scholarly journals The Clinical and Economic Value of a Successful Shutdown During the SARS-CoV-2 Pandemic in Germany

2020 ◽  
Author(s):  
Afschin Gandjour
Keyword(s):  
Economic Value ◽  
Health Gain ◽  
Mortality Data ◽  
Base Case ◽  
German Population ◽  
Case Scenario ◽  
Worst Case ◽  
Herd Protection ◽  
Life Years ◽  
Per Capita

Background and aim: A shutdown of businesses enacted during the SARS-CoV-2 pandemic can serve different goals, e.g., preventing the intensive care unit (ICU) capacity from being overwhelmed ("flattening the curve") or keeping the reproduction number substantially below one ("squashing the curve"). The aim of this study was to determine the clinical and economic value of a shutdown that is successful in "flattening" or "squashing the curve" in Germany. Methods: In the base case, the study compared a successful shutdown to a worst-case scenario with no ICU capacity left to treat COVID-19 patients. To this end, a decision model was developed using, e.g., information on age-specific fatality rates, ICU outcomes, and the herd protection threshold. The value of an additional life year was borrowed from new, innovative oncological drugs, as cancer reflects a condition with a similar morbidity and mortality burden in the general population in the short term as COVID-19. Results: A shutdown that is successful in "flattening the curve" is projected to yield an average health gain between 0.02 and 0.08 life years (0.2 to 0.9 months) per capita in the German population. The corresponding economic value ranges between 1543 and 8027 euros per capita or, extrapolated to the total population, 4% to 19% of the gross domestic product (GDP) in 2019. A shutdown that is successful in "squashing the curve" is expected to yield a minimum health gain of 0.10 life years (1.2 months) per capita, corresponding to 24% of the GDP in 2019. Results are particularly sensitive to mortality data and the prevalence of undetected cases.

scholarly journals Improving patient access to cancer drugs in India: Using economic modeling to estimate a more affordable drug cost based on measures of societal value

2011 ◽  
Vol 27 (1) ◽  
pp. 23-30 ◽  
Author(s):  
George Dranitsaris ◽  
Ilse Truter ◽  
Martie S. Lubbe ◽  
Nitin N. Sriramanakoppa ◽  
Vivian M. Mendonca ◽  
...  
Keyword(s):  
Economic Value ◽  
World Health ◽  
Cancer Drug ◽  
Base Case ◽  
Public Healthcare ◽  
Monthly Cost ◽  
New Drug ◽  
Societal Value ◽  
Life Years ◽  
Per Capita

Background: Using multiples of India's per capita gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), decision analysis modeling was used to estimate a more affordable monthly cost in India for a hypothetical new cancer drug that provides a 3-month survival benefit to Indian patients with metastatic colorectal cancer (mCRC).Methods: A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without the new drug. Costs for chemotherapy and side-effects management were obtained from both public and private hospitals in India. Utility estimates measured as quality-adjusted life-years (QALY) were determined by interviewing twenty-four oncology nurses using the Time Trade-Off technique. The monthly cost of the new drug was then estimated using a target threshold of US$9,300 per QALY gained, which is three times the Indian per capita GDP.Results: The base-case analysis suggested that a price of US$98.00 per dose would be considered cost-effective from the Indian public healthcare perspective. If the drug were able to improve patient quality of life above the standard of care or survival from 3 to 6 months, the price per dose could increase to US$170 and US$253 and offer the same value.Conclusions: The use of the WHO criteria for estimating the cost of a new drug based on economic value for a developing country like India is feasible and can be used to estimate a more affordable cost based on societal value thresholds.

scholarly journals Projected declines in global DHA availability for human consumption as a result of global warming

AMBIO ◽  
2019 ◽  
Vol 49 (4) ◽  
pp. 865-880 ◽  
Author(s):  
Stefanie M. Colombo ◽  
Timothy F. M. Rodgers ◽  
Miriam L. Diamond ◽  
Richard P. Bazinet ◽  
Michael T. Arts
Keyword(s):  
Global Warming ◽  
De Novo ◽  
Critical Role ◽  
Climate Scenario ◽  
Chain Polyunsaturated Fatty Acid ◽  
Human Consumption ◽  
Omega 3 ◽  
Case Scenario ◽  
Worst Case ◽  
Per Capita

