flight control systems: X-29, X-31, F-15 STOL and Maneuver Technology Demonstrator (SMTD), and the Variable In-Flight Stability Test Aircraft (VISTA). The team also discussed the problem with other experts in the field including Ralph Smith and personnel from Calspan. The major conclusions and recommendations from the review are presented.

  17. Pressurised irrigation versus swabbing method in cleansing wounds healed by secondary intention: a randomised controlled trial with cost-effectiveness analysis.

    PubMed

    Mak, Suzanne So-Shan; Lee, Man-Ying; Cheung, Jeanny Sui-Sum; Choi, Kai-Chow; Chung, Tak-Ki; Wong, Tze-Wing; Lam, Kit-Yee; Lee, Diana Tze-fan

    2015-01-01

    Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic material which are commonly present in the wounds that heal by secondary intention. At present, there is no research evidence for whether pressurised irrigation has better wound healing outcomes compared with conventional swabbing practice in cleansing wound. This study investigated the differences between pressurised irrigation and swabbing method in cleansing wounds that healed by secondary intention in relation to wound healing outcomes and cost-effectiveness. Multicentre, prospective, randomised controlled trial. The study took place in four General Outpatient Clinics in Hong Kong. Two hundred and fifty six patients with wounds healing by secondary intention were randomly assigned by having a staff independent of the study opening a serially numbered, opaque and sealed envelope to either pressurised irrigation (n=122) or swabbing (n=134). Staff undertaking study-related assessments was blinded to treatment assignment. Patients' wounds were followed up for 6 weeks or earlier if wounds had healed to determine wound healing, infection, symptoms, satisfaction, and cost effectiveness. The primary outcome was time-to-wound healing. Patients were analysed according to their treatment allocation. This trial is registered with ClinicalTrials.gov, number NCT01885273. Intention-to-treat analysis showed that pressurised irrigation group was associated with a shorter median time-to-wound healing than swabbing group [9.0 days (95% CI: 7.4-13.8) vs. 12.0 (95% CI: 10.2-13.8); p=0.007]. Pressurised irrigation group has significantly more patients experiencing lower grade of pain during wound cleansing (93.4% vs. 84.2%; p=0.02), and significantly higher median satisfaction with either comfort or cleansing method (MD 1 [95% CI: 5-6]; p=0.002; MD 1 [95% CI: 5-6]; p<0.001) than did swabbing group. Wound infection was reported in 4 (3.3%) patients in pressurised

  18. Quadruplex digital flight control system assessment

    NASA Technical Reports Server (NTRS)

    Mulcare, D. B.; Downing, L. E.; Smith, M. K.

    1988-01-01

    Described are the development and validation of a double fail-operational digital flight control system architecture for critical pitch axis functions. Architectural tradeoffs are assessed, system simulator modifications are described, and demonstration testing results are critiqued. Assessment tools and their application are also illustrated. Ultimately, the vital role of system simulation, tailored to digital mechanization attributes, is shown to be essential to validating the airworthiness of full-time critical functions such as augmented fly-by-wire systems for relaxed static stability airplanes.

  19. Decentralized digital adaptive control of robot motion

    NASA Technical Reports Server (NTRS)

    Tarokh, M.

    1990-01-01

    A decentralized model reference adaptive scheme is developed for digital control of robot manipulators. The adaptation laws are derived using hyperstability theory, which guarantees asymptotic trajectory tracking despite gross robot parameter variations. The control scheme has a decentralized structure in the sense that each local controller receives only its joint angle measurement to produce its joint torque. The independent joint controllers have simple structures and can be programmed using a very simple and computationally fast algorithm. As a result, the scheme is suitable for real-time motion control.

  20. 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

  1. Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial.

    PubMed

    Dear, Blake F; Zou, Judy B; Ali, Shehzad; Lorian, Carolyn N; Johnston, Luke; Sheehan, Joanne; Staples, Lauren G; Gandy, Milena; Fogliati, Vincent J; Klein, Britt; Titov, Nickolai

    2015-03-01

    There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60 years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n=35) or the waitlist control group (n=37). The online treatment course was delivered over 8 weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8 weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs=0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety. Australian and New Zealand Clinical Trials Registry: ACTRN12611000929909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000929909. Copyright © 2014. Published by Elsevier Ltd.

  2. Digital gate pulse generator for cycloconverter control

    DOEpatents

    Klein, Frederick F.; Mutone, Gioacchino A.

    1989-01-01

    The present invention provides a digital gate pulse generator which controls the output of a cycloconverter used for electrical power conversion applications by determining the timing and delivery of the firing pulses to the switching devices in the cycloconverter. Previous gate pulse generators have been built with largely analog or discrete digital circuitry which require many precision components and periodic adjustment. The gate pulse generator of the present invention utilizes digital techniques and a predetermined series of values to develop the necessary timing signals for firing the switching device. Each timing signal is compared with a reference signal to determine the exact firing time. The present invention is significantly more compact than previous gate pulse generators, responds quickly to changes in the output demand and requires only one precision component and no adjustments.

  3. Advanced Digital Controller Development Program, Task I.

    DTIC Science & Technology

    1982-07-01

    The control will not allow more than 60*F overshoot above the specified steady-state turbine outlet gas temperature limit. Transient temperature...AD-A129 269 ADVANCED DIGITAL CONTROLLER DEVELOPMENT PROGRAM TASK 1 1/1 ()GENERAL MOTORS CORP INDIANAPOLIS IN DETROIT DIESEL ALLISON D0. d H HUNTER JL... Diesel Allison Division of General Motors Corporation P.O. Box 894 Indianapolis, Indiana 46206 July 1982 Interim Report for Period 1 September 1979-30

  4. Cost effective lighting

    SciTech Connect

    Morse, O.; Verderber, R.

    1987-07-01

    Long-life replacement lamps for the incandescent lamp have been evaluated with regard to their cost effectiveness. The replacements include the use of energy buttons that extend lamp life as well as an adaptive fluorescent circline lamp that will fit into existing incandescent lamp sockets. The initial, operating, and replacement costs for one million lumen-hours are determined for each lamp system. We find the most important lighting cost component is the operating cost. Using lamps that are less efficient or devices that cause lamps to operate less efficiently are not cost-effective. The adaptive fluorescent circline lamp, even at an initial cost of $15.00, is the most cost effective source of illumination compared to the incandescent lamp and lamp systems examined. 3 refs., 6 tabs.

  5. Cost-effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: A 5-year follow-up study.

    PubMed

    Picot, Marie-Christine; Jaussent, Audrey; Neveu, Dorine; Kahane, Philippe; Crespel, Arielle; Gelisse, Philippe; Hirsch, Edouard; Derambure, Philippe; Dupont, Sophie; Landré, Elizabeth; Chassoux, Francine; Valton, Luc; Vignal, Jean-Pierre; Marchal, Cécile; Lamy, Catherine; Semah, Franck; Biraben, Arnaud; Arzimanoglou, Alexis; Petit, Jérôme; Thomas, Pierre; Macioce, Valérie; Dujols, Pierre; Ryvlin, Philippe

    2016-10-01

    Despite its well-known effectiveness, the cost-effectiveness of epilepsy surgery has never been demonstrated in France. We compared cost-effectiveness between resective surgery and medical therapy in a controlled cohort of adult patients with partial intractable epilepsy. A prospective cohort of adult patients with surgically remediable and medically intractable partial epilepsy was followed over 5 years in the 15 French centers. Effectiveness was defined as 1 year without a seizure, based on the International League Against Epilepsy (ILAE) classification. Clinical outcomes and direct costs were compared between surgical and medical groups. Long-term direct costs and effectiveness were extrapolated over the patients' lifetimes with a Monte-Carlo simulation using a Markov model, and an incremental cost-effectiveness ratio (ICER) was computed. Indirect costs were also evaluated. Among the 289 enrolled surgery candidates, 207 were operable-119 in the surgical group and 88 in the medical group-65 were not operable and not analyzed here, 7 were finally not eligible, and 10 were not followed. The proportion of patients completely seizure-free during the last 12 months (ILAE class 1) was 69.0% in the operated group and 12.3% in the medical group during the second year (p < 0.001), and it was respectively 76.8% and 21% during the fifth year (p < 0.001). Direct costs became significantly lower in the surgical group the third year after surgery, as a result of less antiepileptic drug use. The value of the discounted ICER was 10,406 (95% confidence interval [CI] 10,182-10,634) at 2 years and 2,630 (CI 95% 2,549-2,713) at 5 years. Surgery became cost-effective between 9 and 10 years after surgery, and even earlier if indirect costs were taken into account as well. Our study suggests that in addition to being safe and effective, resective surgery of epilepsy is cost-effective in the medium term. It should therefore be considered earlier in the development of epilepsy. Wiley

  6. Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial.

    PubMed

    Stokes, E A; Wordsworth, S; Bargo, D; Pike, K; Rogers, C A; Brierley, R C M; Angelini, G D; Murphy, G J; Reeves, B C

    2016-08-01

    To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery. A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK. 17 specialist cardiac surgery centres in UK NHS hospitals. 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL. Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery. Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is -£182, 95% CI -£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI -0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained. We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery. ISRCTN70923932; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial.

    PubMed

    Blom, Marco M; Bosmans, Judith E; Cuijpers, Pim; Zarit, Steve H; Pot, Anne Margriet

    2013-01-10

    The number of people with dementia is rising rapidly as a consequence of the greying of the world population. There is an urgent need to develop cost effective approaches that meet the needs of people with dementia and their family caregivers. Depression, feelings of burden and caregiver stress are common and serious health problems in these family caregivers. Different kinds of interventions are developed to prevent or reduce the negative psychological consequences of caregiving. The use of internet interventions is still very limited, although they may be a cost effective way to support family caregivers in an earlier stage and diminish their psychological distress in the short and longer run. A pragmatic randomized controlled trial is designed to evaluate the effectiveness and cost-effectiveness of 'Mastery over Dementia', an internet intervention for caregivers of people with dementia. The intervention aims at prevention and decrease of psychological distress, in particular depressive symptoms. The experimental condition consists of an internet course with 8 sessions and a booster session over a maximum period of 6 months guided by a psychologist. Caregivers in the comparison condition receive a minimal intervention. In addition to a pre and post measurement, an intermediate measurement will be conducted. In addition, there will be two follow-up measurements 3 and 6 months after post-treatment in the experimental group only. To study the effectiveness of the intervention, depressive symptoms are used as the primary outcome, whereas symptoms of anxiety, role overload and caregiver perceived stress are used as secondary outcomes. To study which caregivers profit most of the internet intervention, several variables that may modify the impact of the intervention are taken into account. Regarding the cost-effectiveness, an economic evaluation will be conducted from a societal perspective. This study will provide evidence about the effectiveness and cost-effectiveness

  8. A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial.

    PubMed

    Sahlen, Klas-Göran; Boman, Kurt; Brännström, Margareta

    2016-03-01

    Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument. Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective. © The Author(s) 2015.

  9. Cost-effectiveness of aftercare services for people with severe mental disorders: an analysis parallel to a randomised controlled clinical trial in Iran.

    PubMed

    Moradi-Lakeh, Maziar; Yaghoubi, Mohsen; Hajebi, Ahmad; Malakouti, Seyed Kazem; Vasfi, Mohamad Ghadiri

    2017-02-01

    Aftercare services are not part of the usual care for people with severe mental disorders in Iran. This study was performed to assess the cost-effectiveness of aftercare services, including telephone follow-up or home visit, in addition to caregivers' education and training of social skills, for all subjects during the 20 months after hospital discharge. An economic evaluation was performed along with a registered randomised controlled trial (IRCT201009052557N2) on two groups of 60 persons recruited between 2010 and 2012. Intervention's effectiveness was measured by psychopathology and quality of life indicators. Cost-effectiveness and cost-utility were analysed from the societal and Ministry of Health (MoH) perspectives. All indicators of psychopathology, quality of life and satisfaction with services in the intervention group were significantly different from the control group. Mean intervention costs was US$674 (95% confidence interval [CI]: 572-776) per subject in the intervention group. Average total direct costs were US$1445 (95% CI: 1086-1804) and US$1640 (95% CI: 1087-2093) per subject in the intervention and control groups respectively. From the societal perspective, intervention had more effects with lower costs. The ratios for incremental cost-effectiveness was US$8399.1 (95% CI: 8178.2-8620.0) per quality-adjusted life year (QALY) gained from the MoH perspective for 20 months of follow-up. This study showed that aftercare services can create opportunities to use hospital beds more efficiently for unmet needs of people with psychiatric disorders. Indirect and intangible costs were not considered in this study, if taken into account, they are likely to further increase the efficiency of intervention.

  10. Evaluating the (cost-)effectiveness of guided and unguided Internet-based self-help for problematic alcohol use in employees--a three arm randomized controlled trial.

    PubMed

    Boß, Leif; Lehr, Dirk; Berking, Matthias; Riper, Heleen; Schaub, Michael Patrick; Ebert, David Daniel

    2015-10-12

    Problematic alcohol consumption is associated with a high disease burden for affected individuals and has a detrimental impact on companies and society due to direct and indirect health costs. This protocol describes a study design to evaluate the (cost)-effectiveness of a guided and unguided Internet-based self-help intervention for employees called "GET.ON Clever weniger trinken" (be smart - drink less) compared to a waiting list control group. In a three-arm randomized controlled trial, 528 German adults who are currently members of the workforce will be recruited by occupational health departments of major health insurance companies. Employees aged 18 and older displaying problematic drinking patterns (>21/14 drinks per week and an AUDIT score > 8/6 for men/women) will be randomly assigned to one of three following study conditions: 1. unguided web-based self-help for problematic drinking, 2. adherence-focused guided self-help, and 3. waiting list control. Self-report data will be collected at baseline (T1), 6 weeks (T2), and 6 months (T3) after randomization. The primary outcome will be the reduction of alcohol standard units during the 7 days prior to T2, using the Timeline Followback method. Cost-effectiveness analyses to determine direct and indirect costs will be conducted from the perspectives of employers and the society. Data will be analyzed on an intention-to-treat basis and per protocol. There is a need to identify effective low-threshold solutions to improve ill-health and reduce the negative economic consequences due to problematic alcohol drinking in workforces. If the proposed web-based intervention proves both to be efficacious and cost-effective, it may be a useful tool to increase utilization rates of interventions for problematic drinking in occupational settings. German Register of Clinical Studies (DRKS): DRKS00006105 , date of registration: 2014-07-07.

  11. Evaluating the efficacy and cost-effectiveness of web-based indicated prevention of major depression: design of a randomised controlled trial.

    PubMed

    Buntrock, Claudia; Ebert, David D; Lehr, Dirk; Cuijpers, Pim; Riper, Heleen; Smit, Filip; Berking, Matthias

    2014-01-31

    Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. Web-based interventions have shown to be effective in reducing depressive symptom severity. However, it is not known whether web-based interventions may also be effective in preventing the onset of MDD. The aim of this study is to evaluate the (cost-) effectiveness of an indicated web-based guided self-help intervention (GET.ON Mood Enhancer Prevention) on the onset of MDD. A randomised controlled trial (RCT) will be conducted to compare the (cost-) effectiveness of the GET.ON Mood Enhancer Prevention training with a control condition exclusively receiving online-based psychoeducation on depression. Adults with subthreshold depression (N = 406) will be recruited from the general population and randomised to one of the two conditions. The primary outcome is time to onset of MDD within a 12-months follow-up period. MDD will be assessed according to DSM-IV criteria as assessed by the telephone-administered Structured Clinical Interview for DSM-IV (SCID). Time to onset of MDD will be assessed using life charts. Secondary outcomes include changes on various indicators of depressive symptom severity, anxiety and quality of life from baseline to post-treatment, to a 6-month and a 12-month follow up. Additionally, an economic evaluation using a societal perspective will be conducted to examine the intervention's cost-effectiveness. This is one of the first randomised controlled trials that examines the effect of an indicated guided self-help web-based intervention on the incidence of major depression. If shown to be effective, the intervention will contribute to reducing the disease burden due to MDD in the general population. German Clinical Trial Registration DRKS00004709.

  12. Guidelines for selection and application of the most cost-effective NO sub x control technologies for gas, oil and coal fired boilers

    SciTech Connect

    Czerniak, D.O.; Booth, R.B.; McDonald, B.L. ); Feenstra, D.R. )

    1991-01-01

    As a result of the new Clean Air Act, lower NO{sub x} emissions from stationary sources will be required of utilities and independent power producers that burn all fuels including gas, oil and coal. This new legislation, as well as new and more stringent NO{sub x} reduction orders imposed by state and local regulatory agencies, will require rapid evaluation, purchase, installation and start-up of a variety of control technologies. There is substantial volume of literature available discussing NO{sub x} control technologies, their control effectiveness, costs, and chemical reaction mechanisms in forming NO{sub x}. This paper, however, presents more practical aspects of developing a NO{sub x} control strategy and implementing the appropriate cost-effective control technology on a utility or industrial boiler.

  13. Digital control algorithms for microgravity isolation systems

    NASA Technical Reports Server (NTRS)

    Sinha, Alok; Wang, Yung-Peng

    1992-01-01

    New digital control algorithms were developed to achieve the desired acceleration transmissibility function. The attractive electromagnets have been taken as actuators. The relative displacement and the acceleration of the mass were used as feedback signals. Two approaches were developed to find that controller transfer function in Z-domain, which yields the desired transmissibility at each frequency. In the first approach, the controller transfer function is obtained by assuming that the desired transmissibility is known in Z-domain. Since the desired transmissibility H sub d(S) = 1/(tauS+1)(exp 2) is given in S-domain, the first task is to obtain the desired transmissibility in Z-domain. There are three methods to perform this task: bilinear transformation, and backward and forward rectangular rules. The bilinear transformation and backward rectangular rule lead to improper controller transfer functions, which are physically not realizable. The forward rectangular rule does lead to a physically realizable controller. However, this controller is found to be marginally stable because of a pole at Z=1. In order to eliminate this pole, a hybrid control structure is proposed. Here the control input is composed of two parts: analog and digital. The analog input simply represents the velocity (or the integral of acceleration) feedback; and the digital controller which uses only relative displacement signal, is then obtained to achieve the desired closed-loop transfer function. The stability analysis indicates that the controller transfer function is stable for typical values of sampling period. In the second approach, the aforementioned hybrid control structure is again used. First, an analog controller transfer function corresponding to relative displacement feedback is obtained to achieve the transmissibility as 1/(tauS+1)(exp 2). Then the transfer function for the digital control input is obtained by discretizing this analog controller transfer function via bilinear

  14. Effectiveness and cost-effectiveness of meaning-centered group psychotherapy in cancer survivors: protocol of a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Meaning-focused coping may be at the core of adequate adjustment to life after cancer. Cancer survivors who experience their life as meaningful are better adjusted, have better quality of life and psychological functioning. Meaning-Centered Group Psychotherapy for Cancer Survivors (MCGP-CS) was designed to help patients to sustain or enhance a sense of meaning and purpose in their lives. The aim of the proposed study is to evaluate the effectiveness and cost-effectiveness of MCGP-CS. Methods/Design Survivors diagnosed with cancer in the last 5 years and treated with curative intent, are recruited via several hospitals in the Netherlands. After screening, 168 survivors are randomly assigned to one of the three study arms: 1. Meaning-Centered Group Psychotherapy (MCGP-CS) 2. Supportive group psychotherapy (SGP) 3. Care as usual (CAU). Baseline assessment takes place before randomisation, with follow up assessments post-intervention and at 3, 6 and 12 months follow-up. Primary outcome is meaning making (PMP, PTGI, SPWB). Secondary outcome measures address quality of life (EORTC-30), anxiety and depression (HADS), hopelessness (BHS), optimism (LOT-R), adjustment to cancer (MAC), and costs (TIC-P, EQ-5D, PRODISQ). Discussion Meaning-focused coping is key to adjustment to life after cancer, however, there is a lack of evidence based psychological interventions in this area. Many cancer survivors experience feelings of loneliness and alienation, and have a need for peer support, therefore a group method in particular, can be beneficial for sustaining or enhancing a sense of meaning. If this MCGP-CS is effective for cancer survivors, it can be implemented in the practice of psycho-oncology care. Trial registration Netherlands Trial Register, NTR3571 PMID:24467861

  15. Effectiveness and cost-effectiveness of meaning-centered group psychotherapy in cancer survivors: protocol of a randomized controlled trial.

