scholarly journals Evaluating costs and health consequences of sick leave strategies against pandemic and seasonal influenza in Norway using a dynamic model

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027832 ◽  
Author(s):  
Christina Hansen Edwards ◽  
Gianpaolo Scalia Tomba ◽  
Ivar Sonbo Kristiansen ◽  
Richard White ◽  
Birgitte Freiesleben de Blasio
Keyword(s):  
Sick Leave ◽  
Health Benefit ◽  
Population Data ◽  
Population Level ◽  
Cost Effective ◽  
Economic Benefits ◽  
Illness Severity ◽  
Sensitivity Analyses ◽  
Economic Losses ◽  
High Morbidity

ObjectivesTo quantify population-level health and economic consequences of sick leave among workers with influenza symptoms.InterventionsCompared with current sick leave practice (baseline), we evaluated the health and cost consequences of: (1) increasing the proportion of workers on sick leave from 65% (baseline) to 80% or 90%; (2) shortening the maximum duration from symptom onset to sick leave from 4 days (baseline) to 2 days, 1.5 days, 1 day and 0.5 days; and (3) combinations of 1 and 2.MethodsA dynamic compartmental influenza model was developed using Norwegian population data and survey data on employee sick leave practices. The sick leave interventions were simulated under 12 different seasonal epidemic and 36 different pandemic influenza scenarios. These scenarios varied in terms of transmissibility, the proportion of symptomatic cases and illness severity (risk of primary care consultations, hospitalisations and deaths). Using probabilistic sensitivity analyses, a net health benefit approach was adopted to assess the cost-effectiveness of the interventions from a societal perspective.ResultsCompared with current sick leave practice, sick leave interventions were cost-effective for 31 (65%) of the pandemic scenarios, and 11 (92%) of the seasonal scenarios. Economic benefits from sick leave interventions were greatest for scenarios with low transmissibility, high symptomatic proportions and high illness severity. Overall, the health and economic benefits were greatest for the intervention involving 90% of sick workers taking sick leave within one-half day of symptoms. Depending on the influenza scenario, this intervention resulted in a 44.4%–99.7% reduction in the attack rate. Interventions involving sick leave onset beginning 2 days or later, after the onset of symptoms, resulted in economic losses.ConclusionsPrompt sick leave onset and a high proportion of sick leave among workers with influenza symptoms may be cost-effective, particularly during influenza epidemics and pandemics with low transmissibility or high morbidity.

scholarly journals Pharmacist prescribing and care improves cardiovascular risk, but is it cost-effective? A cost-effectiveness analysis of the RxEACH study

2019 ◽  
Vol 152 (4) ◽  
pp. 257-266 ◽  
Author(s):  
Yazid N. Al Hamarneh ◽  
Karissa Johnston ◽  
Carlo A. Marra ◽  
Ross T. Tsuyuki
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Usual Care ◽  
Population Level ◽  
Cost Effective ◽  
Pharmacist Intervention ◽  
Sensitivity Analyses ◽  
Pharmacist Prescribing ◽  
Canadian Health Care System ◽  
Life Years

Background: The RxEACH randomized trial demonstrated that community pharmacist prescribing and care reduced the risk for cardiovascular (CV) events by 21% compared to usual care. Objective: To evaluate the economic impact of pharmacist prescribing and care for CV risk reduction in a Canadian setting. Methods: A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term CV outcomes, using different risk assessment equations. The mean change in CV risk for the 2 groups of RxEACH was extrapolated over 30 years, with costs and health outcomes discounted at 1.5% per year. The model incorporated health outcomes, costs and quality of life to estimate overall cost-effectiveness. It was assumed that the intervention would be 50% effective after 10 years. Individual-level results were scaled up to population level based on published statistics (29.2% of Canadian adults are at high risk for CV events). Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention. Uncertainty was explored via probabilistic sensitivity analysis. Results: It is estimated that the Canadian health care system would save more than $4.4 billion over 30 years if the pharmacist intervention were delivered to 15% of the eligible population. Pharmacist care would be associated with a gain of 576,689 quality-adjusted life years and avoid more than 8.9 million CV events. The intervention is economically dominant (i.e., it is both more effective and reduces costs when compared to usual care). Conclusion: Across a range of 1-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist prescribing and care are both more effective and cost-saving compared to usual care. Canadians need and deserve such care.