Abstract Docosahexaenoic acid (DHA) is an essential, omega-3, long-chain polyunsaturated fatty acid that is a key component of cell membranes and plays a vital role in vertebrate brain function. The capacity to synthesize DHA is limited in mammals, despite its critical role in neurological development and health. For humans, DHA is most commonly obtained by eating fish. Global warming is predicted to reduce the de novo synthesis of DHA by algae, at the base of aquatic food chains, and which is expected to reduce DHA transferred to fish. We estimated the global quantity of DHA (total and per capita) currently available from commercial (wild caught and aquaculture) and recreational fisheries. The potential decrease in the amount of DHA available from fish for human consumption was modeled using the predicted effect of established global warming scenarios on algal DHA production and ensuing transfer to fish. We conclude that an increase in water temperature could result, depending on the climate scenario and location, in a ~ 10 to 58% loss of globally available DHA by 2100, potentially limiting the availability of this critical nutrient to humans. Inland waters show the greatest potential for climate-warming-induced decreases in DHA available for human consumption. The projected decrease in DHA availability as a result of global warming would disproportionately affect vulnerable populations (e.g., fetuses, infants), especially in inland Africa (due to low reported per capita DHA availability). We estimated, in the worst-case scenario, that DHA availability could decline to levels where 96% of the global population may not have access to sufficient DHA.

Survey on aflatoxin in beer sold in Spain and other European countries

2013 ◽  
Vol 6 (1) ◽  
pp. 93-101 ◽  
Author(s):  
P.A. Burdaspal ◽  
T.M. Legarda
Keyword(s):  
Liquid Chromatography ◽  
Lower Bound ◽  
Fluorescence Detection ◽  
Analytical Procedure ◽  
European Countries ◽  
Retail Market ◽  
Case Scenario ◽  
Worst Case ◽  
The Mean ◽  
Per Capita

Aflatoxins (B1, B2, G1 and G2) were surveyed in 417 beer samples purchased from the retail market in Spain (n=336), France (n=49), Portugal (n=15), Ireland (n=11) and Italy (n=6) in the period 2006-2012. In addition, 4 samples were acquired from Ghana and one from Israel. The analytical procedure was based on immunoaffinity clean-up and liquid chromatography with fluorescence detection. Aflatoxin was detected in 72.6% of the samples acquired in the Spanish market and in 182 out of 200 samples brewed in Spain with levels ranging from 0.08 to 36.12 ng/l for all four aflatoxins. The mean and median values of positive samples were estimated to be 3.51 and 2.07 ng/l, respectively, for samples acquired in Spain and 3.82 and 2.60 ng/l, respectively, for samples brewed in Spain. The mean and median values for the group of imported beers were 2.64 and 0.51 ng/l, respectively. Regarding the whole group of beers from European countries (417 samples), the incidence of positive samples was 64.7% with concentrations ranging from 0.07 to 45.18 ng/l for total aflatoxins with mean and median values of 3.47 and 1.82 ng/l, respectively. The overall median concentrations of aflatoxins in the samples of beers produced in Spain were 2.27-2.32 ng/l and for the whole group of European beers 0.43-0.62 ng/l (lower bound - upper bound). The median values obtained in this study for aflatoxin in beers consumed in Spain would result in an intake of approx. 97-112 pg/per capita/day, which represents a very small fraction (approx. 0.5% in a worst-case scenario) of the estimated average exposure to total aflatoxins.

scholarly journals Telepresence-teleguidance to facilitate training and quality assurance in ERCP: a health economic modeling approach

2020 ◽  
Vol 08 (03) ◽  
pp. E326-E337 ◽  
Author(s):  
Johanna Brinne Roos ◽  
Per Bergenzaun ◽  
Kristina Groth ◽  
Lars Lundell ◽  
Urban Arnelo
Keyword(s):  
Health Economic ◽  
Willingness To Pay ◽  
Expert Knowledge ◽  
Positive Impact ◽  
Economic Modeling ◽  
Base Case ◽  
Upper Gastrointestinal Endoscopy ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Life Years

Abstract Background and study aims The aims of this study was to document the clinical and training relevance of endoscopic retrograde cholangiopancreaticography (ERCP) teleguidance (as a clinical model for applied telemedicine) with health economic modeling methodologies. Methods Probabilities and consequences of complications after ERCP performed by either a novice-trainee or supported through teleguidance (TM) by an expert formed the basis of the health economic model. Results The main clinical and economic outcomes originated from the base case scenario representing a low-volume center. In the cohort the patient age was 62 years, 58 % were females, the expert was doing ≥ 250 ERCPs per year and 50 for the novice-trainee. The expert knowledge transferred was set to 50 % and the average complexity grade to 1.98. Given a willingness to pay threshold of 56,180 USD/ quality-adjusted life years (QALY), the probability of cost-effectiveness of TM assistance was 98.9 %. The probability of a QALY gain for patients having an ERCP, to which was added TM, was 91.6 %. Adding TM saved on an average 111.2 USD (95 % CI 959 to 1021 SEK) per patient, and remained cost-effective basically insensitive to the level of willingness to pay. Conclusion Teleguidance during an ERCP procedure has the potential to be the prefered option in many low- to medium-volume hospitals. The main mechanisms behind these effects are positive impact on several adverse patient outcomes, QALY increase, and decreased costs. TM should be considered for integration into future teaching curriculums in advanced upper gastrointestinal endoscopy.