    PubMed

    van der Spek, Nadia; Vos, Joël; van Uden-Kraan, Cornelia F; Breitbart, William; Cuijpers, Pim; Knipscheer-Kuipers, Kitty; Willemsen, Vincent; Tollenaar, Rob A E M; van Asperen, Christi J; Verdonck-de Leeuw, Irma M

    2014-01-28

    Meaning-focused coping may be at the core of adequate adjustment to life after cancer. Cancer survivors who experience their life as meaningful are better adjusted, have better quality of life and psychological functioning. Meaning-Centered Group Psychotherapy for Cancer Survivors (MCGP-CS) was designed to help patients to sustain or enhance a sense of meaning and purpose in their lives. The aim of the proposed study is to evaluate the effectiveness and cost-effectiveness of MCGP-CS. Survivors diagnosed with cancer in the last 5 years and treated with curative intent, are recruited via several hospitals in the Netherlands. After screening, 168 survivors are randomly assigned to one of the three study arms: 1. Meaning-Centered Group Psychotherapy (MCGP-CS) 2. Supportive group psychotherapy (SGP) 3. Care as usual (CAU). Baseline assessment takes place before randomisation, with follow up assessments post-intervention and at 3, 6 and 12 months follow-up. Primary outcome is meaning making (PMP, PTGI, SPWB). Secondary outcome measures address quality of life (EORTC-30), anxiety and depression (HADS), hopelessness (BHS), optimism (LOT-R), adjustment to cancer (MAC), and costs (TIC-P, EQ-5D, PRODISQ). Meaning-focused coping is key to adjustment to life after cancer, however, there is a lack of evidence based psychological interventions in this area. Many cancer survivors experience feelings of loneliness and alienation, and have a need for peer support, therefore a group method in particular, can be beneficial for sustaining or enhancing a sense of meaning. If this MCGP-CS is effective for cancer survivors, it can be implemented in the practice of psycho-oncology care. Netherlands Trial Register, NTR3571.

  16. Distributed and recoverable digital control system

    NASA Technical Reports Server (NTRS)

    Stange, Kent (Inventor); Hess, Richard (Inventor); Kelley, Gerald B (Inventor); Rogers, Randy (Inventor)

    2010-01-01

    A real-time multi-tasking digital control system with rapid recovery capability is disclosed. The control system includes a plurality of computing units comprising a plurality of redundant processing units, with each of the processing units configured to generate one or more redundant control commands. One or more internal monitors are employed for detecting data errors in the control commands. One or more recovery triggers are provided for initiating rapid recovery of a processing unit if data errors are detected. The control system also includes a plurality of actuator control units each in operative communication with the computing units. The actuator control units are configured to initiate a rapid recovery if data errors are detected in one or more of the processing units. A plurality of smart actuators communicates with the actuator control units, and a plurality of redundant sensors communicates with the computing units.

  17. An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study.

    PubMed

    van Vilsteren, Myrthe; Boot, Cécile R L; Steenbeek, Romy; van Schaardenburg, Dirkjan; Voskuyl, Alexandre E; Anema, Johannes R

    2012-07-02

    Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients' supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the

  18. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness

    PubMed Central

    Driessen, Maurice T; Anema, Johannes R; Proper, Karin I; Bongers, Paulien M; Beek, Allard J van der

    2008-01-01

    Background Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP among workers. Methods In a randomised controlled trial (RCT), a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline. The departments consisting of about 150 workers are pre-stratified and randomised. The control departments receive usual practice and the intervention departments receive PE. Within each intervention department a working group is formed including eight workers, a representative of the management, and an occupational health and safety coordinator. During a one day meeting, the working group follows the steps of PE in which the most important risk factors for LBP and NP, and the most adequate ergonomic measures are identified on the basis of group consensus. The implementation of ergonomic measures at the department is performed by the working group. To improve the implementation process, so-called 'ergocoaches' are trained. The primary outcome measure is an episode of LBP and NP. Secondary outcome measures are actual use of ergonomic measures, physical workload, psychosocial workload, intensity of pain, general health status, sick leave, and work productivity. The cost-effectiveness analysis is performed from the societal and company perspective. Outcome measures are assessed using questionnaires at baseline and after 6 and 12 months. Data on the primary outcome as well as on intensity of pain, sick leave, work productivity, and health care costs are collected every 3 months. Discussion Prevention of LBP and NP is beneficial for workers, employers, and society. If the intervention is proven (cost-)effective, the intervention can have a major impact on LBP and NP prevention and, thereby, on

  19. Efficacy and cost-effectiveness of intradiscal methylene blue injection for chronic discogenic low back pain: study protocol for a randomized controlled trial.

    PubMed

    Geurts, José W; Kallewaard, Jan-Willem; Kessels, Alfons; Willems, Paul C; van Santbrink, Henk; Dirksen, Carmen; van Kleef, Maarten

    2015-11-21

    Low back pain (LBP) is a common health problem and a substantial part of LBP is presumed to be attributable to degeneration of the intervertebral disc. For patients suffering from intractable discogenic LBP, there are few evidence-based effective interventional treatment options available. In 2010, the results of a randomized controlled trial (RCT) were published concerning "intradiscal methylene blue injection" (IMBI), in which this intervention appeared to be very successful in relieving discogenic pain. Therefore, we decided to repeat this study to investigate whether we could replicate the published results. The results of our preliminary feasibility study gave reason to set up an RCT. The aim of this RCT is to evaluate if IMBI is a more effective treatment of discogenic low back pain as an intradiscal placebo intervention, and furthermore, to assess the cost-effectiveness of this intervention. Consecutive discogenic low back pain patients referred to four specialized pain treatment facilities are being screened for eligibility. After a positive standardized provocation discography and informed consent, patients are randomized into two groups. The treatment group receives an intradiscal injection with methylene blue, lidocaine, and contrast, and the control group receives intradiscal isotonic saline with lidocaine and contrast. Main outcome measures are pain at the 6-month follow-up, patient's global impression of change, cost-effectiveness, quality of life, disability, and analgesic intake. The importance of this study is emphasized by the fact that for intractable discogenic low back pain patients, evidence-based effective pain treatments are rare. If this study establishes clinical success and cost-effectiveness, IMBI could become the "pain treatment of choice" for a selected group of patients with chronic discogenic low back pain for whom noninvasive treatment options have failed. National Trial register NTR2547 Registered at 29 September 2010 and 31 March

  20. Study protocol for a randomised controlled multicentre study: the Foraminotomy ACDF Cost-Effectiveness Trial (FACET) in patients with cervical radiculopathy

    PubMed Central

    Broekema, A E H; Kuijlen, J M A; Lesman-Leegte, G A T; Bartels, R H M A; van Asselt, A D I; Vroomen, P C A J; Reneman, M F; Soer, R; Groen, R J M

    2017-01-01

    Introduction Cervical radiculopathy due to discogenic or spondylotic stenosis of the neuroforamen can be surgically treated by an anterior discectomy with fusion (ACDF) or a posterior foraminotomy (FOR). Most surgeons prefer ACDF, although there are indications that FOR is as effective as ACDF, has a lower complication rate and is less expensive. A head-to-head comparison of the 2 surgical techniques in a randomised controlled trial has not yet been performed. The study objectives of the Foraminotomy ACDF Cost-Effectiveness Trial (FACET) study are to compare clinical outcomes, complication rates and cost-effectiveness of FOR to ACDF. Methods and analysis The FACET study is a prospective randomised controlled trial conducted in 7 medical centres in the Netherlands. The follow-up period is 2 years. The main inclusion criterion is a radiculopathy of the C4, C5, C6 or C7 nerve root, due to a single-level isolated cervical foraminal stenosis caused by a soft disc and/or osteophytic component, requiring operative decompression. A sample size of 308 patients is required to test the hypothesis of clinical non-inferiority of FOR versus ACDF. Primary outcomes are: ‘operative success’, the measured decrease in radiculopathy assessed by the visual analogue scale and ‘patient success’, assessed by the modified Odom's criteria. Secondary outcomes are: Work Ability Index (single-item WAI), quality of life (EuroQol 5 Dimensions 5 level Survey, EQ-5D-5L), Neck Disability Index (NDI) and complications. An economic evaluation will assess cost-effectiveness. In addition, a budget impact analysis will be performed. Ethics and dissemination Ethical approval was obtained from the Institutional Ethics Committee of the University Medical Center Groningen. Results of this study will be disseminated through national and international papers. The participants and relevant patient support groups will be informed about the results of the study. Trial registration number NTR5536, pre

  1. Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial.

    PubMed

    Nordgren, Lise Bergman; Hedman, Erik; Etienne, Julie; Bodin, Jessica; Kadowaki, Asa; Eriksson, Stina; Lindkvist, Emelie; Andersson, Gerhard; Carlbring, Per

    2014-08-01

    A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7-10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities. Clinicaltrials.gov: NCT01390168. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. A cluster randomized controlled trial of the effectiveness and cost-effectiveness of Intermediate Care Clinics for Diabetes (ICCD): study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background World-wide healthcare systems are faced with an epidemic of type 2 diabetes. In the United Kingdom, clinical care is primarily provided by general practitioners (GPs) rather than hospital specialists. Intermediate care clinics for diabetes (ICCD) potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors. This study aims to (1) compare patients with type 2 diabetes registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (2) assess the cost-effectiveness of the intervention; and (3) explore the views and experiences of patients, health professionals and other stakeholders. Methods/Design This two-arm cluster randomized controlled trial (with integral economic evaluation and qualitative study) is set in general practices in three UK Primary Care Trusts. Practices are randomized to one of two groups with patients referred to either an ICCD (intervention) or to hospital care (control). Intervention group: GP practices in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist. Patients are reviewed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice. or Control group: Standard GP care, with referral to secondary care as required, but no access to ICCD. Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control. The primary outcome is the proportion of participants reaching three risk factor targets: HbA1c (≤7.0%); blood pressure (<140/80); and cholesterol (<4 mmol/l), at the end of the 18-month intervention period. The main secondary outcomes are the proportion of participants reaching individual risk factor targets and the overall 10-year risks

  3. Digital LLRF controller for NICA booster

    NASA Astrophysics Data System (ADS)

    Fatkin, G. A.; Batrakov, A. M.; Ilyin, I. V.; Vasilyev, M. Yu.

    2016-10-01

    The digital LLRF controller based on embedded microcontroller for the booster of the Dubna superconducting accelerator complex NICA is presented. It allows setting the frequency in accordance with the magnetic field value in the 0.5-5 MHz range with an inaccuracy ± 110 Hz. A novel method of frequency calculation based on the derivative is proposed. The specialized tester module allows tuning up and checking the RF system during comissioning and operation.

  4. Technology research for digital flight control

    NASA Technical Reports Server (NTRS)

    Carestia, R. A.

    1983-01-01

    The use of advanced digital systems for flight control and guidance for a specific mission is investigated. The research areas include advanced electronic system architectures, tests with the global positioning system (GPS) in a helicopter, and advanced integrated systems concept for rotorcraft. Emphasis is on a search and rescue mission, differential global positioning systems to provide a data base of performance information for navigation, and a study to determine the present usage and trends of microcomputers and microcomputer components in the avionics industries.

  5. A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba.

    PubMed

    Watkins, David A; Mvundura, Mercy; Nordet, Porfirio; Mayosi, Bongani M

    2015-01-01

    Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986-1996. The present study analyzes the cost-effectiveness of this Cuban program. We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a "do nothing" approach. Our population of interest was the cohort of children aged 5-24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs) averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program's effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children) and saved $7,848,590 (2010 USD) despite a total program cost of $202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving. A 10-year program to

  6. Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.

    PubMed

    Giordano, Alessandro; Bonometti, Gian Pietro; Vanoglio, Fabio; Paneroni, Mara; Bernocchi, Palmira; Comini, Laura; Giordano, Amerigo

    2016-12-07

    Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored. This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios. To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider

  7. Floating-point system quantization errors in digital control systems

    NASA Technical Reports Server (NTRS)

    Phillips, C. L.; Vallely, D. P.

    1978-01-01

    This paper considers digital controllers (filters) operating in floating-point arithmetic in either open-loop or closed-loop systems. A quantization error analysis technique is developed, and is implemented by a digital computer program that is based on a digital simulation of the system. The program can be integrated into existing digital simulations of a system.

  8. A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the Knee Arthroplasty Trial (KAT).

    PubMed

    Murray, David W; MacLennan, Graeme S; Breeman, Suzanne; Dakin, Helen A; Johnston, Linda; Campbell, Marion K; Gray, Alastair M; Fiddian, Nick; Fitzpatrick, Ray; Morris, Richard W; Grant, Adrian M

    2014-03-01

    In the late 1990s, new developments in knee replacement were identified as a priority for research within the NHS. The newer forms of arthroplasty were more expensive and information was needed on their safety and cost-effectiveness. The Knee Arthroplasty Trial examined the clinical effectiveness and cost-effectiveness of four aspects of knee replacement surgery: patellar resurfacing, mobile bearings, all-polyethylene tibial components and unicompartmental replacement. This study comprised a partial factorial, pragmatic, multicentre randomised controlled trial with a trial-based cost-utility analysis which was conducted from the perspective of the NHS and the patients treated. Allocation was computer generated in a 1 : 1 ratio using a central system, stratified by eligible comparisons and surgeon, minimised by participant age, gender and site of disease. Surgeons were not blinded to allocated procedures. Participants were unblinded if they requested to know the prosthesis they received. The setting for the trial was UK secondary care. Patients were eligible for inclusion if a decision had been made for them to have primary knee replacement surgery. Patients were recruited to comparisons for which the surgeon was in equipoise about which type of operation was most suitable. Patients were randomised to receive a knee replacement with the following: patellar resurfacing or no patellar resurfacing irrespective of the design of the prosthesis used; a mobile bearing between the tibial and femoral components or a bearing fixed to the tibial component; a tibial component made of either only high-density polyethylene ('all polyethylene') or a polyethylene bearing fixed to a metal backing plate with attached stem; or unicompartmental or total knee replacement. The primary outcome was the Oxford Knee Score (OKS). Other outcomes were Short Form 12; EuroQol 5D; intraoperative and postoperative complications; additional surgery; cost; and cost-effectiveness. Patients were

  9. An occupational health intervention programme for workers at high risk for sickness absence. Cost effectiveness analysis based on a randomised controlled trial

    PubMed Central

    Taimela, S; Justén, S; Aronen, P; Sintonen, H; Läärä, E; Malmivaara, A; Tiekso, J; Aro, T

    2008-01-01

    Objectives: To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence. Methods: Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed. Results: After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost €974 and €1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant—both cost saving and more effective than usual occupational health care. The saving was €43 per sickness absence day avoided with available direct total cost data, and €17 with missing total cost data imputed. Conclusions: One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of

  10. Cost-effectiveness of multidimensional family therapy compared to cognitive behavioral therapy for adolescents with a cannabis use disorder: Data from a randomized controlled trial.

    PubMed

    Goorden, M; van der Schee, E; Hendriks, V M; Hakkaart-van Roijen, L

    2016-05-01

    To evaluate the cost-effectiveness of Multidimensional Family Therapy (MDFT) for adolescents with a cannabis use disorder, compared to Cognitive Behavioural Therapy (CBT). A parallel-group randomized controlled trial was performed. 109 adolescents with a DSM-IV cannabis use disorder (CBT n=54; MDFT n=55) were included. Assessments were conducted at baseline, and 3, 6, 9 and 12 months post-baseline, and included measures on cannabis and other substance use, delinquency, health care utilization, and general health related quality of life. Excluding those with missing cost-data, 96 participants (MDFT n=49; CBT n=47) were included. From a health care perspective, the average annual direct medical costs in the CBT group were €2015 (95%C.I. 1397-2714), compared to €5446 (95%C.I. 4159-7092) in the MDFT group. The average quality-adjusted life years (QALY's) gained were 0.06 QALY higher for the MDFT group, which led to an incremental cost-effectiveness ratio (ICER) of 54,308 Euro/QALY or €43,405 per recovered patient. Taking the costs of delinquency into account, the costs increased to €21,330 (95%C.I. 12,389-32,894) for the CBT group and to €21,915 (95%C.I. 16,273-28,181) for the MDFT group, which lead to an ICER of 9266 Euro/QALY or a cost per recovered patient of €7491. This is the first comprehensive CEA of MDFT compared to CBT and it demonstrated that when costs of delinquency were included, the ICERS were modest. The results underline the importance of adopting a broader perspective regarding cost effectiveness analyses in mental health care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Evaluation of the Cost-Effectiveness of Pyramidal, Modified Pyramidal and Monoscreen Traps for the Control of the Tsetse Fly, Glossina fuscipes fuscipes, in Uganda

    PubMed Central

    Abila, P.P.; Okello-Onen, J.; Okoth, J.O.; Matete, G.O.; Wamwiri, F.; Politzar, H.

    2007-01-01

    Several trap designs have been used for sampling and control of the tsetse fly, Glossina fuscipes fuscipes, Newstead (Diptera: Glossinidae) based on preferences of individual researchers and program managers with little understanding of the comparative efficiency and cost-effectiveness of trap designs. This study was carried out to evaluate the cost-effectiveness of four commonly used trap designs: monoscreen, modified pyramidal and pyramidal, relative to the standard biconical trap. The study was performed under high tsetse challenge on Buvuma Island, Lake Victoria, Uganda, using a 4 × 4 Latin square design replicated 3 times, so as to separate the trap positions and day effects from the treatment effect. A total of 12 trap positions were tested over 4 days. The monoscreen trap caught significantly higher numbers of G. f. fuscipes (P<0.05) followed by biconical, modified pyramidal and pyramidal traps. Analysis of variance showed that treatment factor was a highly significant source of variation in the data. The index of increase in trap catches relative biconical were O.60 (pyramidal), 0.68 (modified pyramidal) and 1.25 (monoscreen). The monoscreen trap was cheaper (US$ 2.61) and required less material to construct than pyramidal trap (US$ 3.48), biconical and the modified pyramidal traps (US$ 4.06 each). Based on the number of flies caught per meter of material, the monoscreen trap proved to be the most cost-effective (232 flies/m) followed by the biconical trap (185 flies/m). The modified pyramidal and the pyramidal traps caught 112 and 125 flies/m, respectively. PMID:20345292

  12. Cost-effectiveness of structured group psychoeducation versus unstructured group support for bipolar disorder: Results from a multi-centre pragmatic randomised controlled trial.

    PubMed

    Camacho, E M; Ntais, D; Jones, S; Riste, L; Morriss, R; Lobban, F; Davies, L M

    2017-03-15

    Bipolar disorder (BD) costs the English economy an estimated £5.2billion/year, largely through incomplete recovery. This analysis estimated the cost-effectiveness of group psychoeducation (PEd), versus group peer support (PS), for treating BD. A 96-week pragmatic randomised controlled trial (RCT), conducted in NHS primary care. The primary analysis compared PEd with PS, using multiple imputed datasets for missing values. An economic model was used to compare PEd with treatment as usual (TAU). The perspective was Health and Personal Social Services. Participants receiving PEd (n=153) used more (costly) health-related resources than PS (n=151) (net cost per person £1098 (95% CI, £252-£1943)), with a quality-adjusted life year (QALY) gain of 0.023 (95% CI, 0.001-0.056). The cost per QALY gained was £47,739. PEd may be cost-effective (versus PS) if decision makers are willing to pay at least £37,500 per QALY gained. PEd costs £10,765 more than PS to avoid one relapse. The economic model indicates that PEd may be cost-effective versus TAU if it reduces the probability of relapse (by 15%) or reduces the probability of and increases time to relapse (by 10%). Participants were generally inconsistent in attending treatment sessions and low numbers had complete cost/QALY data. Factors contributing to pervasive uncertainty of the results are discussed. This is the first economic evaluation of PEd versus PS in a pragmatic trial. PEd is associated with a modest improvement in health status and higher costs than PS. There is a high level of uncertainty in the data and results. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546

    PubMed Central

    Arts, Mark P; Peul, Wilco C; Brand, Ronald; Koes, Bart W; Thomeer, Ralph TWM

    2006-01-01

    Background Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. Methods/Design Patients (age 18–70 years) presenting with sciatica due to lumbar disc herniation lasting more than 6–8 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. Discussion Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc herniation. Whether

  14. Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: design of four randomised controlled trials with an economic evaluation.

