scholarly journals PRP13: ASSESSING THE COST IMPLICATIONS OF COMBINED PHARMACOTHERAPY IN THE LONG TERM MANAGEMENT OF ASTHMA

2003 ◽  
Vol 6 (3) ◽  
pp. 369-370
Author(s):  
EQ Wu ◽  
KA Johnson ◽  
MB Nichol
Keyword(s):  
Cost Implications ◽  
The Cost ◽  
Term Management

scholarly journals Cost-effective Analysis of Proton Pump Inhibitors in Long-term Management of Gastroesophageal Reflux Disease: A Narrative Review

2019 ◽  
Vol 55 (5) ◽  
pp. 292-305
Author(s):  
Shazia Jamshed ◽  
Akshaya Srikanth Bhagavathula ◽  
Sheikh Muhammad Zeeshan Qadar ◽  
Umaira Alauddin ◽  
Sana Shamim ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Gastroesophageal Reflux Disease ◽  
Cost Effective ◽  
The Other ◽  
Cost Effectiveness Ratio ◽  
On Demand ◽  
Step Down ◽  
The Cost ◽  
Term Management

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that results from regurgitation of acid from the stomach into the esophagus. Treatment available for GERD includes lifestyle changes, antacids, histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and anti-reflux surgery. Aim: The aim of this review is to assess the cost-effectiveness of the use of PPIs in the long-term management of patients with GERD. Method: We searched in PubMed to identify related original articles with close consideration based on inclusion and exclusion criteria to choose the best studies for this narrative review. The first section compares the cost-effectiveness of PPIs with H2RAs in long-term heartburn management. The other sections shall only discuss the cost-effectiveness of PPIs in 5 different strategies, namely, continuous (step-up, step-down, and maintenance), on-demand, and intermittent therapies. Results: Of 55 articles published, 10 studies published from 2000 to 2015 were included. Overall, PPIs are more effective in relieving heartburn in comparison with ranitidine. The use of PPIs in managing heartburn in long-term consumption of nonsteroidal anti-inflammatory drug (NSAID) has higher cost compared with H2RA. However, if the decision-maker is willing to pay more than US$174 788.60 per extra quality-adjusted life year (QALY), then the optimal strategy is traditional NSAID (tNSAID) and PPIs. The probability of being cost-effective was also highest for NSAID and PPI co-therapy users. On-demand PPI treatment strategy showed dominant with an incremental cost-effectiveness ratio of US$2197 per QALY gained and was most effective and cost saving compared with all the other treatments. The average cost-effectiveness ratio was lower for rabeprazole therapy than for ranitidine therapy. Conclusion: Our review revealed that long-term treatment with PPIs is effective but costly. To achieve long-term cost-effective approach, we recommend on-demand approach to treat heartburn symptoms, but if the symptoms persist, treatment with continuous step-down therapy should be applied.

Maritime piracy and the cost of world trade*

2014 ◽  
Vol 24 (3) ◽  
pp. 158-170 ◽  
Author(s):  
Stephanie Jones
Keyword(s):  
World Trade ◽  
Maritime Piracy ◽  
Economic Implications ◽  
Content Type ◽  
Global Trends ◽  
Cost Implications ◽  
The Cost ◽  
The Impact

Purpose – The aim of this study is to determine the nature and extent of the threat of global maritime piracy. The cost of global piracy has been estimated at USD15-25 billion, reaching an all-time high in 2011, remaining an ongoing threat to world trade and contributing to high commodity costs. Design/methodology/approach – Based on a literature review of formal and informal published sources, this exploratory and diagnostic article attempts to approximately quantify global piracy in terms of pirate activity worldwide and shipper response, and looks at global trends and some tentative economic implications. Findings – The overall findings are inconclusive due to unreliable and piecemeal data, but global piracy clearly impacts goods carried by sea. The piracy problem may be estimated in terms of ships and crew affected, ransoms paid, the impact on specific commodities in terms of cargoes carried and cost implications of pirate-avoiding rerouting. Practical implications – Pirates are getting rich, but their compatriots are poorer than ever. Countries desperate for international aid are corruptly laundering pirate ransom income and continuing to support pirate warlords. Prices are continuing to rise for consumers in all countries. Solutions to the piracy problem remain elusive, and are considered in a follow-up article, Maritime piracy – the challenge of providing long-term solutions. Originality/value – Most articles in this field consider specific piracy incidents in particular locations, without an overall analysis of the impact on world trade as a whole. There is a gap in the literature for an up-to-date, analytical study of maritime piracy worldwide.

When Does Regionalization of Expensive Medical Care save Money?

2001 ◽  
Vol 14 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Terri J. Menke ◽  
Nelda P. Wray
Keyword(s):  
Medical Care ◽  
Resource Sharing ◽  
High Technology ◽  
Medical Costs ◽  
Accurate Assessment ◽  
Empirical Estimates ◽  
Unused Capacity ◽  
Cost Implications ◽  
The Cost

Regionalization of expensive, high-technology medical care is often proposed as a way to reduce medical costs. Most empirical estimates of the cost implications of regionalization suffer from methodological shortcomings. Here, we discuss all the factors that must be taken into account to produce an accurate assessment of how regionalization changes costs. These factors include the following: (1) The extent of resource sharing among different services; (2) The extent of unused capacity; (3) Whether regionalized facilities have high, low or average costs; (4) Costs of a regionalized system, including transporting patients to the regionalized facilities, coordinating care between the referring and regionalized providers, and out-of network care; (5) The effect of regionalization on the volume of care; and (6) whether a short- or long-term view is taken.