scholarly journals The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

2020 ◽  
Author(s):  
Frank Sandmann ◽  
Nicholas Davies ◽  
Anna Vassall ◽  
W John Edmunds ◽  
Mark Jit ◽  
...  
Keyword(s):  
National Economy ◽  
Economic Value ◽  
Vaccine Effectiveness ◽  
Transmission Model ◽  
Base Case ◽  
Natural Immunity ◽  
Potential Health ◽  
Monetary Value ◽  
Life Years ◽  
The Uk

Background In response to the coronavirus disease 2019 (COVID-19), the UK adopted mandatory physical distancing measures in March 2020. Vaccines against the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may become available as early as late 2020. We explored the health and economic value of introducing SARS-CoV-2 immunisation alongside physical distancing scenarios in the UK. Methods We used an age-structured dynamic-transmission and economic model to explore different scenarios of immunisation programmes over ten years. Assuming vaccines are effective in 5-64 year olds, we compared vaccinating 90% of individuals in this age group to no vaccination. We assumed either vaccine effectiveness of 25% and 1-year protection and 90% re-vaccinated annually, or 75% vaccine effectiveness and 10-year protection and 10% re-vaccinated annually. Natural immunity was assumed to last 45 weeks in the base case. We also explored the additional impact of physical distancing. We considered benefits from disease prevented in terms of quality-adjusted life-years (QALYs), and costs to the healthcare payer versus the national economy. We discounted at 3.5% annually and monetised health impact at 20,000 per QALY to obtain the net monetary value, which we explored in sensitivity analyses. Findings Without vaccination and physical distancing, we estimated 147.9 million COVID-19 cases (95% uncertainty interval: 48.5 million, 198.7 million) and 2.8 million (770,000, 4.2 million) deaths in the UK over ten years. Vaccination with 75% vaccine effectiveness and 10-year protection may stop community transmission entirely for several years, whereas SARS-CoV-2 becomes endemic without highly effective vaccines. Introducing vaccination compared to no vaccination leads to economic gains (positive net monetary value) of 0.37 billion to +1.33 billion across all physical distancing and vaccine effectiveness scenarios from the healthcare perspective, but net monetary values of physical distancing scenarios may be negative from societal perspective if the daily national economy losses are persistent and large. Interpretation Our model findings highlight the substantial health and economic value of introducing SARS-CoV-2 vaccination. Given uncertainty around both characteristics of the eventually licensed vaccines and long-term COVID-19 epidemiology, our study provides early insights about possible future scenarios in a post-vaccination era from an economic and epidemiological perspective.

scholarly journals Modelling the Population Health Impacts of Heated Tobacco Products in Japan

2020 ◽  
Author(s):  
Oscar M. Camacho ◽  
Andrew Hill ◽  
Stacy Fiebelkorn ◽  
Joshua Jones ◽  
Krishna Prasad ◽  
...  
Keyword(s):  
Population Health ◽  
Health Benefit ◽  
Population Level ◽  
Time Frame ◽  
Baseline Scenario ◽  
Case Scenario ◽  
Cross Sectional ◽  
Worst Case ◽  
Health Gains ◽  
Life Years

Few data are available on the health impact of tobacco heating products (THPs) at the population level. We used systems dynamics modelling to estimate effects in the established THP market in Japan. We projected effects of THP use in overall mortality up to 2100 and compare those projections against a baseline scenario based on smoking rates pre-THP launch, i.e., smoking only. The model was informed using data from publicly available sources and the literature, including population size, yearly deaths and smoking prevalence with initialisation year (2004) and, births and migration from 2004 to 2065. Transitions between products were estimated from cross-sectional population surveys in Japan. Potential life-years saved with the introduction of THPs was 13 million by 2100 compared with smoking only. In worst-case scenario, population health gains would be seen with THPs risk 10–50% lower risk than smoking. Assuming equal risk for dual use and smoking, THP risk would need to be at least 10% lower than smoking to achieve a population health benefit by 2100. In credible scenarios, substantial population health gains will follow the introduction of THPs in Japan in a relatively short time frame.

scholarly journals Evaluating the Impact of the Registered Provisional Immigrant Program: A Cost-Benefit Analysis