    PubMed

    Maas, Esther T; Juch, Johan N S; Groeneweg, J George; Ostelo, Raymond W J G; Koes, Bart W; Verhagen, Arianne P; van Raamt, Merel; Wille, Frank; Huygen, Frank J P M; van Tulder, Maurits W

    2012-12-28

    Minimal interventional procedures are frequently applied in patients with mechanical low back pain which is defined as pain presumably resulting from single sources: facet, disc, sacroiliac joint or a combination of these. Usually, these minimal interventional procedures are an integral part of a multidisciplinary pain programme. A recent systematic review issued by the Dutch Health Insurance Council showed that the effectiveness of these procedures for the total group of patients with chronic low back pain is yet unclear and cost-effectiveness unknown. The aim of the study is to evaluate whether a multidisciplinary pain programme with minimal interventional procedures is cost-effective compared to the multidisciplinary pain programme alone for patients with chronic mechanical low back pain who did not respond to conservative primary care and were referred to a pain clinic. All patients with chronic low back pain who are referred to one of the 13 participating pain clinics will be asked to participate in an observational study. Patients with a suspected diagnosis of facet, disc or sacroiliac joint problems will receive a diagnostic block to confirm this diagnosis. If confirmed, they will be asked to participate in a randomized controlled trial (RCT). For each single source a separate RCT will be conducted. Patients with a combination of facet, disc or sacroiliac joint problems will be invited for participation in a RCT as well. An economic evaluation from a societal perspective will be performed alongside these four RCTs. Patients will complete questionnaires at baseline, 3 and 6 weeks, 3, 6, 9 and 12 months after start of the treatment. Costs will be collected using self-completed cost questionnaires. No trials are yet available which have evaluated the cost-effectiveness of minimal interventional procedures in patients with chronic mechanical low back pain, which emphasizes the importance of this study. National Trial Register: NTR3531.

  15. The clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial

    PubMed Central

    Crawford, Mike J; Sanatinia, Rahil; Barrett, Barbara; Byford, Sarah; Dean, Madeleine; Green, John; Jones, Rachael; Leurent, Baptiste; Sweeting, Michael J; Touquet, Robin; Greene, Linda; Tyrer, Peter; Ward, Helen; Lingford-Hughes, Anne

    2015-01-01

    Objectives To examine the clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people who attend sexual health clinics. Methods Two-arm, parallel group, assessor blind, pragmatic, randomised controlled trial. 802 people aged 19 years or over who attended one of three sexual health clinics and were drinking excessively were randomised to either brief advice or control treatment. Brief advice consisted of feedback on alcohol and health, written information and an offer of an appointment with an Alcohol Health Worker. Control participants received a leaflet on health and lifestyle. The primary outcome was mean weekly alcohol consumption during the previous 90 days measured 6 months after randomisation. The main secondary outcome was unprotected sex during this period. Results Among the 402 randomised to brief advice, 397 (99%) received it. The adjusted mean difference in alcohol consumption at 6 months was −2.33 units per week (95% CI −4.69 to 0.03, p=0.053) among those in the active compared to the control arm of the trial. Unprotected sex was reported by 154 (53%) of those who received brief advice, and 178 (59%) controls (adjusted OR=0.89, 95% CI 0.63 to 1.25, p=0.496). There were no significant differences in costs between study groups at 6 months. Conclusions Introduction of universal screening and brief advice for excessive alcohol use among people attending sexual health clinics does not result in clinically important reductions in alcohol consumption or provide a cost-effective use of resources. Trial registration number Current Controlled Trials ISRCTN 99963322. PMID:24936090

  16. Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectives.

    PubMed

    Wansink, Henny J; Drost, Ruben M W A; Paulus, Aggie T G; Ruwaard, Dirk; Hosman, Clemens M H; Janssens, Jan M A M; Evers, Silvia M A A

    2016-07-07

    The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs). Effects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences. Parenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs. This study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects

  17. Digital control system for space structural dampers

    NASA Technical Reports Server (NTRS)

    Haviland, J. K.

    1984-01-01

    A recently developed concept for a damper was improved by adding a small taper to the proof-mass, and using a proximeter to determine position. Also, an experimental damper was built using a three-inch stroke in place of the standard one-inch stroke. The analog controller initially used was replaced by an independent digital controller slaved to a TRS-80 Model I computer, which also serves as a highly effective, low-cost development system. An overall system concept for the use of proof-mass dampers is presented.

  18. Cost effectiveness analysis of Year 2 of an elementary school-located influenza vaccination program-Results from a randomized controlled trial.

    PubMed

    Yoo, Byung-Kwang; Humiston, Sharon G; Szilagyi, Peter G; Schaffer, Stanley J; Long, Christine; Kolasa, Maureen

    2015-11-16

    School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season). We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; Year 2 n = 9,145 children) with standard-of-care (no SLV-I) in control schools (Year 1 n = 4,534 (10 schools); Year 2 n = 4,796 children (11 schools)). We estimated the cost-per-vaccinated child, by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools). In Years 1 and 2, respectively, the effectiveness measure (proportion of children vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7 % and 40.4 %) than control schools. In year 2, the cost-per-vaccinated child excluding vaccine purchase ($59.88 in 2010 US $) consisted of three component costs: (A) the school costs ($8.25); (B) the project coordination costs ($32.33); and (C) the vendor costs excluding vaccine purchase ($16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated child, excluding vaccine purchase, was $59.73 (Year 1) and $59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing influenza vaccination in medical practices ($39.54). However, taking indirect costs (e.g., averted

  19. A Bayesian micro-simulation to evaluate the cost-effectiveness of interventions for mastitis control during the dry period in UK dairy herds.

    PubMed

    Down, P M; Bradley, A J; Breen, J E; Browne, W J; Kypraios, T; Green, M J

    2016-10-01

    Importance of the dry period with respect to mastitis control is now well established although the precise interventions that reduce the risk of acquiring intramammary infections during this time are not clearly understood. There are very few intervention studies that have measured the clinical efficacy of specific mastitis interventions within a cost-effectiveness framework so there remains a large degree of uncertainty about the impact of a specific intervention and its costeffectiveness. The aim of this study was to use a Bayesian framework to investigate the cost-effectiveness of mastitis controls during the dry period. Data were assimilated from 77 UK dairy farms that participated in a British national mastitis control programme during 2009-2012 in which the majority of intramammary infections were acquired during the dry period. The data consisted of clinical mastitis (CM) and somatic cell count (SCC) records, herd management practices and details of interventions that were implemented by the farmer as part of the control plan. The outcomes used to measure the effectiveness of the interventions were i) changes in the incidence rate of clinical mastitis during the first 30days after calving and ii) the rate at which cows gained new infections during the dry period (measured by SCC changes across the dry period from <200,000cells/ml to >200,000cells/ml). A Bayesian one-step microsimulation model was constructed such that posterior predictions from the model incorporated uncertainty in all parameters. The incremental net benefit was calculated across 10,000 Markov chain Monte Carlo iterations, to estimate the cost-benefit (and associated uncertainty) of each mastitis intervention. Interventions identified as being cost-effective in most circumstances included selecting dry-cow therapy at the cow level, dry-cow rations formulated by a qualified nutritionist, use of individual calving pens, first milking cows within 24h of calving and spreading bedding evenly in

  20. Error-control techniques for digital communication

    NASA Astrophysics Data System (ADS)

    Michelson, A. M.; Levesque, A. H.

    The reliable transmission of digital information is discussed, taking into account the communication system design problem, the elements of a digital communication system, important channel models, information theory and channel capacity, modulation performance on the AWGN channel, and combined modulation and coding for efficient signal design. Other topics studied are related to fundamental and simple block codes, the algebra of linear block codes, binary cyclic codes and BCH codes, decoding techniques for binary BCH codes, nonbinary BCH codes and Reed-Solomon codes, the performance of linear block codes with bounded-distance decoding an introduction to convolutional codes, maximum likelihood decoding of convolutional codes, sequential decoding, and applications of error-control coding. Attention is given to groups, fields, vector spaces, binary linear block codes, the parity-check matrix revisited, dual codes, Hamming distance and the weight distribution, code geometry and error-correction capability, and the representations of finite fields.

  1. Digitally controlled twelve-pulse firing generator

    SciTech Connect

    Berde, D.; Ferrara, A.A.

    1981-01-01

    Control System Studies for the Tokamak Fusion Test Reactor (TFTR) indicate that accurate thyristor firing in the AC-to-DC conversion system is required in order to achieve good regulation of the various field currents. Rapid update and exact firing angle control are required to avoid instabilities, large eddy currents, or parasitic oscillations. The Prototype Firing Generator was designed to satisfy these requirements. To achieve the required /plus or minus/0.77/degree/firing accuracy, a three-phase-locked loop reference was designed; otherwise, the Firing Generator employs digital circuitry. The unit, housed in a standard CAMAC crate, operates under microcomputer control. Functions are performed under program control, which resides in nonvolatile read-only memory. Communication with CICADA control system is provided via an 11-bit parallel interface.

  2. Obsessive Compulsive Treatment Efficacy Trial (OCTET) comparing the clinical and cost effectiveness of self-managed therapies: study protocol for a randomised controlled trial.

    PubMed

    Gellatly, Judith; Bower, Peter; McMillan, Dean; Roberts, Christopher; Byford, Sarah; Bee, Penny; Gilbody, Simon; Arundel, Catherine; Hardy, Gillian; Barkham, Michael; Reynolds, Shirley; Gega, Lina; Mottram, Patricia; Lidbetter, Nicola; Pedley, Rebecca; Peckham, Emily; Connell, Janice; Molle, Jo; O'Leary, Neil; Lovell, Karina

    2014-07-10

    UK National Institute of Health and Clinical Excellence guidelines for obsessive compulsive disorder (OCD) specify recommendations for the treatment and management of OCD using a stepped care approach. Steps three to six of this model recommend treatment options for people with OCD that range from low-intensity guided self-help (GSH) to more intensive psychological and pharmacological interventions. Cognitive behavioural therapy (CBT), including exposure and response prevention, is the recommended psychological treatment. However, whilst there is some preliminary evidence that self-managed therapy packages for OCD can be effective, a more robust evidence base of their clinical and cost effectiveness and acceptability is required. Our proposed study will test two different self-help treatments for OCD: 1) computerised CBT (cCBT) using OCFighter, an internet-delivered OCD treatment package; and 2) GSH using a book. Both treatments will be accompanied by email or telephone support from a mental health professional. We will evaluate the effectiveness, cost and patient and health professional acceptability of the treatments. This study will provide more robust evidence of efficacy, cost effectiveness and acceptability of self-help treatments for OCD. If cCBT and/or GSH prove effective, it will provide additional, more accessible treatment options for people with OCD. Current Controlled Trials: ISRCTN73535163. Date of registration: 5 April 2011.

  3. Obsessive Compulsive Treatment Efficacy Trial (OCTET) comparing the clinical and cost effectiveness of self-managed therapies: study protocol for a randomised controlled trial

    PubMed Central

    2014-01-01

    Background UK National Institute of Health and Clinical Excellence guidelines for obsessive compulsive disorder (OCD) specify recommendations for the treatment and management of OCD using a stepped care approach. Steps three to six of this model recommend treatment options for people with OCD that range from low-intensity guided self-help (GSH) to more intensive psychological and pharmacological interventions. Cognitive behavioural therapy (CBT), including exposure and response prevention, is the recommended psychological treatment. However, whilst there is some preliminary evidence that self-managed therapy packages for OCD can be effective, a more robust evidence base of their clinical and cost effectiveness and acceptability is required. Methods/Design Our proposed study will test two different self-help treatments for OCD: 1) computerised CBT (cCBT) using OCFighter, an internet-delivered OCD treatment package; and 2) GSH using a book. Both treatments will be accompanied by email or telephone support from a mental health professional. We will evaluate the effectiveness, cost and patient and health professional acceptability of the treatments. Discussion This study will provide more robust evidence of efficacy, cost effectiveness and acceptability of self-help treatments for OCD. If cCBT and/or GSH prove effective, it will provide additional, more accessible treatment options for people with OCD. Trial registration Current Controlled Trials: ISRCTN73535163. Date of registration: 5 April 2011 PMID:25011730

  4. Intravenous immunoglobulin for severe sepsis and septic shock: clinical effectiveness, cost-effectiveness and value of a further randomised controlled trial.

    PubMed

    Soares, Marta O; Welton, Nicky J; Harrison, David A; Peura, Piia; Shankar-Hari, Manu; Harvey, Sheila E; Madan, Jason; Ades, Anthony E; Rowan, Kathryn M; Palmer, Stephen J

    2014-12-01

    Prior to investing in a large, multicentre randomised controlled trial (RCT), the National Institute for Health Research in the UK called for an evaluation of the feasibility and value for money of undertaking a trial on intravenous immunoglobulin (IVIG) as an adjuvant therapy for severe sepsis/septic shock. In response to this call, this study assessed the clinical and cost-effectiveness of IVIG (using a decision model), and evaluated the value of conducting an RCT (using expected value of information (EVI) analysis). The evidence informing such assessments was obtained through a series of systematic reviews and meta-analyses. Further primary data analyses were also undertaken using the Intensive Care National Audit & Research Centre Case Mix Programme Database, and a Scottish Intensive Care Society research study. We found a large degree of statistical heterogeneity in the clinical evidence on treatment effect, and the source of such heterogeneity was unclear. The incremental cost-effectiveness ratio of IVIG is within the borderline region of estimates considered to represent value for money, but results appear highly sensitive to the choice of model used for clinical effectiveness. This was also the case with EVI estimates, with maximum payoffs from conducting a further clinical trial between £ 137 and £ 1,011 million. Our analyses suggest that there is a need for a further RCT. Results on the value of conducting such research, however, were sensitive to the clinical effectiveness model used, reflecting the high level of heterogeneity in the evidence base.

  5. A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis.

    PubMed

    Forster, Anne; Dickerson, Josie; Young, John; Patel, Anita; Kalra, Lalit; Nixon, Jane; Smithard, David; Knapp, Martin; Holloway, Ivana; Anwar, Shamaila; Farrin, Amanda

    2013-12-21

    Most patients who have had a stroke are dependent on informal caregivers for activities of daily living. The TRACS trial investigated a training programme for caregivers (the London Stroke Carers Training Course, LSCTC) on physical and psychological outcomes, including cost-effectiveness, for patients and caregivers after a disabling stroke. We undertook a pragmatic, multicentre, cluster randomised controlled trial with a parallel cost-effectiveness analysis. Stroke units were eligible if four of five criteria used to define a stroke unit were met, a substantial number of patients on the unit had a diagnosis of stroke, staff were able to deliver the LSCTC, and most patients were discharged to a permanent place of residence. Stroke units were randomly assigned to either LSCTC or usual care (control group), stratified by geographical region and quality of care, and using blocks of size 2. Patients with a diagnosis of stroke, likely to return home with residual disability and with a caregiver providing support were eligible. The primary outcome for patients was self-reported extended activities of daily living at 6 months, measured with the Nottingham Extended Activities of Daily Living (NEADL) scale. The primary outcome for caregivers was self-reported burden at 6 months, measured with the caregivers burden scale (CBS). We combined patient and caregiver costs with primary outcomes and quality-adjusted life-years (QALYs) to assess cost-effectiveness. This trial is registered with controlled-trials.com, number ISRCTN 49208824. We assessed 49 stroke units for eligibility, of which 36 were randomly assigned to either the intervention group or the control group. Between Feb 27, 2008, and Feb 9, 2010, 928 patient and caregiver dyads were registered, of which 450 were in the intervention group, and 478 in the control group. Patients' self-reported extended activities of daily living did not differ between groups at 6 months (adjusted mean NEADL score 27·4 in the

  6. Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: a randomized controlled trial.

    PubMed

    Titov, Nickolai; Dear, Blake F; Ali, Shehzad; Zou, Judy B; Lorian, Carolyn N; Johnston, Luke; Terides, Matthew D; Kayrouz, Rony; Klein, Britt; Gandy, Milena; Fogliati, Vincent J

    2015-03-01

    Depression is a common and significant health problem among older adults. Unfortunately, while effective psychological treatments exist, few older adults access treatment. The aim of the present randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of a therapist-guided internet-delivered cognitive behavior therapy (iCBT) intervention for Australian adults over 60 years of age with symptoms of depression. Participants were randomly allocated to either a treatment group (n=29) or a delayed-treatment waitlist control group (n=25). Twenty-seven treatment group participants started the iCBT treatment and 70% completed the treatment within the 8-week course, with 85% of participants providing data at posttreatment. Treatment comprised an online 5-lesson iCBT course with brief weekly contact with a clinical psychologist, delivered over 8 weeks. The primary outcome measure was the Patient Health Questionnaire-9 Item (PHQ-9), a measure of symptoms and severity of depression. Significantly lower scores on the PHQ-9 (Cohen's d=2.08; 95% CI: 1.38 - 2.72) and on a measure of anxiety (Generalized Anxiety Disorder-7 Item) (Cohen's d=1.22; 95% CI: 0.61 - 1.79) were observed in the treatment group compared to the control group at posttreatment. The treatment group maintained these lower scores at the 3-month and 12-month follow-up time points and the iCBT treatment was rated as acceptable by participants. The treatment group had slightly higher Quality-Adjusted Life-Years (QALYs) than the control group at posttreatment (estimate: 0.012; 95% CI: 0.004 to 0.020) and, while being a higher cost (estimate $52.9l 95% CI: -23.8 to 128.2), the intervention was cost-effective according to commonly used willingness-to-pay thresholds in Australia. The results support the potential efficacy and cost-effectiveness of therapist-guided iCBT as a treatment for older adults with symptoms of depression. Australian and New Zealand Clinical Trials

  7. Improvement of a Simple and Cost-Effective Passive Cooling Rate-Controlled Device for Cell/Tissue Cryopreservation.

    PubMed

    Huang, Yu; Wang, Jianye; Zhou, Xiaoming; Peng, Ji; Zhang, Zhengliang; Shen, Lingxiao; Gao, Frankliu; Cao, Yunxia

    2017-08-22

    The currently used commercial cooling-rate control device is the liquid nitrogen controlled rate freezer (LNF), which has some shortcomings such as high cost, high liquid nitrogen consumption, and potential operational risks in quality control. Based on thermophysical properties of new materials, we improved, manufactured, and optimized a reliable yet simple device named the "passive cooling rate-controlled device (PCD)" with real-time temperature tracing. In this study, using the improved PCD we cryopreserved human umbilical vein endothelial cells (HUVECs) and compared the results with a standard commercial CryoMed LNF. The temperature profiles and cooling rates of the HUVEC samples in a cryopreservation solution (with dimethyl sulfoxide [DMSO] in 10% v/v concentration) were measured and automatically recorded by the PCD during the controlled cooling process. This study and experimental results showed that the HUVEC survival rates after cryopreservation using the PCD have no significant difference from those using the CryoMed LNF and that the improved PCD is a user-friendly, reliable, and low-cost device to ensure an optimal slow cooling rate ranging from -0.5 to -1°C/min for the cryopreservation. Considering the advantages of low cost, durability, reliability, and no liquid nitrogen consumption for the cooling process, it is concluded that the PCD is an excellent controlled cooling device to achieve a desired optimal cooling rate for cell/tissue cryopreservation.