Thermal ablation versus stereotactic body radiotherapy for stage I non-small cell lung cancer: A cost-effectiveness analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21061-e21061
Author(s):  
Xiao Wu ◽  
Johannes Uhlig ◽  
Justin Blasberg ◽  
Scott N. Gettinger ◽  
Robert Suh ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stereotactic Body Radiotherapy ◽  
Health Benefit ◽  
Cost Effective ◽  
Recurrence Risk ◽  
Small Cell ◽  
Stage I ◽  
Sensitivity Analyses ◽  
Small Cell Lung

e21061 Background: Stereotactic body radiotherapy (SBRT) and thermal ablation are increasingly used to treat medically inoperable patients with non-small cell lung cancer (NSCLC). The purpose of this study is to assess the cost-effectiveness of microwave (MWA) and stereotactic body radiotherapy (SBRT) for patients with stage I NSCLC. Methods: A decision-analysis model was constructed over a 5-year of Medicare billing data from a health care sector’s perspective using TreeAge Pro Suite 2019 (TreeAge Software LLC, Cambridge, MA). The two evaluated strategies were SBRT and MWA. All clinical, cost and health utility parameters were derived from the literature with preference to long-term prospective trials and assigned appropriate statistical distributions. Costs and health utilities (quantified by quality-adjusted life years (QALY)) associated with procedure, short-term complications, long-term surveillance and disease progression were incorporated. A willingness-to-pay (WTP) threshold of $100,000/QALY was used. One QALY is equivalent to 1 year of life in perfect health. Strategies were compared using incremental cost-effectiveness ratio (ICER). Base case calculations, Monte Carlo Simulations with 10,000 iterations drawing parameters from their respective distributions, and multiple sensitivity analyses were performed. Results: Literature review and interpolation showed that average annual recurrence risk of SBRT and MWA were 4.64% and 10.4% respectively. SBRT yielded 2.33 QALY and MWA yielded 2.31 QALY. The difference in health benefit is equivalent to 1 week of life in perfect health. The overall costs were $225,271 and $195,331. The ICER of MWA in reference to SBRT was $1,480,597/QALY, which is more than 10 times of the WTP threshold currently used in the US, indicating that MWA is the more cost-effective strategy. MWA was the optimal strategy in 99.84% of the Monte Carlo simulations. One-way sensitivity analyses showed that MWA is more cost-effective than SBRT if recurrence risk of MWA is < 18.4% per year or recurrence risk of SBRT is > 1.44% per year, or cost of MWA is lower than or at most $7,500 more than SBRT. One-way sensitivity analysis showed that MWA would achieve a higher health benefit than SBRT if the overall survival after MWA was > 76.9% per year or after SBRT was < 75.6% per year. Conclusions: Our study showed that MWA is more cost-effective than SBRT for medically inoperable stage I NSCLC patients with comparable health benefits based on multiple robust probabilistic and deterministic sensitivity analyses.

scholarly journals Cost-effectiveness of paediatric surgery: an economic evaluation of World Paediatric Project surgical interventions in St. Vincent and the Grenadines (2002–2019)

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050286
Author(s):  
Carrie B Dolan ◽  
Samuel A Agyemang ◽  
Brian Clare ◽  
Charles Coleman ◽  
Bill Richter ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
Gdp Per Capita ◽  
Paediatric Surgery ◽  
Surgical Interventions ◽  
Resource Setting ◽  
Life Years ◽  
Per Capita

ObjectivesThe purpose of this study is to examine the cost-effectiveness of six types of surgical interventions as part of a sustained paediatric surgical programme in St.Vincent and the Grenadines from 2002 to 2019.DesignIn this economic model, six paediatric surgical interventions (ophthalmic, orthopaedic, plastic, general, urology, neurosurgery) were compared with no surgery in a deterministic cost-effectiveness model. We assessed health benefits as averted disability-adjusted life-years (DALYs). Costs were included from the programme perspective and measured using standard micro-costing methods. Incremental cost-effectiveness ratios (ICERs) were calculated for each type of surgical intervention. Interventions with ICERs of <50% of gross domestic product (GDP) per capita were considered cost-effective. Costs are reported in 2019 US$. Univariate sensitivity analyses were conducted to assess the effect of uncertainty.ResultsThe average cost per procedure was US$16 685 (range: US$9791.78–US$72 845.76). The cumulative discounted 18-year health impact was 5815 DALYs averted with a cost per DALY averted of US$2622. Most paediatric surgical interventions were cost-effective, yielding cost per DALY estimates less than 50% of GDP per capita of St. Vincent and the Grenadines. When undiscounted, only orthopaedic surgeries had cost per DALY more than 50% GDP per capita. When considering discounting, orthopaedic and urology surgeries exceeded the adopted threshold for cost-effectiveness.ConclusionsWe found that short-term, recurrent surgical interventions could yield substantial economic benefits in this limited resource setting. This research indicates that investment in paediatric surgical interventions is cost-effective for the majority of specialties. These findings are of clinical significance given the large burden of disease attributable to surgically treatable diseases. This work demonstrates that scaling up dedicated surgical programmes for children is a cost-effective and essential component to improve paediatric health.

scholarly journals Modeling the Population Health Impact of ENDS in the U.S.