2016 ◽  
Vol 23 ◽  
pp. 20
Author(s):  
Odia Bintou Cissé
Keyword(s):  
Undocumented Immigrants ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
The United States ◽  
Base Case ◽  
Benefit Analysis ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Worst Case ◽  
The Impact

On June 27, 2013, the Senate passed the Border Security, Economic Opportunity, and Immigration Modernization Act of 2013 (referred to as S.744). The bill addresses key elements of the immigration process through five sections. This analysis serves as an ex-ante Cost-Benefit Analysis (CBA) of the proposed Registered Provisional Immigrant (RPI) program under Section II of S.744, which would allow undocumented immigrants in the US to obtain legal status. The CBA looks at a 10-year timeframe from 2015 through 2025 and estimates the costs and benefits to four groups: undocumented immigrants, US taxpayers, employers of undocumented immigrants, and the United States Citizenship and Immigration Services (USCIS) under a base case scenario, a distributional weight scenario, and a worst-case scenario. Given the positive net benefits observed under the three scenarios, significant evidence recommends the implementation of the RPI program.

scholarly journals Cost/effectiveness model of dabigatran in the prevention of venous thromboembolism in major orthopedic surgery: Adaptation for Italy

2010 ◽  
Vol 11 (2) ◽  
pp. 91-101 ◽  
Author(s):  
Orietta Zaniolo ◽  
Sorrel E. Wolowacz ◽  
Lorenzo Pradelli
Keyword(s):  
Cost Effectiveness ◽  
Orthopedic Surgery ◽  
Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario ◽  
Life Years ◽  
Major Orthopedic Surgery ◽  
Acquisition Costs ◽  
Alternative Scenarios ◽  
The Uk

Venous thromboembolic events (VTE) represent a dangerous complication of major orthopedic surgery, especially in total hip replacement (THR) and total knee replacement (TKR) procedures. Dabigatran etexilate (DBG), a direct and reversible thrombin inhibitor, has proven its non-inferiority with respect to enoxaparin 40mg once-daily, a low molecular weight heparin (LMWH), in the prevention of VTE in patients undergoing THR and TKR, in the RE-NOVATE and RE-MODEL trials, respectively. The objective of this analysis was to estimate cost/effectiveness and cost/utility of DBG compared to standard care for the prevention of VTE in Italy. A decision analytic, Markov-chain based model, originally developed for the UK, was adapted to the Italian context. The adaptation involved cost and demographic characteristics, clinical and utility data were not altered. Costs were taken from national observational studies, where available. Otherwise, current prices and tariffs were applied. Resource consumption was derived from practice guidelines or taken from the UK model. According to the prevalent national practice, extended prophylaxis is considered for both surgical procedures. The time horizon of the analysis was patients’ lifetimes. In order to consider different alternatives for drug dispensation and, consequently, National Health Service acquisition costs, alternative scenarios were developed. A further scenario, excluding LMWHs administration costs (“worst-case” scenario), was considered. Compared to LMWHs, DBG was associated with an expected increase of 0.019 life-years (LYs) and 0.014 quality-adjusted life-years (QALYs) per THR patient and of 0.024 LYs and 0.019 QALYs per TKR patient. DBG-related costs were lower than LMWH in both procedures, with a mean difference ranging from 89 to 116 € for THR, and 107 to 142 for TKR, depending on the LMWH product. Higher acquisition costs for DBG were completely offset and inverted by avoided administration expenses and, to a lesser extent, by savings in VTE management. The results of alternative scenarios confirm the dominance of DBG, with a net saving ranging between 119 €, when both drugs were obtained by auction, and 32 €, when the auction price was applied but DBG was dispensed through territorial pharmacies. The corresponding estimates for TKR were 148 and 54 €. In the “worst-case” scenario, DBG was no longer dominant, with a cost per LYs of 2,788 and 4,514 € and a cost per QALY gained of 3,619 and 5,926 €, for TKR and THR respectively. In conclusion, DBG dominated LMWHs, and was cost-saving and non-inferior in terms of efficacy and safety, except for in the “worst-case” scenario, in which the incremental cost/effectiveness ratio estimate was lower than commonly accepted thresholds in health economics.

scholarly journals Is stratification testing for treatment of chronic obstructive pulmonary disease exacerbations cost-effective in primary care? an early cost-utility analysis

2019 ◽  
Vol 35 (2) ◽  
pp. 116-125
Author(s):  
Lucy Abel ◽  
Helen A. Dakin ◽  
Nia Roberts ◽  
Helen F. Ashdown ◽  
Chris C. Butler ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Sensitivity Analysis ◽  
Pulmonary Disease ◽  
Health Gain ◽  
Base Case ◽  
Chronic Obstructive ◽  
Clinical Effects ◽  
Obstructive Pulmonary Disease ◽  
Life Years