  8. IDSAC-IUCAA digital sampler array controller

    NASA Astrophysics Data System (ADS)

    Chattopadhyay, Sabyasachi; Chordia, Pravin; Ramaprakash, A. N.; Burse, Mahesh P.; Joshi, Bhushan; Chillal, Kalpesh

    2016-07-01

    In order to run the large format detector arrays and mosaics that are required by most astronomical instruments, readout electronic controllers are required which can process multiple CCD outputs simultaneously at high speeds and low noise levels. These CCD controllers need to be modular and configurable, should be able to run multiple detector types to cater to a wide variety of requirements. IUCAA Digital Sampler Array Controller (IDSAC), is a generic CCD Controller based on a fully scalable architecture which is adequately flexible and powerful enough to control a wide variety of detectors used in ground based astronomy. The controller has a modular backplane architecture that consists of Single Board Controller Cards (SBCs) and can control up to 5 CCDs (mosaic or independent). Each Single Board Controller (SBC) has all the resources to a run Single large format CCD having up to four outputs. All SBCs are identical and are easily interchangeable without needing any reconfiguration. A four channel video processor on each SBC can process up to four output CCDs with or without dummy outputs at 0.5 Megapixels/Sec/Channel with 16 bit resolution. Each SBC has a USB 2.0 interface which can be connected to a host computer via optional USB to Fibre converters. The SBC uses a reconfigurable hardware (FPGA) as a Master Controller. IDSAC offers Digital Correlated Double Sampling (DCDS) to eliminate thermal kTC noise. CDS performed in Digital domain (DCDS) has several advantages over its analog counterpart, such as - less electronics, faster readout and easier post processing. It is also flexible with sampling rate and pixel throughput while maintaining the core circuit topology intact. Noise characterization of the IDSAC CDS signal chain has been performed by analytical modelling and practical measurements. Various types of noise such as white, pink, power supply, bias etc. has been considered while creating an analytical noise model tool to predict noise of a controller

  9. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Keith Hohn; Sarah R. Nuss-Warren

    2011-08-31

    This final report describes a project intended to identify, develop, test, and commercialize emissions control and monitoring technologies that can be implemented by E&P operators to significantly lower their cost of environmental compliance and expedite project permitting. Technologies were installed and tested in controlled laboratory situations and then installed and tested on field engines based on the recommendations of an industry-based steering committee, analysis of installed horsepower, analysis of available emissions control and monitoring technologies, and review of technology and market gaps. The industry-recognized solution for lean-burn engines, a low-emissions-retrofit including increased airflow and pre-combustion chambers, was found to successfully control engine emissions of oxides of nitrogen (NO{sub X}) and carbon monoxide (CO). However, the standard non-selective catalytic reduction (NSCR) system recognized by the industry was found to be unable to consistently control both NO{sub X} and CO emissions. The standard NSCR system was observed to produce emissions levels that changed dramatically on a day-to-day or even hour-to-hour basis. Because difficulties with this system seemed to be the result of exhaust gas oxygen (EGO) sensors that produced identical output for very different exhaust gas conditions, models were developed to describe the behavior of the EGO sensor and an alternative, the universal exhaust gas oxygen (UEGO) sensor. Meanwhile, an integrated NSCR system using an advanced, signal-conditioned UEGO sensor was tested and found to control both NO{sub X} and CO emissions. In conjunction with this project, advanced monitoring technologies, such as Ion Sense, and improved sensors for emissions control, such as the AFM1000+ have been developed and commercialized.

  10. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Allen J. Adriani

    2004-01-01

    For the period of the 8th reporting period high-impact control technologies were identified during the meeting at Cooper in Oklahoma City. The technologies that were identified will be tested on the Ajax DP-115 engine and are capable of being widely utilized by the E&P industry. Two major areas where engine controls and ignition systems, but still included were other alternatives to reduce emissions. The most exhilarating item for this quarter was when Ajax engine was delivered to the test bed at the NGML.

  11. Droplet position control in digital microfluidic systems.

    PubMed

    Bhattacharjee, Biddut; Najjaran, Homayoun

    2010-02-01

    Research on so called digital microfluidic systems (DMS) capable of manipulating individual microdroplets on a cell-based structure has enormously increased in the past few years, mainly due to the demand of the technology-dependent biomedical applications. Significant research in this area has been related to the simulation and modeling of droplet motion, demonstration of different drop actuation techniques on laboratory-scale prototypes, and droplet routing and scheduling for more efficient assay procedures. This paper introduces the basics of the control analysis and design of a DMS, which is a relatively unexplored area in digital microfluidics. This paper starts with a discussion on a simplified dynamic model of droplet motion in a planar array of cells, and continues with more complicated dynamic models that are necessary to realize the structure of an appropriate closed-loop control system for the DMS. The control analysis and design includes both the transient and steady-state responses of the DMS under external driving forces. The proposed control analysis and design approach is implemented into SIMULINK models to demonstrate the performance of the DMS through simulation using the system parameters previously reported in the literature.

  12. Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial.

    PubMed

    Robertson, Wendy; Stewart-Brown, Sarah; Stallard, Nigel; Petrou, Stavros; Griffiths, Frances; Thorogood, Margaret; Simkiss, Douglas; Lang, Rebecca; Reddington, Kate; Poole, Fran; Rye, Gloria; Khan, Kamran A; Hamborg, Thomas; Kirby, Joanna

    2013-03-20

    Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base. This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (≥91st centile BMI) or obese (≥98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton).Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality.A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children's BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style will also be assessed.Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. A de

  13. Cost-effectiveness of insulin glargine versus NPH insulin for the treatment of Type 2 diabetes mellitus, modeling the interaction between hypoglycemia and glycemic control in Switzerland.

    PubMed

    Brändle, M; Azoulay, M; Greiner, R-A

    2011-03-01

    The objective of this study was to evaluate the short-term and long-term clinical and economic outcomes associated with insulin glargine or NPH insulin in patients with Type 2 diabetes mellitus (T2DM) inadequately controlled with oral anti-diabetic drugs in Switzerland, modeling the interaction between hypoglycemia and glycemic control (HbA1c). A validated discrete event simulation model for T2DM was used to predict incidence of short-term complications (symptomatic, nocturnal and severe hypoglycemic events) and long-term complications (microvascular and macrovascular events), life expectancy, quality-adjusted life years (QALYs) and direct medical costs in patients treated with insulin glargine or NPH insulin. The model was populated with published Swiss patient characteristics with T2DM. Baseline risks of hypoglycemic events, utility decrements of diabetes-related long-term complications and the hypoglycemia fear score were derived from the literature. Relative risk reductions of hypoglycemia adjusted for HbA1c using insulin glargine compared with NPH insulin were based on a published negative binomial meta-regression analysis. Costs of severe hypoglycemia, micro- and macrovascular events were analyzed from literature whenever possible otherwise guideline-projected resource-use estimations were valued with Swiss official prices or tariffs in 2006 CHF. Simulations were run with 1,000 patients per cohort over a time horizon of 40 years. Incremental cost effectiveness ratios (ICERs) were presented as cost per QALY and per life year gained (LYG). Future costs and clinical benefits were discounted at 3.5%. Wide-range one-way sensitivity analyses were performed. Insulin glargine was associated with an improvement in quality of life (0.098 QALYs per patient) and additional life expectancy (0.05 life years gained per patient) compared to NPH insulin. Incremental costs of CHF 2,578 resulted in an ICER of CHF 26,271 per QALY and CHF 51,100 per LYG. The cost per QALY was

  14. Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked randomized controlled trials

    PubMed Central

    2014-01-01

    Background As the population ages, more people are suffering from long-term health conditions (LTCs). Health services around the world are exploring new ways of supporting people with LTCs and there is great interest in the use of telehealth: technologies such as the Internet, telephone and home self-monitoring. Methods/Design This study aims to evaluate the effectiveness and cost-effectiveness of a telehealth intervention delivered by NHS Direct to support patients with LTCs. Two randomized controlled trials will be conducted in parallel, recruiting patients with two exemplar LTCs: depression or raised cardiovascular disease (CVD) risk. A total of 1,200 patients will be recruited from approximately 42 general practices near Bristol, Sheffield and Southampton, UK. Participants will be randomly allocated to either usual care (control group) or usual care plus the NHS Direct Healthlines Service (intervention group). The intervention is based on a conceptual model incorporating promotion of self-management, optimisation of treatment, coordination of care and engagement of patients and general practitioners. Participants will be provided with tailored help, combining telephone advice from health information advisors with support to use a range of online resources. Participants will access the service for 12 months. Outcomes will be collected at baseline, four, eight and 12 months for the depression trial and baseline, six and 12 months for the CVD risk trial. The primary outcome will be the proportion of patients responding to treatment, defined in the depression trial as a PHQ-9 score <10 and an absolute reduction in PHQ-9 ≥5 after 4 months, and in the CVD risk trial as maintenance or reduction of 10-year CVD risk after 12 months. The study will also assess whether the intervention is cost-effective from the perspective of the NHS and personal social services. An embedded qualitative interview study will explore healthcare professionals’ and patients’ views of

  15. Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base. Methods/design This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (≥91st centile BMI) or obese (≥98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton). Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality. A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children’s BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children’s waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents’ BMI and mental well-being, family eating/activity, parent–child relationships and parenting style will also be assessed. Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per

  16. Oral corticosteroid use for clinical and cost-effective symptom relief of sore throat: study protocol for a randomized controlled trial.

    PubMed

    Cook, Johanna; Hayward, Gail; Thompson, Matthew; Hay, Alastair D; Moore, Michael; Little, Paul; Harman, Kim; Wolstenholme, Jane; Perera, Rafael; Voysey, Merryn; Allen, Julie; Breen, Maria; Heneghan, Carl

    2014-09-18

    Management of acute sore throat poses a significant burden on UK general practices, with almost 10% of registered patients attending their GP with sore throat every year. Nearly half of all patients presenting with acute sore throat are treated with antibiotics, despite their limited effect. In a recent systematic review we demonstrated that a single dose of steroids reduced the severity and time to resolution of sore throat. However, all of the trials included looked at the use of steroids alongside antibiotics and only one was in a primary care setting. This trial aims to assess the efficacy and cost-effectiveness of a single oral dose of corticosteroids on symptoms of sore throat in patients receiving either a delayed antibiotic prescription or no antibiotics at all in UK primary care. A double-blind, two arm, randomized, placebo controlled trial in adults (≥ 18 years of age) presenting to primary care with acute sore throat (controlled trial of oral corticosteroids in adults presenting to primary care with sore throat in the UK, and the first to examine the clinical and cost-effectiveness of oral corticosteroids for the treatment of sore throat in the absence of antibiotics. This trial is registered with Current Controlled Trials on 26 March 2013, registration number: ISRCTN17435450.

  17. Digital system accurately controls velocity of electromechanical drive

    NASA Technical Reports Server (NTRS)

    Nichols, G. B.

    1965-01-01

    Digital circuit accurately regulates electromechanical drive mechanism velocity. The gain and phase characteristics of digital circuits are relatively unimportant. Control accuracy depends only on the stability of the input signal frequency.

  18. Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania.

    PubMed Central

    Hanson, Kara; Kikumbih, Nassor; Armstrong Schellenberg, Joanna; Mponda, Haji; Nathan, Rose; Lake, Sally; Mills, Anne; Tanner, Marcel; Lengeler, Christian

    2003-01-01

    OBJECTIVE: To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use. METHODS: Project cost data were collected prospectively from accounting records. Community effectiveness was estimated on the basis of a nested case-control study and a cross-sectional cluster sample survey. FINDINGS: The social marketing approach to the distribution of insecticide-treated nets was estimated to cost 1560 US dollars per death averted and 57 US dollars per disability-adjusted life year averted. These figures fell to 1018 US dollars and 37 US dollars, respectively, when the costs and consequences of untreated nets were taken into account. CONCLUSION: The social marketing of insecticide-treated nets is an attractive intervention for preventing childhood deaths from malaria. PMID:12764493

  19. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Allen J. Adriani

    2005-04-01

    During the eighth reporting period, high-impact monitoring and control technologies were identified during a series of meetings at Ajax/Cooper in Oklahoma City. Many of the technologies that were identified will be tested on the Ajax DP-115 engine and are capable of being widely utilized by the E&P industry. Two major areas were engine controls and ignition systems but still included other alternatives to reduce emissions. Another major advance was the completion of setting the Ajax DP-115 engine. This includes anchoring and leveling the engine. Shortly after the engine was prepared, all the necessary utilities were installed. Once the utilities were installed the engine was successfully operated over its normal operating range at the end of the reporting period.

  20. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Allen Adriani

    2004-04-01

    During the fifth reporting period, the main goal for the team was to focus on collecting data to develop Oxygen Sensor Recording System (OSRS) parametric relationships for several rich-burn engines. An air/fuel ratio controller was intergraded with an O{sub 2} sensor. With the use of an Alternative Continuous Emissions Monitoring System (ACEMS) provided by Eastern Municipal Water District (EMWD), the performance will be observed during normal operation.

  1. Efficient control of air pollution through plants, a cost-effective alternative: studies on Dalbergia sissoo Roxb.

    PubMed

    Kapoor, C S; Bamniya, B R; Kapoor, K

    2013-09-01

    Plants can be used as both passive biomonitors and biomitigators in urban and industrial environments to indicate the environmental quality and to ameliorate pollution level in a locality. Many studies reveal that plants are negatively affected by the ambient levels of air pollutants. The present study was conducted to evaluate the impact of air pollution on comparative basis with reference to changes in photosynthetic pigments, plant height, leaves, as well as, biochemical parameters of plants of different sites around Udaipur city receiving varying levels of pollution load. The investigated tree species Dalbergia sissoo Roxb. (Family: Fabaceae) exhibited a reduction in various physiological and biochemical growth parameters that correspond with air pollution levels at different sites. The tree species growing in polluted and control areas were compared with respect to foliar dust load, leaf area, and chlorophyll and total carbohydrate and total protein concentration in the leaves. Our studies suggest that D. sissoo Roxb. can successfully be grown in an area for monitoring air pollution, where it is mild and droughts are common. It will prove as an ideal tree species to control pollution effectively beside acting as a shade tree and being a source of food for birds and animals. By plantation of D. sissoo Roxb., mitigative measure at the polluted sites to control generation of particulate matter and the air quality required can be ensured. Our results also confirm that industrial and vehicular air pollution level in Udaipur city is shifting beyond limits.

  2. Dynamic verification of a digital flight control system.

    NASA Technical Reports Server (NTRS)

    Nabers, J. P., Jr.; Bowman, J. D.

    1972-01-01

    Development of a digital control system dynamic variation technique which accounts for the limitation of available frequency response analyzers. Digital control system theory is briefly reviewed, and generation of the necessary theoretical frequency responses is discussed. Results of the dynamic verification of a digital control system for a Saturn V launch vehicle are presented, and attention is given to the limitations of this technique along with its applicability to other types of digital control systems. A technique for performing open-loop frequency response analyses of a flight program implemented in a 'flight-type' digital computer and interface hardware with vehicle dynamics simulated on an analog computer is described.

  3. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Greg Beshouri; Kirby S. Chapman; Jim McCarthy; Sarah R. Nuss-Warren; Mike Whelan

    2006-03-01

    This quarterly report re-evaluates current market objectives in the exploration and production industry, discusses continuing progress in testing that evaluates emission control technologies applied to a two-stroke cycle natural gas-fueled engine, and presents a scheme for enacting remote monitoring and control of engines during upcoming field tests. The examination of current market objectives takes into account technological developments and changing expectations for environmental permitting which may have occurred over the last year. This demonstrates that the continuing work in controlled testing and toward field testing is on track Market pressures currently affecting the gas exploration and production industry are shown to include a push for increased production, as well as an increasing cost for environmental compliance. This cost includes the direct cost of adding control technologies to field engines as well as the indirect cost of difficulty obtaining permits. Environmental regulations continue to require lower emissions targets, and some groups of engines which had not previously been regulated will be required to obtain permits in the future. While the focus remains on NOx and CO, some permits require reporting of additional emissions chemicals. Continuing work in controlled testing uses a one cylinder Ajax DP-115 (a 13.25 in bore x 16 in stroke, 360 rpm engine) to assess a sequential analysis and evaluation of a series of engine upgrades. As with most of the engines used in the natural gas industry, the Ajax engine is a mature engine with widespread usage throughout the gas gathering industry. The end point is an assessment of these technologies that assigns a cost per unit reduction in NOx emissions. Technologies including one pre-combustion chamber, in-cylinder sensors, the means to adjust the air-to-fuel ratio, and modification of the air filter housing have been evaluated in previous reports. Current work focuses on final preparations for testing

  4. Glycemic control with insulin glargine plus insulin glulisine versus premixed insulin analogues in real-world practices: a cost-effectiveness study with a randomized pragmatic trial design.

    PubMed

    Levin, Philip A; Zhang, Quanwu; Mersey, James H; Lee, Francis Y; Bromberger, Lee A; Bhushan, Madhu; Bhushan, Rajat

    2011-07-01

    Cost can be an important consideration, along with safety and efficacy, in deciding the most appropriate treatment for patients with type 2 diabetes. Both basal-bolus and premixed insulin analogue regimens are widely used in clinical practice; however, limited information is available regarding cost-effectiveness. The goal of this study was to compare glycemic control, cost-effectiveness, and quality of life effects of insulin glargine plus insulin glulisine (glargine/glulisine) versus premixed insulin analogues in real-world clinical practice. Adults with type 2 diabetes (glycosylated hemoglobin [HbA(1c)] ≥7.0%) at 3 US endocrinology centers were randomly assigned to receive either glargine/glulisine or premixed insulin analogues and continued treatment following the centers' usual practice. HbA(1c), weight, insulin dose, concomitant oral antidiabetic drug (OAD) usage, and hypoglycemia were evaluated at baseline and 3, 6, and 9 months. Medication costs, including costs for all insulin or OAD regimens, were estimated using published wholesale acquisition costs. A total of 197 patients were randomized to receive glargine/glulisine therapy (n = 106) or premixed analogue therapy (n = 91). Overall, the mean age was 56 years, the mean duration of diabetes was 13 years, with a mean HbA(1c) of 9.25% and mean BMI of 35.8 kg/m(2) at baseline. Patients randomized to receive glargine/glulisine had a greater mean HbA(1c) reduction from baseline (-2.3%) than patients receiving a premixed analogue regimen (-1.7%). Adjusted mean follow-up HbA(1c) was 6.9% versus 7.5%, respectively (difference, -0.59%; P < 0.01). The glargine/glulisine group also used a lower mean number of OADs (0.86 vs 1.14; difference, -0.28; P = 0.04) but had a higher weight (240 vs 235 lb; difference, 4.55 lb; P = 0.03) than the premixed analogue group at follow-up. There were no significant differences in daily insulin dose and rates of hypoglycemia. Overall medication costs per 1.0% reduction in HbA(1c

  5. Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees. Methods The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α = .05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen’s Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol. Discussion The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves

  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. The clinical impact and cost-effectiveness of essential oils and aromatherapy for the treatment of acne vulgaris: a protocol for a randomized controlled trial.

    PubMed

    Agnew, Tamara; Leach, Matthew; Segal, Leonie

    2014-05-01

    Acne is a prevalent, chronic, and sometimes severe skin disorder affecting an estimated 85% of adolescents and 50% of adults older than age 20 years. The psychosocial implications of acne can be considerable, often continuing long after physical symptoms resolve. Although effective acne medications are available, most exhibit adverse-effect profiles that can leave the patient with few effective treatment options. Emerging evidence indicates that plant-derived essential oils may be a biologically plausible treatment for acne, although high-quality evidence of effectiveness and safety is lacking. To examine the clinical effectiveness and cost-effectiveness of essential oils and aromatherapy for the treatment of acne. This randomized, wait-list controlled trial will have three parallel groups; 192 participants with acne vulgaris, aged 16-45 years, will be recruited primarily through eight Technical and Further Education campuses across Adelaide, South Australia. Participants will be randomly assigned to standard essential oil blend, customized aromatherapy treatment, or wait-list control. Changes in the physical and psychosocial symptoms of acne will be assessed at baseline and 6 and 12 weeks by using the Leeds Acne Grading System, Assessment of Quality of Life-8 Dimension instrument, and Acne-Specific Quality of Life instrument. Costs of treatment will be measured on the basis of resource inputs and unit costs and will be limited to acne treatment. The clinical effectiveness and cost-effectiveness will be compared between each intervention and against usual care, using standard health economic techniques. The provision of high-quality evidence of the effectiveness of essential oils and aromatherapy in the treatment of acne may help consumers make better-informed choices about acne management. Insights gained from this research will also contribute to the academic field of complementary medicine, specifically aromatherapy, for which the evidence base is extremely

  8. The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial

    PubMed Central

    Ndosi, Mwidimi; Lewis, Martyn; Hale, Claire; Quinn, Helen; Ryan, Sarah; Emery, Paul; Bird, Howard; Hill, Jackie

    2014-01-01

    Objective To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA). Methods In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D. Results Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was −0.31 (−0.63 to 0.02) for PP and -0.15 (−0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (−£352, £1773) and −£128 (−£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher ‘general satisfaction’ scores than RLC in week 26. Conclusions The results provide robust evidence to support non-inferiority of NLC in the management of RA. Trial registration ISRCTN29803766 PMID:23982436

  9. Control of hair growth using long-pulsed alexandrite laser is an efficient and cost effective therapy for patients suffering from recurrent pilonidal disease.

