Principles for integrated island management in the tropical Pacific

2014 ◽  
Vol 20 (2) ◽  
pp. 193 ◽  
Author(s):  
Stacy D Jupiter ◽  
Aaron P Jenkins ◽  
Warren J Lee Long ◽  
Sean L Maxwell ◽  
Tim J B Carruthers ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Case Studies ◽  
Pacific Islands ◽  
Management Practice ◽  
Cost Effective ◽  
Well Being ◽  
New Approach ◽  
The Pacific ◽  
National Systems

We propose a new approach for island-wide planning and implementation of ecosystem management in the Pacific, recognizing a lack of replicability, sustainability and cost-effectiveness in other approaches. ʻIntegrated island managementʼ (IIM) operates through coordinated networks of institutions and communities focused on sustainable and adaptive management of natural resources. IIM enables simultaneous and cost-effective achievement of ecosystem-based management, climate change adaptation and disaster risk reduction while conserving biodiversity, maintaining ecosystem services and securing human health and well-being. We present ten guiding principles for IIM, and then use these to evaluate 36 case studies from the Pacific islands. Most case studies were pilot or demonstration projects with little evidence of planning to ensure long-term financial and human capacity needs were sustained, beyond the life of the projects, or could be replicated at significant scales. Management outcomes in the Pacific will be enhanced by: (1) building on foundations of customary management practice and social networks; (2) working holistically across relevant ecological and governance scales, through coordinated but decentralized and nested institutions; (3) empowering local communities to participate in integrated planning and implementation; and (4) embedding IIM practice into national systems for long-term sustainability and replication. These also ultimately depend on the context and externalities, beyond the control of practitioners. Cost-effectiveness and appropriateness are also critical for successful IIM in the Pacific islands but ultimately there is little alternative for effective biodiversity conservation.

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

scholarly journals First-Line Atezolizumab Plus Bevacizumab versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 931
Author(s):  
Chi-Leung Chiang ◽  
Sik-Kwan Chan ◽  
Shing-Fung Lee ◽  
Horace Cheuk-Wai Choi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Lifetime Cost ◽  
Cost Effective ◽  
First Line ◽  
First Line Therapy ◽  
Payer Perspective ◽  
Life Years ◽  
Using Data

Background: The IMbrave 150 trial revealed that atezolizumab plus bevacizumab (atezo–bev) improves survival in patients with unresectable hepatocellular carcinoma (HCC) (1 year survival rate: 67.2% vs. 54.6%). We assessed the cost-effectiveness of atezo–bev vs. sorafenib as first-line therapy in patients with unresectable HCC from the US payer perspective. Methods: Using data from the IMbrave 150, we developed a Markov model to compare the lifetime cost and efficacy of atezo–bev as first-line systemic therapy in HCC with those of sorafenib. The main outcomes were life-years, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). Results: Atezo–bev demonstrated a gain of 0.44 QALYs, with an additional cost of USD 79,074. The ICER of atezo–bev was USD 179,729 per QALY when compared with sorafenib. The model was most sensitive to the overall survival hazard ratio and body weight. If we assumed that all patients at the end of the IMbrave 150 trial were cured of HCC, atezo–bev was cost-effective (ICER USD 53,854 per QALY). However, if all patients followed the Surveillance, Epidemiology, and End Results data, the ICER of atezo–bev was USD 385,857 per QALY. Reducing the price of atezo–bev by 20% and 29% would satisfy the USD 150,000/QALY and 100,000/QALY willingness-to-pay threshold. Moreover, capping the duration of therapy to ≤12 months or reducing the dosage of bev to ≤10 mg/kg would render atezo–bev cost-effective. Conclusions: The long-term effectiveness of atezo–bev is a critical but uncertain determinant of its cost-effectiveness. Price reduction would favorably influence cost-effectiveness, even if long-term clinical outcomes were modest. Further studies to optimize the duration and dosage of therapy are warranted.

Agrodeforestation and the loss of agrobiodiversity in the Pacific Islands: a call for conservation

2014 ◽  
Vol 20 (2) ◽  
pp. 180 ◽  
Author(s):  
Randolph Thaman
Keyword(s):  
Biodiversity Conservation ◽  
Sustainable Management ◽  
Pacific Islands ◽  
Agricultural Land ◽  
Ecosystem Goods And Services ◽  
Livelihood Security ◽  
Goods And Services ◽  
The Pacific ◽  
Aichi Biodiversity Targets

Our ability to conserve biodiversity and to adapt to climate, environmental and economic change in the Pacific Islands will be greatly dependent on the conservation, restoration and enrichment of biodiversity within traditional multispecies agricultural land use systems. “Agrobiodiversity” is the most well-known, culturally-useful and accessible biodiversity on most islands and constitutes the most important foundation for ecosystem goods and services that support food, health, energy and livelihood security. This rich Pacific agrobiodiversity heritage, including associated ethnobiodiversity is highly threatened and deserves more prominence in mainstream conservation initiatives as a foundation for long-term sustainability. Such action is in line with Aichi Biodiversity Targets 7 and 13 which set goals for sustainable management of agriculture, fisheries and forestry, and the maintenance of genetic diversity as critical for successful biodiversity conservation globally. It is also supported by the findings of the Japan Satoyama-Satoumi Assessment, which stresses the critical importance of biodiversity conservation and ecosystem services provided by traditional agricultural and village landscapes.