AbstractObjectivesPatients with chronic obstructive pulmonary disease (COPD) who experience acute exacerbations usually require treatment with oral steroids or antibiotics, depending on the etiology of the exacerbation. Current management is based on clinician's assessment and judgement, which lacks diagnostic accuracy and results in overtreatment. A test to guide these decisions in primary care is in development. We developed an early decision model to evaluate the cost-effectiveness of this treatment stratification test in the primary care setting in the United Kingdom.MethodsA combined decision tree and Markov model was developed of COPD progression and the exacerbation care pathway. Sensitivity analysis was carried out to guide technology development and inform evidence generation requirements.ResultsThe base case test strategy cost GBP 423 (USD 542) less and resulted in a health gain of 0.15 quality-adjusted life-years per patient compared with not testing. Testing reduced antibiotic prescriptions by 30 percent, potentially lowering the risk of antimicrobial resistance developing. In sensitivity analysis, the result depended on the clinical effects of treating patients according to the test result, as opposed to treating according to clinical judgement alone, for which there is limited evidence. The results were less sensitive to the accuracy of the test.ConclusionsTesting may be cost-saving in primary care, but this requires robust evidence on whether test-guided treatment is effective. High quality evidence on the clinical utility of testing is required for early modeling of diagnostic tests generally.

scholarly journals The Impact of Risk Factors Reduction Scenarios on Hospital Admissions, Disability-Adjusted Life Years and the Hospitalisation Cost of Cardiovascular Disease in Thailand

2020 ◽  
Author(s):  
Khaled Khatab ◽  
Rungkren Inthavong ◽  
Malcolm Whitfield ◽  
Karen Collins ◽  
Mubarak Ismail ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Hospital Admissions ◽  
Disability Adjusted Life Years ◽  
Case Scenario ◽  
Cvd Risk ◽  
Worst Case ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Care Costs

Cardiovascular disease (CVD) is considered to be one of the leading health issues in Thailand. CVD not only contributes to an increase in the number of hospital admissions year on year but also impacts on the rising health care expenditure for the treatment and long-term care of CVD patients. Therefore, this study is aimed at examining the impacts of risk reduction strategies on the number of CVD hospital admissions, Disability-Adjusted Life Years (DALYs) and the costs of hospitalisation. To estimate such impacts a CVD cost-offset model wasapplied using a Microsoft Excel spreadsheet. The number of the mid-year population was classified by age, gender and the CVD risk factor profiles from the recent Thai National Health Examination Survey (NHES) IV. This survey was chosen as the baseline population. The CVD risk factor profiles included age, gender, systolic blood pressure, total cholesterol, and smoking status. The Asia-Pacific Collaborative Cohort Study (APCCS) equation was applied to predict the probability of developing CVD over the next eight-year period. Estimates on the following were obtained from the model: (1.) the CVD events both fatal and non-fatal; (2.) the difference between the projected number of deaths and the actual number of deaths in that population; (3.) the number of patients who are expected to live with CVD; (4.) the DALYs from the estimated number of fatal and non-fatal events; (5.) the cost of hospital admissions. Four CVD risk strategy scenarios were investigated as follows: (1.) the do nothing scenario; (2.) the optimistic scenario; (3.) achieve the UN millennium development goal; and (4.) the worst-case scenario. The findings showed that over the next eight years there are likely to be 3,297,428 recorded cases of CVD; 5,870,049 cases of DALYs; and, approximately ฿57,000 million, ($1.9 billion), is projected as the total cost of hospital admissions. However, if the current health policy can reduce the levels of risk factors as defined in the optimistic scenario or such policy meets the specifications of the UN millennium development goal,there would be a significant reduction in the number of hospital admissions. These are estimated to be a reduction of 522,179 male and 515,416 female cases. With these results it is expected that health care costs would save approximately ฿9,000 million, ($298.3 million), for CVD and 900,000 million of DALYs over the next eight years. However, if there is an upward trend in the risk factors as predicted in the worst-case scenario, then there will be an increase of 428,220 CVD cases; consequently, DALYs cases may rise by 766,029 while the hospitalisation costs may increase by approximately ฿7,000 million, ($232.1 million). Based on our findings, reducing the levels of CVD risk factors in the population will drastically reduce: (1.) the number of CVD cases; (2.) DALYs cases; and (3.) health care costs. Therefore it is recommended that the health policy should enhance the primary prevention programs which would be targeted at reducing the CVD risk factors in the population.

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