    PubMed

    Khan, Muhammad Adil Abbas; Javed, Ammar Asrar; Govindan, Karthikeyan Srinivasan; Rafiq, Sadia; Thomas, Kay; Baker, Lynne; Kenealy, John

    2016-07-01

    Pilonidal sinus (PNS) and its surgical management have a profound impact on hospital resources in terms of finances and productive man-hours. Surgical treatment has been the mainstay of treatment of both acute and chronic pilonidal sinus but recurrence is common. The control of hair growth in the sinus region plays an important role in preventing recurrence. Here, we discuss our experience of treating 19 patients suffering from recurrent pilonidal sinus with laser depilation and its long-term cost effectiveness. This is a retrospective study on patients who had recurrence of pilonidal sinus following multiple surgical treatments. They were treated using long-pulsed alexandrite laser for depilation in the sinus area, an outpatient procedure. Their clinical characteristics and outcomes were then evaluated. There was a significant reduction in hair density after laser treatment (p < 0.001). The disease-free period after laser treatment was significantly longer than that one after surgical treatment (p < 0.001). The average cost of repeated surgical treatment per disease-free month was significantly higher than that of laser treatment (p < 0.001). Evidence suggests the role of natal cleft hair growth in the evolution of the pilonidal disease; therefore, control of hair growth should be considered as an adjunct to the initial treatment via surgery. Compared to surgical treatment of recurrences, laser depilation is an efficient and cost-effective method of preventing recurrence and reducing morbidity and loss of man-hours. We suggest that laser depilation of the pilonidal sinus should be funded by clinical commissioning groups.

  10. An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative

    PubMed Central

    Edwards, Rhiannon Tudor; Williams, Nefyn; Raisanen, Larry; Moore, Graham; Linck, Pat; Hounsome, Natalia; Din, Nafees Ud; Moore, Laurence

    2012-01-01

    Background The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention. Method A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale. Results Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (OR −1.56, 95% CI −2.75 to −0.38) and depression (OR −1.39, 95% CI −2.60 to −0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12 111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session. Conclusions NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds. Trial registration Current Controlled Trials ISRCTN47680448. PMID:22577180

  11. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman

    2004-01-01

    During the fourth reporting period, the project team investigated the Non-Selective Catalytic Reduction technologies that are in use on rich-burn four-stroke cycle engines. Several engines were instrumented and data collected to obtain a rich set of engine emissions and performance data. During the data collection, the performance of the catalyst under a variety of operating conditions was measured. This information will be necessary to specify a set of sensors that can then be used to reliably implement NSCRs as plausible technologies to reduce NOx emissions for four-stroke cycle engines used in the E&P industry. A complete summary all the technologies investigated to data is included in the report. For each technology, the summary includes a description of the process, the emission reduction that is to be expected, information on the cost of the technology, development status, practical considerations, compatibility with other air pollutant control technologies, and any references used to obtain the information.

  12. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman

    2005-10-01

    This quarterly report discusses the results from a testing phase of the project that evaluates emission control technologies applied to a two-stroke cycle natural gas-fueled engine. In this phase, a one cylinder Ajax DP-115 (a 13.25 in bore x 16 in stroke, 360 rpm engine) is used to assess a sequential analysis and evaluation of a series of engine upgrades. As with most of the engines used in the natural gas industry, the Ajax engine is a mature engine with widespread usage throughout gas gathering industry. The end point is an assessment of these technologies that assigns a cost per unit reduction in NO{sub x} emissions. This report describes potential emission reduction technologies followed by a battery of tests that demonstrate synergies between some of the more promising technologies. While the end-goal is a closed loop control, low cost NO{sub x} retrofit package, additional work remains. The battery of tests include pre-combustion chambers, in-cylinder sensors, the means to adjust the air-to-fuel ratio, and modification of the air filter housing. During several phases of the tests, the ignition timing also was varied to determine the optimal point for ignition timing. The results from these tests suggest that an optimum exists where fuel consumption is minimized along with NO{sub x} emissions. By using the Ajax DP-115 these tests are completed in a low-cost and efficient manner. The various technologies can be quickly exchanged with different hardware, and the cost to operate the engine is very inexpensive.

  13. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Sarah R. Nuss-Warren; Kirby S. Chapman

    2005-12-01

    This quarterly report discusses continuing work in the testing phase of the project that evaluates emission control technologies applied to a two-stroke cycle natural gas-fueled engine. In this phase, a one cylinder Ajax DP-115 (a 13.25 in bore x 16 in stroke, 360 rpm engine) is used to assess a sequential analysis and evaluation of a series of engine upgrades. As with most of the engines used in the natural gas industry, the Ajax engine is a mature engine with widespread usage throughout the gas gathering industry. The end point is an assessment of these technologies that assigns a cost per unit reduction in NO{sub x} emissions. This report describes potential emission reduction technologies, some of which have already been tested, and describes progress toward completing remaining tests to evaluate further synergies between some of the more promising technologies. While the end-goal is a closed-loop control system coupled with a low cost NO{sub x} retrofit package, additional work remains. Technologies including pre-combustion chambers, in-cylinder sensors, the means to adjust the air-to-fuel ratio, and modification of the air filter housing have been evaluated in previous reports. Current work focuses on preparing the test cell for tests using a 180 psig fuel valve. By using the Ajax DP-115 these tests are completed in a low-cost and efficient manner. The various technologies can be quickly exchanged with different hardware, and it is inexpensive to run the engine.

  14. Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

    SciTech Connect

    Kirby S. Chapman; Sarah R. Nuss-Warren

    2006-07-01

    Continuing work in controlled testing uses a one cylinder Ajax DP-115 (a 13.25 in bore x 16 in stroke, 360 rpm engine) to assess a sequential analysis and evaluation of a series of engine upgrades. As with most of the engines used in the natural gas industry, the Ajax engine is a mature engine with widespread usage throughout the gas gathering industry. The end point is an assessment of these technologies that assigns a cost per unit reduction in NOX emissions. Technologies including one pre-combustion chamber, in-cylinder sensors, the means to adjust the air-to-fuel ratio, and modification of the air filter housing have been evaluated in previous reports. Current work focuses on final preparations for testing pre-combustion chambers with different characteristics and using mid-to-high-pressure fuel valves and initial runs of these tests. By using the Ajax DP-115 these tests are completed in a low-cost and efficient manner. The various technologies can be quickly exchanged with different hardware, and it is inexpensive to run the engine. Progress in moving toward field testing is discussed, and changes to the first planned field test are presented. Although changes have been made to the previous plan, it is expected that several new sites will be selected soon. Field tests will begin in the next quarter.

  15. Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial.

    PubMed

    Suman, Arnela; Schaafsma, Frederieke G; Elders, Petra J M; van Tulder, Maurits W; Anema, Johannes R

    2015-05-31

    Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session. The timing these clusters receive the training is the unit of randomisation. LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aimed at improving beliefs, cognitions, and self-management. The primary outcome measure of this study is patient back beliefs. Secondary outcome measures on patient level include pain, functional status, quality of life, health care utility, and productivity losses. Outcome measures on professional level include knowledge and attitude towards the guideline, and guideline adherence. A process evaluation for the implementation strategy will be performed among the health care providers and the patients. Furthermore, a qualitative subgroup analysis among patients with various ethnic backgrounds will be performed. This study will give insight into the (cost-) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non

  16. The (cost-)effectiveness of a patient-tailored intervention programme to enhance adherence to antihypertensive medication in community pharmacies: study protocol of a randomised controlled trial.

    PubMed

    van der Laan, Danielle M; Elders, Petra J M; Boons, Christel C L M; Bosmans, Judith E; Nijpels, Giel; Hugtenburg, Jacqueline G

    2017-01-19

    Medication non-adherence is a complex health care problem. Due to non-adherence, substantial numbers of cardiovascular patients benefit from their medication to only a limited extent. In order to improve adherence, a variety of pharmacist-led interventions have been developed. However, even the most effective interventions achieved only a modest positive effect. To be effective, interventions should be targeted at underlying barriers to adherence, developed in a systematic manner and tailored to specific features of a target group and setting. The current paper describes the design of the Cardiovascular medication non-Adherence Tailored Intervention (CATI) study aimed to evaluate the (cost-)effectiveness of a patient-tailored intervention programme in patients using antihypertensive medication. The CATI study is a randomised controlled trial that will be performed in 13 community pharmacies. Patients aged 45-75 years using antihypertensive medication and considered non-adherent according to pharmacy dispensing data, as well according to a self-report questionnaire, are eligible to participate. Patients in the intervention condition will receive a patient-tailored, pharmacist-led intervention programme. This programme consists of a structured interview at the pharmacy to identify patients' barriers to adherence and to counsel patients in order to overcome these barriers. The primary outcome is self-reported medication adherence measured with the MARS-5 questionnaire. Secondary outcome measures are blood pressure, illness perceptions, quality of life and societal costs. A cost-effectiveness analysis and process evaluation will also be performed. This study will provide insight into the (cost-)effectiveness of a patient-tailored, pharmacist-led intervention programme in non-adherent patients using antihypertensive medication. This intervention programme allows community pharmacists to support their patients in overcoming barriers to adherence and improving medication

  17. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial.

    PubMed

    van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

    2016-04-02

    Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared

  18. Components for digitally controlled aircraft engines

    NASA Technical Reports Server (NTRS)

    Meador, J. D.

    1981-01-01

    Control system components suitable for use in digital electronic control systems are defined. Compressor geometry actuation concepts and fuel handling system concepts suitable for use in large high performance turbofan/turbojet engines are included. Eight conceptual system designs were formulated for the actuation of the compressor geometry. Six conceptual system designs were formulated for the engine fuel handling system. Assessment criteria and weighting factors were established and trade studies performed on their candidate systems to establish the relative merits of the various concepts. Fuel pumping and metering systems for small turboshaft engines were also studied. Seven conceptual designs were formulated, and trade studies performed. A simplified bypassing fuel metering scheme was selected and a preliminary design defined.

  19. Space shuttle digital flight control system

    NASA Technical Reports Server (NTRS)

    Minott, G. M.; Peller, J. B.; Cox, K. J.

    1976-01-01

    The space shuttle digital, fly by wire, flight control system presents an interesting challenge in avionics system design. In residence in each of four redundant general purpose computers at lift off are the guidance, navigation, and control algorithms for the entire flight. The mission is divided into several flight segments: first stage ascent, second stage ascent; abort to launch site, abort once around; on orbit operations, entry, terminal area energy management; and approach and landing. The FCS is complicated in that it must perform the functions to fly the shuttle as a boost vehicle, as a spacecraft, as a reentry vehicle, and as a conventional aircraft. The crew is provided with both manual and automatic modes of operations in all flight phases including touchdown and rollout.

  20. The cost-effectiveness of a treatment-based classification system for low back pain: design of a randomised controlled trial and economic evaluation.

    PubMed

    Apeldoorn, Adri T; Ostelo, Raymond W; van Helvoirt, Hans; Fritz, Julie M; de Vet, Henrika C W; van Tulder, Maurits W

    2010-03-26

    Systematic reviews have shown that exercise therapy and spinal manipulation are both more effective for low back pain (LBP) than no treatment at all. However, the effects are at best modest. To enhance the clinical outcomes, recommendations are to improve the patient selection process, and to identify relevant subgroups to guide clinical decision-making. One of the systems that has potentials to improve clinical decision-making is a treatment-based classification system that is intended to identify those patients who are most likely to respond to direction-specific exercises, manipulation, or stabilisation exercises. The primary aim of this randomised controlled trial will be to assess the effectiveness of a classification-based system. A sample of 150 patients with subacute and chronic LBP who attend a private physical therapy clinic for treatment will be recruited. At baseline, all participants will undergo a standard evaluation by trained research physical therapists and will be classified into one of the following subgroups: direction-specific exercises, manipulation, or stabilisation. The patient will not be informed about the results of the examination. Patients will be randomly assigned to classification-based treatment or usual care according to the Dutch LBP guidelines, and will complete questionnaires at baseline, and 8, 26, and 52 weeks after the start of the treatment. The primary outcomes will be general perceived recovery, functional status, and pain intensity. Alongside this trial, an economic evaluation of cost-effectiveness and cost-utility will be conducted from a societal perspective. The present study will contribute to our knowledge about the effectiveness and cost-effectiveness of classification-based treatment in patients with LBP. NTR1176.

  1. Protocol investigating the clinical outcomes and cost-effectiveness of cognitive–behavioural therapy delivered remotely for unscheduled care users with health anxiety: randomised controlled trial

    PubMed Central

    Patel, Shireen; Malins, Sam; Guo, Boliang; James, Marilyn; Kai, Joe; Kaylor-Hughes, Catherine; Rowley, Emma; Simpson, Jayne; Smart, David; Stubley, Michelle; Tyrer, Helen

    2016-01-01

    Background Health anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable. Aims To investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive–behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036). Method A multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6–12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome. Results This trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety. Conclusions The findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703758

  2. Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial.

    PubMed

    Coulton, Simon; Clift, Stephen; Skingley, Ann; Rodriguez, John

    2015-09-01

    As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people. To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England. A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more. A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06-4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53-7.01), anxiety (mean difference = -1.78; -2.5 to -1.06) and depression (mean difference = -1.52; -2.13 to -0.92). Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people. © The Royal College of Psychiatrists 2015.

  3. The cost-effectiveness of a treatment-based classification system for low back pain: design of a randomised controlled trial and economic evaluation

    PubMed Central

    2010-01-01

    Background Systematic reviews have shown that exercise therapy and spinal manipulation are both more effective for low back pain (LBP) than no treatment at all. However, the effects are at best modest. To enhance the clinical outcomes, recommendations are to improve the patient selection process, and to identify relevant subgroups to guide clinical decision-making. One of the systems that has potentials to improve clinical decision-making is a treatment-based classification system that is intended to identify those patients who are most likely to respond to direction-specific exercises, manipulation, or stabilisation exercises. Methods/Design The primary aim of this randomised controlled trial will be to assess the effectiveness of a classification-based system. A sample of 150 patients with subacute and chronic LBP who attend a private physical therapy clinic for treatment will be recruited. At baseline, all participants will undergo a standard evaluation by trained research physical therapists and will be classified into one of the following subgroups: direction-specific exercises, manipulation, or stabilisation. The patient will not be informed about the results of the examination. Patients will be randomly assigned to classification-based treatment or usual care according to the Dutch LBP guidelines, and will complete questionnaires at baseline, and 8, 26, and 52 weeks after the start of the treatment. The primary outcomes will be general perceived recovery, functional status, and pain intensity. Alongside this trial, an economic evaluation of cost-effectiveness and cost-utility will be conducted from a societal perspective. Discussion The present study will contribute to our knowledge about the effectiveness and cost-effectiveness of classification-based treatment in patients with LBP. Trial registration Trial registration number: NTR1176 PMID:20346133

  4. Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh.

    PubMed

    Gundre, Nitin P; Iyer, Sandhya P; Subramaniyan, Prabhakar

    2012-03-01

    Most patients who come to a general hospital in a developing country are poor. The most important prohibiting factor for use of polypropylene mesh in hernia repair is its exorbitant cost. Hence, research workers have been on the lookout for an equally effective but economically affordable mesh. Worldwide, surgical repair of inguinal hernia is the most common general surgery procedure performed at the present. Lifetime risk of groin hernia is 15% in males and 5% in females. Most of the patients who visit a general hospital are from either lower middle class or poor socioeconomic strata. The most important prohibiting factor for use of polypropylene mesh in hernia repair for the common man is its exorbitant cost. The aim of this study is to document the feasibility, safety and cost-effectiveness of the use of polyethylene mesh. A single blind, prospective, randomized controlled study, comparing 35 patients of two groups was conducted in a tertiary teaching hospital over a period of 5 years. The patients in both groups underwent inguinal hernioplasty, and were administered similar antibiotics and analgesics. The postoperative course with regard to pain, seroma formation, infection, hospital stay, recurrence and scar quality was evaluated and compared. Statistical analysis was performed with Chi square test. The properties of both meshes were the same with respect to ease of handling, pain score, seroma formation, infection rate, resumption of daily activities, scar quality and mesh rejection. Recurrence rate was zero for both groups. Polyethylene mesh was 2,808 times cheaper than the commercially available polypropylene mesh. This study proved the safety, simplicity, efficacy and cost-effectiveness of polyethylene mesh for inguinal hernia meshplasty, insuring economical, accessible health care for the financially weak section of the population.

  5. Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial.

    PubMed

    Priebe, Stefan; Savill, Mark; Wykes, Til; Bentall, Richard; Lauber, Christoph; Reininghaus, Ulrich; McCrone, Paul; Mosweu, Iris; Bremner, Stephen; Eldridge, Sandra; Röhricht, Frank

    2016-02-01

    The negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control. A parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted. age 18-65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. inability to participate in the groups and insufficient command of English. Participants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces. Control intervention: a 10-week, 90-minute, 20-session group beginners' Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist. The primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up. A total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in

  6. Numerically Controlled Phase Locked Loop Using Direct Digital Synthesizer

    SciTech Connect

    Pei, Alex

    1993-04-13

    A direct digital synthesizer is a highly stable digitally controlled frequency generator that outputs high spectrum purity rf signals. Because of the all digital design, it is immune to various environmental disturbances that plague conventional LC based VCOs. As a result, a PLL based on DDS can achieve high spectrum purity with very narrow tracking bandwidth.

  7. Optimal digital redesign of continuous-time controllers

    NASA Technical Reports Server (NTRS)

    Shieh, Leang S.; Zhang, Jian L.; Coleman, Norman P.

    1991-01-01

    This paper proposes a new optimal digital redesign technique for finding a dynamic digital control law from the available analog counterpart and simultaneously minimizing a quadratic performance index. The proposed technique can be applied to a system with a more general class of reference inputs, and the developed digital regulator can be implemented using low cost microcomputers.

  8. Digitally Controlled Slot Coupled Patch Array

    NASA Technical Reports Server (NTRS)

    D'Arista, Thomas; Pauly, Jerry

    2010-01-01

    A four-element array conformed to a singly curved conducting surface has been demonstrated to provide 2 dB axial ratio of 14 percent, while maintaining VSWR (voltage standing wave ratio) of 2:1 and gain of 13 dBiC. The array is digitally controlled and can be scanned with the LMS Adaptive Algorithm using the power spectrum as the objective, as well as the Direction of Arrival (DoA) of the beam to set the amplitude of the power spectrum. The total height of the array above the conducting surface is 1.5 inches (3.8 cm). A uniquely configured microstrip-coupled aperture over a conducting surface produced supergain characteristics, achieving 12.5 dBiC across the 2-to-2.13- GHz and 2.2-to-2.3-GHz frequency bands. This design is optimized to retain VSWR and axial ratio across the band as well. The four elements are uniquely configured with respect to one another for performance enhancement, and the appropriate phase excitation to each element for scan can be found either by analytical beam synthesis using the genetic algorithm with the measured or simulated far field radiation pattern, or an adaptive algorithm implemented with the digitized signal. The commercially available tuners and field-programmable gate array (FPGA) boards utilized required precise phase coherent configuration control, and with custom code developed by Nokomis, Inc., were shown to be fully functional in a two-channel configuration controlled by FPGA boards. A four-channel tuner configuration and oscilloscope configuration were also demonstrated although algorithm post-processing was required.

  9. A randomised controlled trial and cost-effectiveness evaluation of 'booster' interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods.