“The ice has gone”: Vernacular meteorology, fisheries and human–ice relationships on Sakhalin Island

Polar Record ◽  
2021 ◽  
Vol 57 ◽  
Author(s):  
Nadezhda Mamontova
Keyword(s):  
Well Being ◽  
Community Based ◽  
Rural People ◽  
The Past ◽  
Weather Observations ◽  
The Pacific ◽  
Management Policies ◽  
Subsistence Activities ◽  
Human Subsistence

Abstract This paper examines vernacular weather observations amongst rural people on Sakhalin, Russia’s largest island on the Pacific Coast, and their relationship to the ice. It is based on a weather diary (2000–2016) of one of the local inhabitants and fieldwork that the author conducted in the settlement of Trambaus in 2016. The diary as a community-based weather monitoring allows us to examine how people understand, perceive and deal with the weather both daily and in the long-term perspective. Research argues that amongst all natural phenomena, the ice is the most crucial for the local inhabitants as it determines human subsistence activities, navigation and relations with other environmental forces and beings. People perceive the ice as having an agency, engage in a dialogue with it, learn and adjust themselves to its drifting patterns. Over the past decade, the inability to predict the ice’s behaviour has become a major problem affecting people’s well-being in the settlement. The paper advocates further integrating vernacular weather observations and their relations with natural forces into research on climate change and local fisheries management policies.

A cost-effectiveness analysis of social transfers on human capital accumulation

2021 ◽  
Vol 52 (207) ◽  
Author(s):  
Andrés Mideros
Keyword(s):  
Human Capital ◽  
Cost Effectiveness ◽  
Capital Accumulation ◽  
Cost Effective ◽  
Cash Transfers ◽  
Human Capital Accumulation ◽  
Effectiveness Analysis ◽  
Long Term Effect ◽  
Social Transfers

The paper reports on an ex-ante evaluation of the long-term effect of the Ecuadorian social transfer programme called “Bono de Desarrollo Humano (BDH)” on human capital accumulation. A dynamic cohort microsimulation model is used to analyse for cost-effectiveness of different policy scenarios. Results show that cash transfers do promotehuman capital accumulation but with rather small effect. Transfers targeted at critical ages are the most cost-effective to promote human capital accumulation

scholarly journals Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Thorax ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 459-467 ◽  
Author(s):  
Juan F Masa ◽  
Babak Mokhlesi ◽  
Iván Benítez ◽  
Francisco Javier Gómez de Terreros Caro ◽  
M-Ángeles Sánchez-Quiroga ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Outcome ◽  
Cost Effective ◽  
Sleep Apnoea ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
The Mean ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

BackgroundObesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.ObjectivesWe performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.MethodsHospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.ResultsIn total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.ConclusionCPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA.Trial registration numberNCT01405976

scholarly journals Early invasive strategy in senior patients with non-ST-segment elevation myocardial infarction: is it cost-effective? - a decision-analytic model and value of information analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030678 ◽  
Author(s):  
Julija Simpson ◽  
Mehdi Javanbakht ◽  
Luke Vale
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Elderly Patients ◽  
Value Of Information ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Information Analysis ◽  
Invasive Strategy ◽  
Early Invasive Strategy

BackgroundNon-ST-elevation myocardial infarction (NSTEMI) is the most common type of heart attack in the UK and it is becoming increasingly prevalent among older people. An early invasive treatment strategy may be effective and cost-effective for treating NSTEMI but evidence is currently unclear.ObjectivesTo assess the cost-effectiveness of the early invasive strategy versus medical management in elderly patients with NSTEMI and to provide guidance for future research in this area.MethodsA long-term Markov state transition model was developed. Model inputs were systematically derived from a number of sources most appropriate to a UK relevant analysis, such as published studies and national routine data. Costs were estimated from the perspective of National Health Service and Personal Social Services. The model was developed using TreeAge Pro software. Based on a probabilistic sensitivity analysis, a value of information analysis was carried out to establish the value of decision uncertainty both overall and for specific input parameters.ResultsIn 2017 UK £, the incremental cost-effectiveness ratio of the early invasive strategy was £46 916 for each additional quality-adjusted life-year (QALY) gained, with a probability of being cost-effective of 23% at a cost-effectiveness threshold of £20 000/QALY. There was a considerable decision uncertainty with these results. The value of removing all this uncertainty was up to £1 920 000 annually. Most uncertainty related to clinical effectiveness parameters and the optimal study design to remove this uncertainty would be a randomised controlled trial.ConclusionBased on current evidence, the early invasive strategy is not likely to be cost-effective for elderly patients with NSTEMI. This conclusion should be interpreted with caution mainly due to the absence of NSTEMI-specific data and long-term clinical effectiveness estimates.