The cost of omeprazole versus open anti-reflux surgery in the long-term management of reflux esophagitis

1998 ◽  
Vol 114 ◽  
pp. A238 ◽  
Author(s):  
HE Myrvold ◽  
L Lundell ◽  
B Liedman ◽  
J Hatlebakk ◽  
P Miettinen ◽  
...  
Keyword(s):  
Reflux Esophagitis ◽  
The Cost ◽  
Term Management

scholarly journals The Costs of What? Measuring Services and Quality of Care

2007 ◽  
Vol 6 (3) ◽  
pp. 397-409 ◽  
Author(s):  
Ann Netten ◽  
Julien Forder
Keyword(s):  
Quality Of Care ◽  
Long Term Care ◽  
Social Care ◽  
Government Expenditure ◽  
Pragmatic Approach ◽  
Term Care ◽  
Cost Implications ◽  
The Cost

If we are to be able to reflect the cost implications of changes in the nature, quality and productivity of long-term care interventions in future projections, we need an approach to measurement that reflects the value and quality of care. This paper describes a theoretically based but pragmatic approach to identifying the welfare gain from government expenditure on social care and illustrates an application in projecting the costs of long-term care used in the Wanless review of future needs of social care for older people in England.

scholarly journals HIV Prevention: The Key to Ending AIDS by 2030

2016 ◽  
Vol 10 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Nana K. Poku
Keyword(s):  
Hiv Infections ◽  
Health Concern ◽  
Public Health Concern ◽  
Long Term Outcomes ◽  
Noticeable Improvement ◽  
Prevention Programmes ◽  
Cost Implications ◽  
The Cost ◽  
Biomedical Interventions

There is no viable substitute for re-energizing, funding and supporting culturally attuned, locally staffed HIV advocacy and prevention programmes, especially in resource poor settings. The evidence that such interventions are effective remains compelling; and although the cost implications are not negligible, the medium to long-term outcomes must be regarded not as complementary, but as integral, to biomedical interventions. The success of the anti-retroviral drugs upscale has enabled a noticeable improvement in AIDS related morbidity and mortality in the recent years; yet the underlying dynamics of the epidemic remains undetermined by the rate at which new infections are taking place in relation to the number of AIDS deaths. While the rate of new HIV infections is stabilising in some of the hardest hit countries, it remains far too high and the future cost of maintaining an ever-expanding pool of people reliant on daily drugs for survival is unsustainable. Countries must exercise caution in continuing to focus on treatment as a ‘quick fix’ to end AIDS as a public health concern. HIV is a socially culturally induced crisis and, as such, a variety of measures are needed simultaneously to appeal to different people, groups and circumstances.

When does regionalization of expensive medical care save money?

2001 ◽  
Vol 14 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Terri J. Menke ◽  
Nelda P. Wray
Keyword(s):  
Medical Care ◽  
Resource Sharing ◽  
High Technology ◽  
Medical Costs ◽  
Accurate Assessment ◽  
Empirical Estimates ◽  
Unused Capacity ◽  
Cost Implications ◽  
The Cost

Regionalization of expensive, high-technology medical care is often proposed as a way to reduce medical costs. Most empirical estimates of the cost implications of regionalization suffer from methodological shortcomings. Here, we discuss all the factors that must be taken into account to produce an accurate assessment of how regionalization changes costs. These factors include the following: (1) The extent of resource sharing among different services; (2) The extent of unused capacity; (3) Whether regionalized facilities have high, low or average costs; (4) Costs of a regionalized system, including transporting patients to the regionalized facilities, coordinating care between the referring and regionalized providers, and out-of network care; (5) The effect of regionalization on the volume of care; and (6) whether a short- or long-term view is taken.

OPTIMIZATION AND VALIDATION OF A CHEMICAL PROCESS FOR URANIUM, MERCURY AND CESIUM LEACHING FROM CEMENTED RADIOACTIVE WASTES

2015 ◽  
Vol 4 (2) ◽  
pp. 131-139
Author(s):  
Nicolas Reynier ◽  
Rolando Lastra ◽  
Cheryl Laviolette ◽  
Nabil Bouzoubaâ ◽  
Mark Chapman
Keyword(s):  
Sulfuric Acid ◽  
Chemical Process ◽  
Management Strategy ◽  
Fission Products ◽  
Concentrated Sulfuric Acid ◽  
Direct Leaching ◽  
The Cost ◽  
Optimized Conditions ◽  
Term Management

Canadian Nuclear Laboratories (CNL) is developing a treatment and long-term management strategy for a legacy cemented radioactive waste that contains uranium, mercury, and fission products. Extracting the uranium would be advantageous for decreasing the waste classification and reducing the cost of long-term management. The chemical leachability of 3 key elements (U, Hg, and Cs) from a surrogate cemented waste (SCW) was studied with several lixiviants. The results showed that the most promising approach to leach and recover U, Hg, and Cs is the direct leaching of the SCW with H2SO4 in strong saline media. Operating parameters such as particle size, temperature, pulp density, leaching time, acid and salt concentrations, number of leaching/washing steps, etc. were optimized to improve key elements solubilization. Sulfuric leaching in saline media of a SCW (U5) containing 1182 ppm of U, 1598 ppm of Hg, and 7.9 ppm of Cs in the optimized conditions allows key elements solubilisation of 98.5 ± 0.4%, 96.6 ± 0.1%, and 93.8 ± 1.1% of U, Hg, and Cs, respectively. This solubilization process was then applied in triplicate to 7 other SCWs prepared with different cements, liquid ratios, and at different aging times and temperatures. Concentrated sulfuric acid is added to the slurry until the pH is about 2, which causes the complete degradation of cement and the formation of CaSO4. Sulfuric acid is particularly useful because it produces a leachate that is amenable to conventional ion exchange technology for the separation and recovery of uranium.

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