    PubMed

    Goyder, Elizabeth; Hind, Daniel; Breckon, Jeff; Dimairo, Munyaradzi; Minton, Jonathan; Everson-Hock, Emma; Read, Simon; Copeland, Robert; Crank, Helen; Horspool, Kimberly; Humphreys, Liam; Hutchison, Andrew; Kesterton, Sue; Latimer, Nicolas; Scott, Emma; Swaile, Peter; Walters, Stephen J; Wood, Rebecca; Collins, Karen; Cooper, Cindy

    2014-02-01

    More evidence is needed on the potential role of 'booster' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary populations. To determine whether objectively measured physical activity, 6 months after a brief intervention, is increased in those receiving physical activity 'booster' consultations delivered in a motivational interviewing (MI) style, either face to face or by telephone. Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with nested qualitative research fidelity and geographical information systems and health economic substudies. Treatment allocation was carried out using a web-based simple randomisation procedure with equal allocation probabilities. Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only. Deprived areas of Sheffield, UK. Previously sedentary people, aged 40-64 years, living in deprived areas of Sheffield, UK, who had increased their physical activity levels after receiving a brief intervention. Participants were randomised to the control group (no further intervention) or to two sessions of MI, either face to face ('full booster') or by telephone ('mini booster'). Sessions were delivered 1 and 2 months post-randomisation. The primary outcome was total energy expenditure (TEE) per day in kcal from 7-day accelerometry, measured using an Actiheart device (CamNtech Ltd, Cambridge, UK). Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment. An estimate of the per-participant intervention costs, resource use data collected by questionnaire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective. An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness. In total, 282 people were

  10. 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

  11. Investigating the (cost-) effectiveness of attention bias modification (ABM) for outpatients with major depressive disorder (MDD): a randomized controlled trial protocol.

    PubMed

    Ferrari, Gina R A; Becker, Eni S; Smit, Filip; Rinck, Mike; Spijker, Jan

    2016-11-03

    Despite the range of available, evidence-based treatment options for Major Depressive Disorder (MDD), the rather low response and remission rates suggest that treatment is not optimal, yet. Computerized attention bias modification (ABM) trainings may have the potential to be provided as cost-effective intervention as adjunct to usual care (UC), by speeding up recovery and bringing more patients into remission. Research suggests, that a selective attention for negative information contributes to development and maintenance of depression and that reducing this negative bias might be of therapeutic value. Previous ABM studies in depression, however, have been limited by small sample sizes, lack of long-term follow-up measures or focus on sub-clinical samples. This study aims at evaluating the long-term (cost-) effectiveness of internet-based ABM, as add-on treatment to UC in adult outpatients with MDD, in a specialized mental health care setting. This study presents a double-blind randomized controlled trial in two parallel groups with follow-ups at 1, 6, and 12 months, combined with an economic evaluation. One hundred twenty six patients, diagnosed with MDD, who are registered for specialized outpatient services at a mental health care organization in the Netherlands, are randomized into either a positive training (towards positive and away from negative stimuli) or a sham training, as control condition (continuous attentional bias assessment). Patients complete eight training sessions (seven at home) during a period of two weeks (four weekly sessions). Primary outcome measures are change in attentional bias (pre- to post-test), mood response to stress (at post-test) and long-term effects on depressive symptoms (up to 1-year follow-up). Secondary outcome measures include rumination, resilience, positive and negative affect, and transfer to other cognitive measures (i.e., attentional bias for verbal stimuli, cognitive control, positive mental imagery), as well as

  12. 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

    Seesing, Femke M; Drost, Gea; van der Wilt, Gert-Jan; van Engelen, Baziel G M

    2011-08-23

    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. 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. 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 current therapeutical spectrum. When

  13. Digital adaptive control of a VTOL aircraft

    NASA Technical Reports Server (NTRS)

    Reid, G. F.

    1976-01-01

    A technique has been developed for calculating feedback and feedforward gain matrices that stabilize a VTOL aircraft while enabling it to track input commands of forward and vertical velocity. Leverrier's algorithm is used in a procedure for determining a set of state variable, feedback gains that force the closed loop poles and zeroes of one pilot input transfer function to be at preselected positions in the s plane. This set of feedback gains is then used to calculate the feedback and feedforward gains for the velocity command controller. The method is computationally attractive since the gains are determined by solving systems of linear, simultaneous equations. Responses obtained using a digital simulation of the longitudinal dynamics of the CH-47 helicopter are presented.

  14. Digital Control of Flight Simulator Motion Base Actuator.

    DTIC Science & Technology

    1984-01-01

    SYNTHESIS 3.1 Basic Considerations As a starting point for digital controller design a proportional plus integral ( PI ) control law of the form - V(s...on closed loop stability arising from digital realization of the PI control law, computational time delay and sampling have to be taken into

  15. Effectiveness and cost-effectiveness of an injury prevention programme for adult male amateur soccer players: design of a cluster-randomised controlled trial

    PubMed Central

    Krist, Mark R; Schmikli, Sandor L; Stubbe, Janine H; de Wit, G Ardine; Inklaar, Han; van de Port, Ingrid G L; Backx, Frank J G

    2010-01-01

    Background and aims Approximately 16% of all sports injuries in the Netherlands are caused by outdoor soccer. A cluster-randomised controlled trial has been designed to investigate the effectiveness and cost-effectiveness of an injury prevention programme (‘The11’) for male amateur soccer players. The injury prevention programme The11, developed with the support of the World Football Association FIFA, aims to reduce the impact of intrinsic injury risk factors in soccer. Methods Teams playing at first-class amateur level in two districts in the Netherlands are participating in the study. Teams in the intervention group were instructed to apply The11 during each practice session throughout the 2009–10 season. All participants of the control group continued their practice sessions as usual. All soccer-related injuries and related costs for each team were systematically reported online by a member of the medical staff. Player exposure to practice sessions and matches was reported weekly by the coaches. Also the use of The11 during the season after the intervention season will be monitored. Discussion Our hypothesis is that integrating the The11 exercises in the warm-up for each practice session is effective in terms of injury incidence, injury severity, healthcare use, and its associated costs and/or absenteeism. Prevention of soccer injuries is expected to be beneficial to adult soccer players, soccer clubs, the Royal Dutch Football Association (KNVB), health insurance companies and society. PMID:21177664

  16. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

    PubMed Central

    Avery, Anthony J; Rodgers, Sarah; Cantrill, Judith A; Armstrong, Sarah; Cresswell, Kathrin; Eden, Martin; Elliott, Rachel A; Howard, Rachel; Kendrick, Denise; Morris, Caroline J; Prescott, Robin J; Swanwick, Glen; Franklin, Matthew; Putman, Koen; Boyd, Matthew; Sheikh, Aziz

    2012-01-01

    Summary Background Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-effectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months' follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0

  17. Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial

    PubMed Central

    Stoddart, Andrew; Hanley, Janet; Wild, Sarah; Pagliari, Claudia; Paterson, Mary; Lewis, Steff; Sheikh, Aziz; Krishan, Ashma; Padfield, Paul; McKinstry, Brian

    2013-01-01

    Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS). Design Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach. Setting 20 socioeconomically diverse general practices in Lothian, Scotland. Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg). Intervention Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history. Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced. Results Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient. Conclusions Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications. Trial

  18. Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial

    PubMed Central

    van Oostrom, Sandra H; Anema, Johannes R; Terluin, Berend; de Vet, Henrica CW; Knol, Dirk L; van Mechelen, Willem

    2008-01-01

    Background Considering the high costs of sick leave and the consequences of sick leave for employees, an early return-to-work of employees with mental disorders is very important. Therefore, a workplace intervention is developed based on a successful return-to-work intervention for employees with low back pain. The objective of this paper is to present the design of a randomized controlled trial evaluating the cost-effectiveness of the workplace intervention compared with usual care for sick-listed employees with common mental disorders. Methods The study is designed as a randomized controlled trial with a follow-up of one year. Employees eligible for this study are on sick leave for 2 to 8 weeks with common mental disorders. The workplace intervention will be compared with usual care. The workplace intervention is a stepwise approach that aims to reach consensus about a return-to-work plan by active participation and strong commitment of both the sick-listed employee and the supervisor. Outcomes will be assessed at baseline, 3, 6, 9 and 12 months. The primary outcome of this study is lasting return-to-work, which will be acquired from continuous registration systems of the companies after the follow-up. Secondary outcomes are total number of days of sick leave during the follow-up, severity of common mental disorders, coping style, job content, and attitude, social influence, and self-efficacy determinants. Cost-effectiveness will be evaluated from the societal perspective. A process evaluation will also be conducted. Discussion Return-to-work is difficult to discuss in the workplace for sick-listed employees with mental disorders and their supervisors. Therefore, this intervention offers a unique opportunity for the sick-listed employee and the supervisor to discuss barriers for return-to-work. Results of this study will possibly contribute to improvement of disability management for sick-listed employees with common mental disorders. Results will become

  19. Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: A protocol for a randomised, double-blind, placebo-controlled trial

    PubMed Central

    Bennell, Kim; Coburn, Sally; Wee, Elin; Green, Sally; Harris, Anthony; Forbes, Andrew; Buchbinder, Rachelle

    2007-01-01

    Background Chronic rotator cuff pathology (CRCP) is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there is little conclusive evidence to support or refute its effectiveness and no formal evaluation of its cost-effectiveness. Methods/Design This randomised, double-blind, placebo-controlled trial will involve 200 participants with CRCP recruited from medical practices, outpatient departments and the community via print and radio media. Participants will be randomly allocated to a physiotherapy or placebo group using concealed allocation stratified by treating physiotherapist. Both groups will receive 10 sessions of individual standardised treatment over 10 weeks from one of 10 project physiotherapists. For the following 12 weeks, the physiotherapy group will continue a home exercise program and the placebo group will receive no treatment. The physiotherapy program will comprise shoulder joint and spinal mobilisation, soft tissue massage, postural taping, and home exercises for scapular control, posture and rotator cuff strengthening. The placebo group will receive inactive ultrasound and gentle application of an inert gel over the shoulder region. Blinded assessment will be conducted at baseline and at 10 weeks and 22 weeks after randomisation. The primary outcome measures are self reported questionnaires including the shoulder pain and disability index (SPADI), average pain on an 11-point numeric rating scale and participant perceived global rating of change. Secondary measures include Medical Outcomes Study 36-item short form (SF-36), Assessment of Quality of Life index, numeric rating scales for shoulder pain and stiffness, participant perceived rating of change for pain, strength and stiffness, and manual muscle testing for shoulder strength using a handheld dynamometer. To evaluate cost-effectiveness, participants will record the use of all health-related treatments in a log

  20. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis.

    PubMed

    Avery, Anthony J; Rodgers, Sarah; Cantrill, Judith A; Armstrong, Sarah; Cresswell, Kathrin; Eden, Martin; Elliott, Rachel A; Howard, Rachel; Kendrick, Denise; Morris, Caroline J; Prescott, Robin J; Swanwick, Glen; Franklin, Matthew; Putman, Koen; Boyd, Matthew; Sheikh, Aziz

    2012-04-07

    Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to researchers and statisticians involved in processing and analysing the data. The allocation was not masked to general practices, pharmacists, patients, or researchers who visited practices to extract data. [corrected]. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-effectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. 72 general practices with a combined list size of 480,942 patients were randomised. At 6 months' follow-up, patients in the PINCER group were significantly less likely to have

  1. [Cost-effectiveness of colorectal cancer screening].

    PubMed

    Heresbach, Denis; Manfrédi, Sylvain; Branger, Bernard; Bretagne, Jean-François

    2006-01-01

    Colorectal cancer (CRC) screening in France is based on a faecal occult blood test every two years in average risk subjects 50-74 years of age while other endoscopic or non-endoscopic screening methods are used in Europe and in the USA. Beside the reduced incidence of and mortality from CRC found in available studies, cost-effectiveness data need to be taken into account. Because of the delay between randomized controlled trials and clinical results, transitional probabilistic models of screening programs are useful for public health policy makers. The aim of the present review was to promote the implementation of cost-effectiveness studies, to provide a guide to analyze cost-effectiveness studies on CRC screening and, to propose a French cost effectiveness study comparing CRC screening strategies. Most of these trials were performed by US or UK authors and demonstrate that the incremental cost-effectiveness ratio varies between 5 000 and 15 000 US dollars/one year life gained, with wide variations: these results were highly dependent on the unit costs of the different devices as well as the predictive values of the screening tests. Although CRC screening programs have been implemented in several administrative districts of France since 2002, and the results of these randomized controlled trials using fecal occult blood have been updated, cost-effectiveness criteria need to be integrated; especially since the results of screening campaigns based on other tools such as flexible sigmoidoscopy should be available in 2007.

  2. Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.

    PubMed

    Richards, David A; Bower, Peter; Chew-Graham, Carolyn; Gask, Linda; Lovell, Karina; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Barkham, Michael; Bland, J Martin; Gilbody, Simon; Green, Colin; Lewis, Glyn; Manning, Chris; Kontopantelis, Evangelos; Hill, Jacqueline J; Hughes-Morley, Adwoa; Russell, Abigail

    2016-02-01

    Collaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness. To determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression. Cluster randomised controlled trial. UK primary care practices (n = 51) in three UK primary care districts. A total of 581 adults aged ≥ 18 years in general practice with a current International Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment. Collaborative care: 14 weeks of 6-12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice. Blinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months. In total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31; p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64; p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for

  3. Digital Camera Control for Faster Inspection

    NASA Technical Reports Server (NTRS)

    Brown, Katharine; Siekierski, James D.; Mangieri, Mark L.; Dekome, Kent; Cobarruvias, John; Piplani, Perry J.; Busa, Joel

    2009-01-01

    Digital Camera Control Software (DCCS) is a computer program for controlling a boom and a boom-mounted camera used to inspect the external surface of a space shuttle in orbit around the Earth. Running in a laptop computer in the space-shuttle crew cabin, DCCS commands integrated displays and controls. By means of a simple one-button command, a crewmember can view low- resolution images to quickly spot problem areas and can then cause a rapid transition to high- resolution images. The crewmember can command that camera settings apply to a specific small area of interest within the field of view of the camera so as to maximize image quality within that area. DCCS also provides critical high-resolution images to a ground screening team, which analyzes the images to assess damage (if any); in so doing, DCCS enables the team to clear initially suspect areas more quickly than would otherwise be possible and further saves time by minimizing the probability of re-imaging of areas already inspected. On the basis of experience with a previous version (2.0) of the software, the present version (3.0) incorporates a number of advanced imaging features that optimize crewmember capability and efficiency.

  4. A digital controlled solar array regulator employing the charge control

    SciTech Connect

    Cho, Y.J.; Cho, B.H.

    1997-12-31

    A microprocessor controlled SAR system is presented. The inner analog loops employing the charge current control scheme continuously regulate the solar array output power according to the reference value generated by the ECU. The ECU consists of the peak power tracking and the battery charge current regulation algorithm. Modeling, analysis and a design procedure of the inner loops and the system loop are presented taking into account of interaction between the inner analog loops and the outer digital loops. Utilizing the inherent characteristics of the inner voltage and current loop, the system dynamic performance and stability can be optimized up to the speed limit of the microprocessor.

  5. The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR).

    PubMed Central

    Crawford, Mike J; Sanatinia, Rahil; Barrett, Barbara; Byford, Sarah; Dean, Madeleine; Green, John; Jones, Rachael; Leurent, Baptiste; Lingford-Hughes, Anne; Sweeting, Michael; Touquet, Robin; Tyrer, Peter; Ward, Helen

    2014-01-01

    BACKGROUND Excessive use of alcohol is associated with poor sexual health, but the clinical effectiveness and cost-effectiveness of brief alcohol intervention in this setting has not been investigated. OBJECTIVE To examine the effects and cost-effectiveness of brief intervention for excessive alcohol consumption among people who attend sexual health clinics. DESIGN A two-arm, parallel-group, single-blind, pragmatic, randomised controlled trial. Participants were randomised via an independent and remote telephone randomisation service using permuted blocks, stratified by clinic. SETTING Study participants were recruited from three sexual health clinics in central and west London. PARTICIPANTS For inclusion, potential participants had to be aged ≥ 19 years, drink excessive alcohol according to the Modified-Single Alcohol Screening Question, and be willing to provide written informed consent. We excluded those who were unable to communicate in English sufficiently well to complete the baseline assessment and those who could not provide contact details for the follow-up assessment. INTERVENTIONS Brief advice was delivered by the treating clinician and comprised feedback on the possible health consequences of excessive drinking, a discussion of whether the participant's clinic attendance was linked to current alcohol use, written information on alcohol and health and an offer of an appointment with an alcohol health worker (AHW). Appointments with AHWs took place either in person or by telephone, lasted up to 30 minutes, and used the 'FRAMES' (Feedback about the adverse effects of alcohol, an emphasis on personal Responsibility for changing drinking behaviour, Advice about alcohol consumption, a Menu of options for further help and advice, an Empathic stance towards the patient and an emphasis on Self-efficacy) approach. Those in the control arm of the trial were offered a copy of a leaflet providing general information on health and lifestyle. MAIN OUTCOME MEASURES

  6. The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR).

    PubMed

    Crawford, Mike J; Sanatinia, Rahil; Barrett, Barbara; Byford, Sarah; Dean, Madeleine; Green, John; Jones, Rachael; Leurent, Baptiste; Lingford-Hughes, Anne; Sweeting, Michael; Touquet, Robin; Tyrer, Peter; Ward, Helen

    2014-05-01

    Excessive use of alcohol is associated with poor sexual health, but the clinical effectiveness and cost-effectiveness of brief alcohol intervention in this setting has not been investigated. To examine the effects and cost-effectiveness of brief intervention for excessive alcohol consumption among people who attend sexual health clinics. A two-arm, parallel-group, single-blind, pragmatic, randomised controlled trial. Participants were randomised via an independent and remote telephone randomisation service using permuted blocks, stratified by clinic. Study participants were recruited from three sexual health clinics in central and west London. For inclusion, potential participants had to be aged ≥ 19 years, drink excessive alcohol according to the Modified-Single Alcohol Screening Question, and be willing to provide written informed consent. We excluded those who were unable to communicate in English sufficiently well to complete the baseline assessment and those who could not provide contact details for the follow-up assessment. Brief advice was delivered by the treating clinician and comprised feedback on the possible health consequences of excessive drinking, a discussion of whether the participant's clinic attendance was linked to current alcohol use, written information on alcohol and health and an offer of an appointment with an alcohol health worker (AHW). Appointments with AHWs took place either in person or by telephone, lasted up to 30 minutes, and used the 'FRAMES' (Feedback about the adverse effects of alcohol, an emphasis on personal Responsibility for changing drinking behaviour, Advice about alcohol consumption, a Menu of options for further help and advice, an Empathic stance towards the patient and an emphasis on Self-efficacy) approach. Those in the control arm of the trial were offered a copy of a leaflet providing general information on health and lifestyle. Outcomes were assessed 6 months after randomisation. The primary outcome was mean

  7. An analysis of the short- and long-term cost-effectiveness of starting biphasic insulin aspart 30 in insulin-naïve people with poorly controlled type 2 diabetes.

    PubMed

    Shafie, Asrul Akmal; Gupta, Vishal; Baabbad, Ranya; Hammerby, Eva; Home, Philip

    2014-11-01

    This study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria. The IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A(1)chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of <3.0 times GDPc. Comprehensive sensitivity analyses were performed. In the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of >1 year and was highly cost-effective, with ICERs of -0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective. Starting BIAsp 30 in people with type 2 diabetes in the A(1)chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Randomized Controlled Trial of Rituximab and Cost-Effectiveness Analysis in Treating Fatigue and Oral Dryness in Primary Sjögren's Syndrome.