scholarly journals Scalable modEls of Community rehAbilitation for Individuals Recovering From COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol—“SeaCole Cohort Evaluation”

2021 ◽  
Vol 9 ◽  
Author(s):  
Benjamin Kelly ◽  
Aidan Innes ◽  
Marc Holl ◽  
Laura Mould ◽  
Susan Powell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Outcome Measures ◽  
Well Being ◽  
Rehabilitation Programme ◽  
Secondary Outcome ◽  
Rehabilitation Service ◽  
Community Rehabilitation ◽  
Life Years ◽  
The Uk

Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community.Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment.Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19.Trial Registration: Current Trials ISRCTN ISRCTN14707226Web: http://www.isrctn.com/ISRCTN14707226

scholarly journals Cost-Effectiveness of Pembrolizumab Plus Chemotherapy Versus Pembrolizumab Monotherapy in Metastatic Non-Squamous and Squamous NSCLC Patients With PD-L1 Expression ≥ 50%

2022 ◽  
Vol 12 ◽  
Author(s):  
Qiao Liu ◽  
Zhen Zhou ◽  
Xia Luo ◽  
Lidan Yi ◽  
Liubao Peng ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Life Expectancy ◽  
Cost Effective ◽  
Base Case ◽  
First Line ◽  
Term Survival ◽  
First Line Therapy ◽  
Line Therapy ◽  
Nsclc Patients

Objective To compare the cost-effectiveness of the combination of pembrolizumab and chemotherapy (Pembro+Chemo) versus pembrolizumab monotherapy (Pembro) as the first-line treatment for metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC) with PD-L1expression ≥50%, respectively, from a US health care perspective.Material and Methods A comprehensive Makrov model were designed to compare the health costs and outcomes associated with first-line Pembro+Chemo and first-line Pembro over a 20-years time horizon. Health states consisted of three main states: progression-free survival (PFS), progressive disease (PD) and death, among which the PFS health state was divided into two substates: PFS while receiving first-line therapy and PFS with discontinued first-line therapy. Two scenario analyses were performed to explore satisfactory long-term survival modeling.Results In base case analysis, for non-squamous NSCLC patients, Pembro+Chemo was associated with a significantly longer life expectancy [3.24 vs 2.16 quality-adjusted life-years (QALYs)] and a substantially greater healthcare cost ($341,237 vs $159,055) compared with Pembro, resulting in an ICER of $169,335/QALY; for squamous NSCLC patients, Pembro+Chemo was associated with a slightly extended life expectancy of 0.22 QALYs and a marginal incremental cost of $3,449 compared with Pembro, resulting in an ICER of $15,613/QALY. Our results were particularly sensitive to parameters that determine QALYs. The first scenario analysis yielded lower ICERs than our base case results. The second scenario analysis founded Pembro+Chemo was dominated by Pembro.Conclusion For metastatic non-squamous NSCLC patients with PD-L1 expression ≥50%, first-line Pembro+Chemo was not cost-effective when compared with first-line Pembro. In contrast, for the squamous NSCLC patient population, our results supported the first-line Pembro+Chemo as a cost-effective treatment. Although there are multiple approaches that are used for extrapolating long-term survival, the optimal method has yet to be determined.

scholarly journals An approach for long-term, multi-probe Neuropixels recordings in unrestrained rats

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Thomas Zhihao Luo ◽  
Adrian Gopnik Bondy ◽  
Diksha Gupta ◽  
Verity Alexander Elliott ◽  
Charles D Kopec ◽  
...  
Keyword(s):  
Cost Effective ◽  
New Approach ◽  
Neural Recordings ◽  
Chronic Recording ◽  
Long Term Stability ◽  
Multiple Cycles ◽  
Single Unit Recordings ◽  
Freely Moving ◽  
High Yields

The use of Neuropixels probes for chronic neural recordings is in its infancy and initial studies leave questions about long-term stability and probe reusability unaddressed. Here, we demonstrate a new approach for chronic Neuropixels recordings over a period of months in freely moving rats. Our approach allows multiple probes per rat and multiple cycles of probe reuse. We found that hundreds of units could be recorded for multiple months, but that yields depended systematically on anatomical position. Explanted probes displayed a small increase in noise compared to unimplanted probes, but this was insufficient to impair future single-unit recordings. We conclude that cost-effective, multi-region, and multi-probe Neuropixels recordings can be carried out with high yields over multiple months in rats or other similarly sized animals. Our methods and observations may facilitate the standardization of chronic recording from Neuropixels probes in freely moving animals.

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