    PubMed

    Bowman, Simon J; Everett, Colin C; O'Dwyer, John L; Emery, Paul; Pitzalis, Costantino; Ng, Wan-Fai; Pease, Colin T; Price, Elizabeth J; Sutcliffe, Nurhan; Gendi, Nagui S T; Hall, Frances C; Ruddock, Sharon P; Fernandez, Catherine; Reynolds, Catherine; Hulme, Claire T; Davies, Kevin A; Edwards, Christopher J; Lanyon, Peter C; Moots, Robert J; Roussou, Euthalia; Giles, Ian P; Sharples, Linda D; Bombardieri, Michele

    2017-07-01

    To investigate whether rituximab, an anti-B cell therapy, improves symptoms of fatigue and oral dryness in patients with primary Sjögren's syndrome (SS). We conducted a multicenter, randomized, double-blind, placebo-controlled, parallel-group trial that included health economic analysis. Anti-Ro-positive patients with primary SS, symptomatic fatigue, and oral dryness were recruited from 25 UK rheumatology clinics from August 2011 to January 2014. Patients were centrally randomized to receive either intravenous (IV) placebo (250 ml saline) or IV rituximab (1,000 mg in 250 ml saline) in 2 courses at weeks 0, 2, 24, and 26, with pre- and postinfusion medication including corticosteroids. The primary end point was the proportion of patients achieving a 30% reduction in either fatigue or oral dryness at 48 weeks, as measured by visual analog scale. Other outcome measures included salivary and lacrimal flow rates, quality of life, scores on the European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index and EULAR Sjögren's Syndrome Disease Activity Index, symptoms of ocular and overall dryness, pain, globally assessed disease activity, and cost-effectiveness. All 133 patients who were randomized to receive placebo (n = 66) or rituximab (n = 67) were included in the primary analysis. Among patients with complete data, 21 of 56 placebo-treated patients and 24 of 61 rituximab-treated patients achieved the primary end point. After multiple imputation of missing outcomes, response rates in the placebo and rituximab groups were 36.8% and 39.8%, respectively (adjusted odds ratio 1.13 [95% confidence interval 0.50, 2.55]). There were no significant improvements in any outcome measure except for unstimulated salivary flow. The mean ± SD costs per patient for rituximab and placebo were £10,752 ± 264.75 and £2,672 ± 241.71, respectively. There were slightly more adverse events (AEs) reported in total for rituximab, but there was

  9. The Community In-Reach and Care Transition (CIRACT) clinical and cost-effectiveness study: study protocol for a randomised controlled trial.

    PubMed

    Watson, Alison; Charlesworth, Lisa; Jacob, Ruth; Kendrick, Denise; Logan, Philippa; Marshall, Fiona; Montgomery, Alan; Sach, Tracey; Tan, Wei; Walker, Maria; Waring, Justin; Whitham, Diane; Sahota, Opinder

    2015-02-08

    Older people represent a significant proportion of patients admitted to hospital. Their care compared to younger patients is more challenging, length of stay is longer, risk of hospital-acquired problems higher and the risk of being re-admitted within 28 days greater. This study aims to compare a Community In-Reach and Care Transition (CIRACT) service with Traditional Hospital Based rehabilitation (THB-Rehab) provided to the older person. The CIRACT service differs from the THB-rehab service in that they are able to provide more intensive hospital rehabilitation, visiting patients daily, and are able to continue with the patient's rehabilitation following discharge allowing a seamless, integrated discharge working alongside community providers. A pilot comparing the two services showed that the CIRACT service demonstrated reduced length of stay and reduced re-admission rates when analysed over a four-month period. This trial will evaluate the clinical and cost-effectiveness of the CIRACT service, conducted as a randomised controlled trial (RCT) with an integral qualitative mechanism and action study designed to provide the explanatory and theoretical components on how the CIRACT service compares to current practice. The RCT element consists of 240 patients over 70 years of age, being randomised to either the THB therapy group or the CIRACT service following an unplanned hospital admission. The primary outcome will be hospital length of stay from admission to discharge from the general medical elderly care ward. Additional outcome measures including the Barthel Index, Charlson Co-morbidity Scale, EuroQoL-5D and the modified Client Service Receipt Inventory will be assessed at the time of recruitment and repeated at 91 days post-discharge. The qualitative mechanism and action study will involve a systematic programme of organisational profiling, observations of work processes, interviews with key informants and care providers and tracking of participants. In

  10. The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial.

    PubMed

    Speklé, Erwin M; Heinrich, Judith; Hoozemans, Marco J M; Blatter, Birgitte M; van der Beek, Allard J; van Dieën, Jaap H; van Tulder, Maurits W

    2010-11-11

    The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave. The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping. The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found. In this study, the RSI Quick

  11. Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients--the INDICA study: a cluster randomized controlled trial.

    PubMed

    Ramallo-Fariña, Yolanda; García-Pérez, Lidia; Castilla-Rodríguez, Iván; Perestelo-Pérez, Lilisbeth; Wägner, Ana María; de Pablos-Velasco, Pedro; Domínguez, Armando Carrillo; Cortés, Mauro Boronat; Vallejo-Torres, Laura; Ramírez, Marcos Estupiñán; Martín, Pablo Pedrianes; García-Puente, Ignacio; Salinero-Fort, Miguel Ángel; Serrano-Aguilar, Pedro Guillermo

    2015-04-09

    Type 2 diabetes mellitus is a chronic disease whose health outcomes are related to patients and healthcare professionals' decision-making. The Diabetes Intervention study in the Canary Islands (INDICA study) aims to evaluate the effectiveness and cost-effectiveness of educational interventions supported by new technology decision tools for type 2 diabetes patients and primary care professionals in the Canary Islands. The INDICA study is an open, community-based, multicenter, clinical controlled trial with random allocation by clusters to one of three interventions or to usual care. The setting is primary care where physicians and nurses are invited to participate. Patients with diabetes diagnosis, 18-65 years of age, and regular users of mobile phone were randomly selected. Patients with severe comorbidities were excluded. The clusters are primary healthcare practices with enough professionals and available places to provide the intervention. The calculated sample size was 2,300 patients. Patients in group 1 are receiving an educational group program of eight sessions every 3 months led by trained nurses and monitored by means of logs and a web-based platform and tailored semi-automated SMS for continuous support. Primary care professionals in group 2 are receiving a short educational program to update their diabetes knowledge, which includes a decision support tool embedded into the electronic clinical record and a monthly feedback report of patients' results. Group 3 is receiving a combination of the interventions for patients and professionals. The primary endpoint is the change in HbA1c in 2 years. Secondary endpoints are cardiovascular risk factors, macrovascular and microvascular diabetes complications, quality of life, psychological outcomes, diabetes knowledge, and healthcare utilization. Data is being collected from interviews, questionnaires, clinical examinations, and records. Generalized linear mixed models with repeated time measurements will be used

  12. Exploring the comparative cost-effectiveness of economic incentive and command-and-control instruments, and of renewable energy technologies in PM10 emission control: A case study of Lima-Callao, Peru

    NASA Astrophysics Data System (ADS)

    Kroeger, Timm

    Much economic literature expounds the superior cost-effectiveness of economic incentive (EI) policies over command-and-control (CAC) ones, based on appealing theoretical arguments. However, one of the assumptions underlying much of this literature is that monitoring and enforcement (M&E) of policies are not only feasible, but essentially costless. In reality, M&E are never costless and sometimes infeasible, and, crucially, M&E requirements vary across policy types. Furthermore, in technical economic terms, cost-effectiveness is defined with respect to variable costs only; however, in choosing among policies, the objective generally is to identify that with the lowest total (variable plus fixed) cost per unit abatement, which in its own right may be termed cost-effective. The neglect of M&E and of fixed costs throws up the question of the validity of much of the policy advice that draws on the environmental economics literature for developing countries, where the institutional capacity for effective M&E often is strongly limited, and where creating this capacity will require considerable infrastructure investments. The limited institutional capacity also has led to the suggestion that in developing countries, conventional environmental policies, such as input or output taxes, emission charges, or standards, may be less cost-effective than non-conventional environmental policies, such as direct public provision of electricity from renewable sources, because the M&E capacity required for the implementation of non-conventional policies is often less stringent. I test the hypotheses of superior cost-effectiveness of EI over CAC and of non-conventional over conventional environmental policy instruments. The samples of pollution control policies used to test the hypotheses are drawn from a list of frequently recommended urban air pollution abatement measures for developing countries, plus two renewable energy sources. Both sets of environmental policy types are compared

  13. Digital control of magnetic bearings supporting a multimass flexible rotor

    NASA Technical Reports Server (NTRS)

    Keith, F. J.; Williams, R. D.; Allaire, P. E.; Schafer, R. M.

    1993-01-01

    The characteristics of magnetic bearings used to support a three mass flexible rotor operated at speeds up to 14,000 RPM are discussed. The magnetic components of the bearing are of a type reported in the literature previously, but the earlier analog controls were replaced by digital ones. Analog-to-digital and digital-to-analog converters and digital control software were installed in an AT&T PC. This PC-based digital controller was used to operate one of the magnetic bearings on the test rig. Basic proportional-derivative control was applied to the bearings, and the bearing stiffness and damping characteristics were evaluated. Particular attention is paid to the frequency dependent behavior of the stiffness and damping properties, and comparisons are made between the actual controllers and ideal proportional-derivative control.

  14. Screening uptake rates and the clinical and cost effectiveness of screening for gestational diabetes mellitus in primary versus secondary care: study protocol for a randomised controlled trial.

    PubMed

    O'Dea, Angela; Infanti, Jennifer J; Gillespie, Paddy; Tummon, Olga; Fanous, Samuel; Glynn, Liam G; McGuire, Brian E; Newell, John; Dunne, Fidelma P

    2014-01-17

    The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings. This will be an unblinded, two-group, parallel randomised controlled trial (RCT). The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Ireland: Galway University Hospital and Mayo General Hospital. Participants will be offered universal screening for GDM at 24 to 28 weeks gestation in either primary care (n=392) or secondary care (n=392) locations. The primary outcome variable is the uptake rate of screening. Secondary outcomes include indicators of clinical effectiveness of screening at each screening site (primary and secondary) including gestational week at time of screening, time to access antenatal diabetes services for women diagnosed with GDM, and pregnancy and neonatal outcomes for women with GDM. In addition, parallel economic and qualitative evaluations will be conducted. The trial will cover the period from the woman's first hospital antenatal

  15. 47 CFR 97.221 - Automatically controlled digital station.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Automatically controlled digital station. 97.221 Section 97.221 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO SERVICE Special Operations § 97.221 Automatically controlled digital...

  16. 47 CFR 97.221 - Automatically controlled digital station.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Automatically controlled digital station. 97.221 Section 97.221 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO SERVICE Special Operations § 97.221 Automatically controlled digital...

  17. 47 CFR 97.221 - Automatically controlled digital station.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 5 2013-10-01 2013-10-01 false Automatically controlled digital station. 97.221 Section 97.221 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO SERVICE Special Operations § 97.221 Automatically controlled digital...

  18. 47 CFR 97.221 - Automatically controlled digital station.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 5 2011-10-01 2011-10-01 false Automatically controlled digital station. 97.221 Section 97.221 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO SERVICE Special Operations § 97.221 Automatically controlled digital...

  19. 47 CFR 97.221 - Automatically controlled digital station.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 5 2012-10-01 2012-10-01 false Automatically controlled digital station. 97.221 Section 97.221 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO SERVICE Special Operations § 97.221 Automatically controlled digital...

  20. COSPAS/SARSAT 406-MHz emergency beacon digital controller

    NASA Technical Reports Server (NTRS)

    Ivancic, William D.

    1988-01-01

    The digital control portion of a low-cost 406-MHz COSPAS/SARSAT emergency beacon has been designed and breadboarded at the NASA Lewis Research Center. This report discusses the requirements and design tradeoffs of the digital controller and describes the hardware and software design, which is available only to United States citizens and companies.

  1. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up.

    PubMed

    Brooker, Simon; Kabatereine, Narcis B; Fleming, Fiona; Devlin, Nancy

    2008-01-01

    Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intra-country variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with district officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US$ per schoolchild treated, and an incremental cost-effectiveness ratio (cost in US$ per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US$0.54 and the cost-effectiveness was US$3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children who received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$0.41-0.91) and cost per anaemia case averted (US$1.70-9.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations.

  2. Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial.

    PubMed

    Bosmans, J E; Dozeman, E; van Marwijk, Harm W J; van Schaik, Digna J F; Stek, Max L; Beekman, Aartjan T F; van der Horst, Henriette E

    2014-02-01

    Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, -593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care. Copyright © 2013 John Wiley & Sons, Ltd.

  3. Digital Flight Control System for Tactical Fighter. Volume 1. Digital Flight Control System Analysis

    DTIC Science & Technology

    1974-06-01

    30 34 34 37 38 41 45 47 47 53 55 5fi 5 « (il R4 G7 * ..it hv^irWMiM MraiMtMiaiiMiflMaiMifliarii^^MMiyiiJ ■.pi.miwwuiwi.iiii.iii, mm...the Digital Control Software System 5 (DIGIKON) 3 Control and Computational Requirements 7 4 Interactive Analysis, Design, and Performance...Evaluation 7 in the s-Plane 5 Interactive Analysis, Design, and Performance Evaluation 8 in the s-z Plane 6 Interactive Analysis, Design, and Performance

  4. Digital control of the Kuiper Airborne Observatory telescope

    NASA Technical Reports Server (NTRS)

    Mccormack, Ann C.; Snyder, Philip K.

    1989-01-01

    The feasibility of using a digital controller to stabilize a telescope mounted in an airplane is investigated. The telescope is a 30 in. infrared telescope mounted aboard a NASA C-141 aircraft known as the Kuiper Airborne Observatory. Current efforts to refurbish the 14-year-old compensation system have led to considering a digital controller. A typical digital controller is modeled and added into the telescope system model. This model is simulated on a computer to generate the Bode plots and time responses which determine system stability and performance parameters. Important aspects of digital control system hardware are discussed. A summary of the findings shows that a digital control system would result in satisfactory telescope performance.

  5. Cost-effectiveness of functional cardiac testing in the diagnosis and management of coronary artery disease: a randomised controlled trial. The CECaT trial.

    PubMed

    Sharples, L; Hughes, V; Crean, A; Dyer, M; Buxton, M; Goldsmith, K; Stone, D

    2007-12-01

    To assess the acceptability and feasibility of functional tests as a gateway to angiography for management of coronary artery disease (CAD), the ability of diagnostic strategies to identify patients who should undergo revascularisation, patient outcomes in each diagnostic strategy, and the most cost-effective diagnostic strategy for patients with suspected or known CAD. A rapid systematic review of economic evaluations of alternative diagnostic strategies for CAD was carried out. A pragmatic and generalisable randomised controlled trial was undertaken to assess the use of the functional cardiac tests: angiography (controls); single photon emission computed tomography (SPECT); magnetic resonance imaging (MRI); stress echocardiography. The setting was Papworth Hospital NHS Foundation Trust, a tertiary cardiothoracic referral centre. Patients with suspected or known CAD and an exercise test result that required non-urgent angiography. Patients were randomised to one of the four initial diagnostic tests. Eighteen months post-randomisation: exercise time (modified Bruce protocol); cost-effectiveness compared with angiography (diagnosis, treatment and follow-up costs). The aim was to demonstrate equivalence in exercise time between those randomised to functional tests and those randomised to angiography [defined as the confidence interval (CI) for mean difference from angiography within 1 minute]. The 898 patients were randomised to angiography (n = 222), SPECT (n = 224), MRI (n = 226) or stress echo (n = 226). Initial diagnostic tests were completed successfully with unequivocal results for 98% of angiography, 94% of SPECT (p = 0.05), 78% of MRI (p < 0.001) and 90% of stress echocardiography patients (p < 0.001). Some 22% of SPECT patients, 20% of MRI patients and 25% of stress echo patients were not subsequently referred for an angiogram. Positive functional tests were confirmed by positive angiography in 83% of SPECT patients, 89% of MRI patients and 84% of stress

  6. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial.

    PubMed

    Knapp, Martin; King, Derek; Romeo, Renee; Schehl, Barbara; Barber, Julie; Griffin, Mark; Rapaport, Penny; Livingston, Debbie; Mummery, Cath; Walker, Zuzana; Hoe, Juanita; Sampson, Elizabeth L; Cooper, Claudia; Livingston, Gill

    2013-10-25

    To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone. Cost effectiveness analysis nested within a pragmatic randomised controlled trial. Three mental health and one neurological outpatient dementia service in London and Essex, UK. Family carers of people with dementia. Eight session, manual based, coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment, compared with usual treatment alone. Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline. Of the 260 participants recruited to the study, 173 were randomised to the START intervention, and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference -1.79 (95% CI -3.32 to -0.33)), indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (-0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (-28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30,000 per QALY gained, and a high probability of cost effectiveness on the HADS-T measure. The manual based coping intervention START, when added to treatment as usual, was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers, and carer based QALYs). ISCTRN 70017938.

  7. Rationale and support for a One Health program for canine vaccination as the most cost-effective means of controlling zoonotic rabies in endemic settings.

    PubMed

    Lavan, Robert P; King, Alasdair I MacG; Sutton, David J; Tunceli, Kaan

    2017-03-23

    Although dog vaccination has been demonstrated to reduce and eliminate rabies in humans, during meetings there are often calls for further pilot studies. The assembled data proves that a widespread approach is now required. While zoonotic rabies has a minimal presence in developed nations, it is endemic throughout most of Asia and Africa, where it is considered to be a neglected tropical disease. In these areas, rabies causes an estimated annual mortality of at least 55,000 human deaths. Worldwide rabid dogs are the source of the vast majority of human rabies exposures. The World Health Organization (WHO), the Food and Agriculture Organization (FAO) of the United Nations and the World Organization for Animal Health (OIE) advocate a collaborative One Health approach involving human public health and veterinary agencies, with mass canine vaccination programs in endemic areas being the mainstay of strategies to eliminate dog-mediated human rabies. While post-exposure prophylaxis (PEP) is effective in preventing deaths in people exposed to rabies, it is comparatively expensive and has little impact on the canine reservoir that is the primary source of zoonotic rabies. Indiscriminate culling of the dog population is expensive and there is little evidence that it is effective in controlling rabies in non-island locations. Mass canine vaccination programs using a One Health framework that achieves a minimum 70% vaccination coverage during annual campaigns have proven to be cost-effective in controlling zoonotic rabies in endemic, resource-poor regions. Case studies, such as in Tanzania and Bhutan, illustrate how an approach based on mass canine rabies vaccination has effectively reduced both canine and human rabies to minimal levels. The multiple benefits of mass canine rabies vaccination in these cases included eliminating rabies in the domestic dog reservoirs, eliminating human rabies cases, and decreasing the rabies economic burden by reducing expenditures on PEP.

  8. Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

    PubMed Central

    2012-01-01

    Background Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. Methods/design A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline. Discussion Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Trial registration Netherlands Trial Register NTR2233 PMID:22937959

  9. Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial.

    PubMed

    Kok, Robin N; van Straten, Annemieke; Beekman, Aartjan; Bosmans, Judith; de Neef, Manja; Cuijpers, Pim

    2012-08-31

    Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline. Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Netherlands Trial Register NTR2233.

  10. A digital control system for high level acoustic noise generation

    NASA Technical Reports Server (NTRS)

    Lee, John P.; Bosco, Jerry H.

    1986-01-01

    As part of the modernization of the Acoustic Test Facility at Lockheed Missiles and Space Company, Sunnyvale, a digital acoustic control system was designed and built. The requirements imposed by Lockheed on the control system and the degree to which those requirements were met are discussed. Acceptance test results as well as some of the features of the digital control system not found in traditional manual control systems are discussed.

  11. REVIEW OF NRC APPROVED DIGITAL CONTROL SYSTEMS ANALYSIS

    SciTech Connect

    D.W. Markman

    1999-09-17

    Preliminary design concepts for the proposed Subsurface Repository at Yucca Mountain indicate extensive reliance on modern, computer-based, digital control technologies. The purpose of this analysis is to investigate the degree to which the U. S. Nuclear Regulatory Commission (NRC) has accepted and approved the use of digital control technology for safety-related applications within the nuclear power industry. This analysis reviews cases of existing digitally-based control systems that have been approved by the NRC. These cases can serve as precedence for using similar types of digitally-based control technologies within the Subsurface Repository. While it is anticipated that the Yucca Mountain Project (YMP) will not contain control systems as complex as those required for a nuclear power plant, the review of these existing NRC approved applications will provide the YMP with valuable insight into the NRCs review process and design expectations for safety-related digital control systems. According to the YMP Compliance Program Guidance, portions of various NUREGS, Regulatory Guidelines, and nuclear IEEE standards the nuclear power plant safety related concept would be applied to some of the designs on a case-by-case basis. This analysis will consider key design methods, capabilities, successes, and important limitations or problems of selected control systems that have been approved for use in the Nuclear Power industry. An additional purpose of this analysis is to provide background information in support of further development of design criteria for the YMP. The scope and primary objectives of this analysis are to: (1) Identify and research the extent and precedence of digital control and remotely operated systems approved by the NRC for the nuclear power industry. Help provide a basis for using and relying on digital technologies for nuclear related safety critical applications. (2) Identify the basic control architecture and methods of key digital control

  12. Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.

    PubMed

    Epps, H; Ginnelly, L; Utley, M; Southwood, T; Gallivan, S; Sculpher, M; Woo, P

    2005-10-01

    To compare the effects of combined hydrotherapy and land-based physiotherapy (combined) with land-based physiotherapy only (land) on cost, health-related quality of life (HRQoL) and outcome of disease in children with juvenile idiopathic arthritis (JIA). Also to determine the cost-effectiveness of combined hydrotherapy and land-based physiotherapy in JIA. A multicentre randomised controlled, partially blinded trial was designed with 100 patients in a control arm receiving land-based physiotherapy only (land group) and 100 patients in an intervention arm receiving a combination of hydrotherapy and land-based physiotherapy (combined group). Three tertiary centres in the UK. Patients aged 4-19 years diagnosed more than 3 months with idiopathic arthritides, onset before their 16th birthday, stable on medication with at least one active joint. Patients in the combined and land groups received 16 1-hour treatment sessions over 2 weeks followed by local physiotherapy attendances for 2 months. Disease improvement defined as a decrease of > or =30% in any three of six core set variables without there being a 30% increase in more than one of the remaining three variables was used as the primary outcome measure and assessed at 2 months following completion of intervention. Health services resource use (in- and outpatient care, GP visits, drugs, interventions, and investigations) and productivity costs (parents' time away from paid work) were collected at 6 months follow-up. HRQoL was measured at baseline and 2 and 6 months following intervention using the EQ-5D, and quality-adjusted life-years (QALYs) were calculated. Secondary outcome measures at 2 and 6 months included cardiovascular fitness, pain, isometric muscle strength and patient satisfaction. Seventy-eight patients were recruited into the trial and received treatment. Two months after intervention 47% patients in the combined group and 61% patients in the land group had improved disease with 11 and 5% with worsened

  13. Research study on IPS digital controller design

    NASA Technical Reports Server (NTRS)

    Kuo, B. C.; Folkerts, C.

    1976-01-01

    The performance is investigated of the simplified continuous-data model of the Instrument Pointing System (IPS). Although the ultimate objective is to study the digital model of the system, knowledge on the performance of the continuous-data model is important in the sense that the characteristics of the digital system should approach those of the continuous-data system as the sampling period approaches zero.

  14. Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial.

    PubMed

    Hassiotis, Angela; Strydom, Andre; Crawford, Mike; Hall, Ian; Omar, Rumana; Vickerstaff, Victoria; Hunter, Rachael; Crabtree, Jason; Cooper, Vivien; Biswas, Asit; Howie, William; King, Michael

    2014-08-03

    Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services. The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS. The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour. This trial is registered with Clinical Trials.gov (Ref NCT01680276 ). Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/ .

  15. The development and demonstration of hybrid programmable attitude control electronics. [with adaptable analog/digital design approach

    NASA Technical Reports Server (NTRS)

    Smith, L. S.; Kopf, E. H., Jr.

    1974-01-01

    HYPACE provides an adaptable, analog/digital design approach that permits preflight and in-flight accommodation of mission changes, component performance variations, spacecraft changes, etc., through programing. This enabled broad multimission flexibility of application in a cost-effective manner. The HYPACE design, which was demonstrated in breadboard form on a single-axis gas-bearing spacecraft simulation, uses a single control channel to perform the attitude control functions sequentially, thus significantly reducing the number of component parts over hard-wired designs. The success of this effort resulted in the concept being selected for the Mariner/Jupiter/Saturn 1977 spacecraft application.

  16. The development and demonstration of hybrid programmable attitude control electronics. [with adaptable analog/digital design approach

    NASA Technical Reports Server (NTRS)

    Smith, L. S.; Kopf, E. H., Jr.

    1974-01-01

    HYPACE provides an adaptable, analog/digital design approach that permits preflight and in-flight accommodation of mission changes, component performance variations, spacecraft changes, etc., through programing. This enabled broad multimission flexibility of application in a cost-effective manner. The HYPACE design, which was demonstrated in breadboard form on a single-axis gas-bearing spacecraft simulation, uses a single control channel to perform the attitude control functions sequentially, thus significantly reducing the number of component parts over hard-wired designs. The success of this effort resulted in the concept being selected for the Mariner/Jupiter/Saturn 1977 spacecraft application.

  17. Cost-effectiveness of a fixed-dose combination of solifenacin and oral controlled adsorption system formulation of tamsulosin in men with lower urinary tract symptoms associated with benign prostatic hyperplasia.

    PubMed

    Nazir, Jameel; Heemstra, Lars; van Engen, Anke; Hakimi, Zalmai; Ivanescu, Cristina

    2015-05-09

    Storage symptoms, associated with benign prostatic hyperplasia (BPH), often co-exist with voiding symptoms in men with lower urinary tract symptoms (LUTS). Storage symptoms are likely to be most bothersome, and may not be adequately resolved by treatment with α-blocker or antimuscarinic monotherapy. A recent randomised controlled phase 3 trial (NEPTUNE) demonstrated that a fixed-dose combination (FDC) of solifenacin 6 mg plus an oral controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS, 0.4 mg) improved storage symptoms, as well as quality of life, compared with TOCAS alone in men with moderate-to-severe storage symptoms and voiding symptoms. This analysis aimed to assess the cost-effectiveness of a FDC tablet of solifenacin 6 mg plus TOCAS relative to tolterodine plus tamsulosin given concomitantly, from the perspective of the UK National Health Service (NHS). A Markov model was developed for men aged ≥45 years with LUTS/BPH who have moderate-to-severe storage symptoms and voiding symptoms. The model calculated cost-effectiveness over an analytical time horizon of 1 year and estimated total treatment costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratio. The FDC tablet of solifenacin 6 mg plus TOCAS was associated with lower total annual costs (£860 versus £959) and increased QALYs (0.839 versus 0.836), and was therefore dominant compared with tolterodine plus tamsulosin. Time horizon, discontinuation or withdrawal rates, drug cost and utility values were the main drivers of cost-effectiveness. The probability that the FDC tablet of solifenacin 6 mg plus TOCAS is cost-effective was 100% versus tolterodine plus tamsulosin, at a willingness-to-pay threshold of £20,000/QALY gained. The FDC tablet of solifenacin 6 mg plus TOCAS provides important clinical benefits and is a cost-effective treatment strategy in the UK NHS compared with tolterodine plus tamsulosin for men with both storage and voiding LUTS/BPH.

  18. Cost-effectiveness of controlling emissions for various alternative-fuel vehicle types, with vehicle and fuel price subsidies estimated on the basis of monetary values of emission reductions

    SciTech Connect

    Wang, M.Q.

    1993-12-31

    Emission-control cost-effectiveness is estimated for ten alternative-fuel vehicle (AFV) types (i.e., vehicles fueled with reformulated gasoline, M85 flexible-fuel vehicles [FFVs], M100 FFVs, dedicated M85 vehicles, dedicated M100 vehicles, E85 FFVS, dual-fuel liquefied petroleum gas vehicles, dual-fuel compressed natural gas vehicles [CNGVs], dedicated CNGVs, and electric vehicles [EVs]). Given the assumptions made, CNGVs are found to be most cost-effective in controlling emissions and E85 FFVs to be least cost-effective, with the other vehicle types falling between these two. AFV cost-effectiveness is further calculated for various cases representing changes in costs of vehicles and fuels, AFV emission reductions, and baseline gasoline vehicle emissions, among other factors. Changes in these parameters can change cost-effectiveness dramatically. However, the rank of the ten AFV types according to their cost-effectiveness remains essentially unchanged. Based on assumed dollars-per-ton emission values and estimated AFV emission reductions, the per-vehicle monetary value of emission reductions is calculated for each AFV type. Calculated emission reduction values ranged from as little as $500 to as much as $40,000 per vehicle, depending on AFV type, dollar-per-ton emission values, and baseline gasoline vehicle emissions. Among the ten vehicle types, vehicles fueled with reformulated gasoline have the lowest per-vehicle value, while EVs have the highest per-vehicle value, reflecting the magnitude of emission reductions by these vehicle types. To translate the calculated per-vehicle emission reduction values to individual AFV users, AFV fuel or vehicle price subsidies are designed to be equal to AFV emission reduction values. The subsidies designed in this way are substantial. In fact, providing the subsidies to AFVs would change most AFV types from net cost increases to net cost decreases, relative to conventional gasoline vehicles.

  19. PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study.

    PubMed

    Little, Paul; Hobbs, F D Richard; Moore, Michael; Mant, David; Williamson, Ian; McNulty, Cliodna; Lasseter, Gemma; Cheng, M Y Edith; Leydon, Geraldine; McDermott, Lisa; Turner, David; Pinedo-Villanueva, Rafael; Raftery, James; Glasziou, Paul; Mullee, Mark

    2014-01-01

    Antibiotics are still prescribed to most patients attending primary care with acute sore throat, despite evidence that there is modest benefit overall from antibiotics. Targeting antibiotics using either clinical scoring methods or rapid antigen detection tests (RADTs) could help. However, there is debate about which groups of streptococci are important (particularly Lancefield groups C and G), and uncertainty about the variables that most clearly predict the presence of streptococci. This study aimed to compare clinical scores or RADTs with delayed antibiotic prescribing. The study comprised a RADT in vitro study; two diagnostic cohorts to develop streptococcal scores (score 1; score 2); and, finally, an open pragmatic randomised controlled trial with nested qualitative and cost-effectiveness studies. The setting was UK primary care general practices. Participants were patients aged ≥ 3 years with acute sore throat. An internet program randomised patients to targeted antibiotic use according to (1) delayed antibiotics (control group), (2) clinical score or (3) RADT used according to clinical score. The main outcome measures were self-reported antibiotic use and symptom duration and severity on seven-point Likert scales (primary outcome: mean sore throat/difficulty swallowing score in the first 2-4 days). The IMI TestPack Plus Strep A (Inverness Medical, Bedford, UK) was sensitive, specific and easy to use. Lancefield group A/C/G streptococci were found in 40% of cohort 2 and 34% of cohort 1. A five-point score predicting the presence of A/C/G streptococci [FeverPAIN: Fever; Purulence; Attend rapidly (≤ 3 days); severe Inflammation; and No cough or coryza] had moderate predictive value (bootstrapped estimates of area under receiver operating characteristic curve: 0.73 cohort 1, 0.71 cohort 2) and identified a substantial number of participants at low risk of streptococcal infection. In total, 38% of cohort 1 and 36% of cohort 2 scored ≤ 1 for Fever

  20. Efficacy and cost-effectiveness of an experimental short-term inpatient Dialectical Behavior Therapy (DBT) program: study protocol for a randomized controlled trial.

    PubMed

    van den Bosch, Louisa M C; Sinnaeve, Roland; Hakkaart-van Roijen, Leona; van Furth, Eric F

    2014-05-01

    Borderline Personality Disorder (BPD) is a serious psychiatric condition associated with substantial mortality, burden and public health costs. DBT is the treatment model with the largest number of published research articles showing effectiveness. However, some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior, making hospitalization necessary. The Center for Personality Disorders Jelgersma developed an intensive 12-week inpatient DBT program that (i) rapidly reduces core borderline symptoms like suicidal behavior, (ii) minimizes the negative effects of an inpatient setting, and (iii) enhances compliance with outpatient treatment. We evaluate the (cost-) effectiveness of this experimental program. Seventy patients, aged 18 to 45 years with a primary diagnosis of BPD, showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms, are randomly allocated to the control and intervention groups. Subjects in the control group receive standard outpatient DBT, provided in one of three regular mental health settings in GGZ Rivierduinen. Subjects in the intervention group receive 12 weeks of intensified inpatient DBT plus six months of standard DBT, provided in the Center for Personality Disorders Jelgersma. The primary outcome is the number of suicide attempts/self-harming acts. Secondary outcomes are severity of other borderline complaints, quality of life, general psychopathological symptoms and health care utilization and productivity costs. Data are gathered using a prospective, two (group: intervention and control) by five (time of measurement) repeated measures factorial design.Participants will complete three-monthly outcome assessments in the course of therapy: at baseline, and 12, 24, 36 and 52 weeks after the start of the treatment. The period of recruitment started in March 2012 and the study will end in December 2014. Highly suicidal

  1. Effectiveness and cost-effectiveness of a group-based pain self-management intervention for patients undergoing total hip replacement: feasibility study for a randomized controlled trial.

    PubMed

    Wylde, Vikki; Marques, Elsa; Artz, Neil; Blom, Ashley; Gooberman-Hill, Rachael

    2014-05-20

    Total hip replacement (THR) is a common elective surgical procedure and can be effective for reducing chronic pain. However, waiting times can be considerable. A pain self-management intervention may provide patients with skills to more effectively manage their pain and its impact during their wait for surgery. This study aimed to evaluate the feasibility of conducting a randomized controlled trial to assess the effectiveness and cost-effectiveness of a group-based pain self-management course for patients undergoing THR. Patients listed for a THR at one orthopedic center were posted a study invitation pack. Participants were randomized to attend a pain self-management course plus standard care or standard care only. The lay-led course was delivered by Arthritis Care and consisted of two half-day sessions prior to surgery and one full-day session after surgery. Participants provided outcome and resource-use data using a diary and postal questionnaires prior to surgery and one month, three months and six months after surgery. Brief telephone interviews were conducted with non-participants to explore barriers to participation. Invitations were sent to 385 eligible patients and 88 patients (23%) consented to participate. Interviews with 57 non-participants revealed the most common reasons for non-participation were views about the course and transport difficulties. Of the 43 patients randomized to the intervention group, 28 attended the pre-operative pain self-management sessions and 11 attended the post-operative sessions. Participant satisfaction with the course was high, and feedback highlighted that patients enjoyed the group format. Retention of participants was acceptable (83% of recruited patients completed follow-up) and questionnaire return rates were high (72% to 93%), with the exception of the pre-operative resource-use diary (35% return rate). Resource-use completion rates allowed for an economic evaluation from the health and social care payer perspective

  2. Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial.

    PubMed

    Horn, Eva K; van Benthem, Tjeerd B; Hakkaart-van Roijen, Leona; van Marwijk, Harm W J; Beekman, Aartjan T F; Rutten, Frans F; van der Feltz-Cornelis, Christina M

    2007-02-26

    Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. CC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Earlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster

  3. Digital Controller For Laser-Beam-Steering Subsystem

    NASA Technical Reports Server (NTRS)

    Ansari, Homayoon

    1995-01-01

    Report presents additional information about proposed apparatus described in "Beam-Steering Subsystem for Laser Communication" (NPO-19069). Discusses design of digital beam-steering control subsystem and, in particular, that part of design pertaining to digital compensation for frequency response of steering mirror.

  4. Implementation of Adaptive Digital Controllers on Programmable Logic Devices

    NASA Technical Reports Server (NTRS)

    Gwaltney, David A.; King, Kenneth D.; Smith, Keary J.; Monenegro, Justino (Technical Monitor)

    2002-01-01

    Much has been made of the capabilities of FPGA's (Field Programmable Gate Arrays) in the hardware implementation of fast digital signal processing. Such capability also makes an FPGA a suitable platform for the digital implementation of closed loop controllers. Other researchers have implemented a variety of closed-loop digital controllers on FPGA's. Some of these controllers include the widely used proportional-integral-derivative (PID) controller, state space controllers, neural network and fuzzy logic based controllers. There are myriad advantages to utilizing an FPGA for discrete-time control functions which include the capability for reconfiguration when SRAM-based FPGA's are employed, fast parallel implementation of multiple control loops and implementations that can meet space level radiation tolerance requirements in a compact form-factor. Generally, a software implementation on a DSP (Digital Signal Processor) or microcontroller is used to implement digital controllers. At Marshall Space Flight Center, the Control Electronics Group has been studying adaptive discrete-time control of motor driven actuator systems using digital signal processor (DSP) devices. While small form factor, commercial DSP devices are now available with event capture, data conversion, pulse width modulated (PWM) outputs and communication peripherals, these devices are not currently available in designs and packages which meet space level radiation requirements. In general, very few DSP devices are produced that are designed to meet any level of radiation tolerance or hardness. The goal of this effort is to create a fully digital, flight ready controller design that utilizes an FPGA for implementation of signal conditioning for control feedback signals, generation of commands to the controlled system, and hardware insertion of adaptive control algorithm approaches. An alternative is required for compact implementation of such functionality to withstand the harsh environment

  5. Army/NASA small turboshaft engine digital controls research program

    NASA Technical Reports Server (NTRS)

    Sellers, J. F.; Baez, A. N.

    1981-01-01

    The emphasis of a program to conduct digital controls research for small turboshaft engines is on engine test evaluation of advanced control logic using a flexible microprocessor based digital control system designed specifically for research on advanced control logic. Control software is stored in programmable memory. New control algorithms may be stored in a floppy disk and loaded directly into memory. This feature facilitates comparative evaluation of different advanced control modes. The central processor in the digital control is an Intel 8086 16 bit microprocessor. Control software is programmed in assembly language. Software checkout is accomplished prior to engine test by connecting the digital control to a real time hybrid computer simulation of the engine. The engine currently installed in the facility has a hydromechanical control modified to allow electrohydraulic fuel metering and VG actuation by the digital control. Simulation results are presented which show that the modern control reduces the transient rotor speed droop caused by unanticipated load changes such as cyclic pitch or wind gust transients.

  6. Digital control of high-intensity acoustic testing

    NASA Technical Reports Server (NTRS)

    Slusser, R. A.

    1975-01-01

    To eliminate previous system instabilities and control high-intensity acoustic tests, a digital control vibration test system is modified by a software change. Three systems for the control of acoustic testing are compared: a hybrid digital/analog system, a digital vibration system, and the same digital vibration system modified by a software change to allow acoustic testing. It is shown that the hybrid system and the modified vibration system exhibit almost equal performance, although the hybrid system performs testing twice as fast. The development of a specialized acoustic test control system is justified since it costs far less than the general-purpose vibration control system. However, the latter is much easier to set up for a test, which is important in preventing overtesting of valuable spacecraft components.

  7. Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR).

    PubMed

    Penaloza-Ramos, Maria Cristina; Jowett, Sue; Mant, Jonathan; Schwartz, Claire; Bray, Emma P; Sayeed Haque, M; Richard Hobbs, F D; Little, Paul; Bryan, Stirling; Williams, Bryan; McManus, Richard J

    2016-06-01

    A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive medication evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease and/or previous cardiovascular disease. A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year-old 'high risk' patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years. A subgroup analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management. Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more quality adjusted life years (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per quality adjusted life year gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year. Self-management of blood pressure in high-risk people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of healthcare resources. © The European Society of Cardiology 2015.

  8. Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes: analysis of the ADDITION-UK cluster-randomized controlled trial.

    PubMed

    Tao, L; Wilson, E C F; Wareham, N J; Sandbaek, A; Rutten, G E H M; Lauritzen, T; Khunti, K; Davies, M J; Borch-Johnsen, K; Griffin, S J; Simmons, R K

    2015-07-01

    To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes. Cost-utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level. Adjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted at 3.5%). Adjusted incremental QALYs were 0.0000, - 0.0040, 0.0140 and 0.0465 over the same time horizons. Point estimate incremental cost-effectiveness ratios (ICERs) suggested that the intervention was not cost-effective although the ratio improved over time: the ICER over 10 years was £82,250, falling to £37,500 over 30 years. The ICER fell below £30 000 only when the intervention cost was below £631 per patient: we estimated the cost at £981. Given conventional thresholds of cost-effectiveness, the intensive treatment delivered in ADDITION was not cost-effective compared with routine care for individuals with screen-detected diabetes in the UK. The intervention may be cost-effective if it can be delivered at reduced cost. © 2015 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

  9. Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes: analysis of the ADDITION-UK cluster-randomized co