2021 ◽  
Vol 45 (3) ◽  
pp. 588-610
Author(s):  
Rasmus Wissmann ◽  
Changhua Zhan ◽  
Kenneth D'Amica ◽  
Shivaani Prakash ◽  
Yingying Xu
Keyword(s):  
Population Health ◽  
Health Benefit ◽  
Population Level ◽  
Health Impact ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Premature Deaths ◽  
Key Population ◽  
The Us ◽  
Health Model

Objectives: Our objective was to improve understanding of the population health impact of electronic nicotine delivery systems (ENDS) availability in the US via computational modeling. Methods: We present an agent-based population health model (PHM) that simulates annual smoking, ENDS use, and associated mortality for individual agents representing the US population, both adults and youth, between 2000 and 2100. Model transitions were derived from key population surveys and a large longitudinal study of JUUL purchasers. The mortality impact of ENDS is modeled as excess risk relative to smoking. Outcomes are compared between a cigarettes-only Base Case and a Modified Case where ENDS are introduced in 2010. Model validation demonstrates that the PHM simulates population-level behavior and outcomes realistically. Results: The availability of ENDS in the US is projected to reduce smoking and prevent 2.5 million premature deaths by 2100 in the Modified Case. Sensitivity analyses show that a significant population health benefit occurs under all plausible scenarios. Conclusions: Our results suggest the availability of ENDS is likely to result in a significant health benefit to the US population as a whole, after accounting for both beneficial and harmful uses.

scholarly journals Development of an Energy-Efficient Smart Socket Based on STM32F103

2018 ◽  
Vol 8 (11) ◽  
pp. 2276 ◽  
Author(s):  
Mei Ma ◽  
Bin Huang ◽  
Bin Wang ◽  
Jian Chen ◽  
Lida Liao
Keyword(s):  
Energy Efficient ◽  
Cost Effective ◽  
Economic Benefits ◽  
Economic Losses ◽  
Lifecycle Assessment ◽  
Output Analysis ◽  
User Friendly ◽  
Technical Solutions ◽  
Energy Saving Control ◽  
Safety Enhancement

Many efforts have recently been dedicated to developing smart sockets that seek to provide insights into the reduction of standby energy waste coupled to electric appliances. However, not all technical solutions consider the techno-economic benefits in the development. This research presents a hardware solution based on STM32F103 (STM32F103 devices use the Cortex-M3 core, with a maximum CPU speed of 72 MHz) for the development of an energy-efficient smart socket to address the standby energy waste of household electric appliances and associated economic losses. Input-output analysis on monitored voltage and current was employed to assess the performance and examine the precision of the developed system. As it was targeted at facilitating easier operation, the smart socket was developed to be compatible with other remote controllers of household electric appliances. Experimental results indicated that the developed system could measure voltage values accurately to avoid overvoltage for security protection. The measuring unit could monitor current values with high precision to support the energy-saving control. A functional testing was conducted on the prototypes with a lifecycle assessment employed to validate the economic attractiveness of the developed system. Results indicated that the system is user friendly and cost-effective as no extra wiring required and network environment independent. Indeed, indirect fruits, such as lifespan extension and safety enhancement, could also be achieved for appliances.

scholarly journals Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047072
Author(s):  
Kathy W Tannous ◽  
Ajesh George ◽  
Moin Uddin Ahmed ◽  
Anthony Blinkhorn ◽  
Hannah G Dahlen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Oral Health ◽  
Health Benefit ◽  
Cost Effective ◽  
Economic Benefits ◽  
Dental Service ◽  
Public Healthcare ◽  
Life Years ◽  
The Cost

ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.

338 Variation in the Cost/Benefit of Spine Surgery at the Individual Patient Level: Re-examining the Definition of Healthcare Value

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 275-276
Author(s):  
Scott L Parker ◽  
Silky Chotai ◽  
Clinton J Devin ◽  
Lindsay Tetreault ◽  
Matthew J McGirt
Keyword(s):  
Health Benefit ◽  
Population Level ◽  
Cost Effective ◽  
Patient Specific ◽  
Individual Patient Level ◽  
Patient Level ◽  
Patient Reported ◽  
Specific Care ◽  
The Individual ◽  
Prospective Longitudinal

Abstract INTRODUCTION Currently, specific spine treatments are deemed altogether cost-effective vs not based on group average costs and group average health benefit. These approaches ignore that certain treatments may be highly cost-effective in subsets of patients while group averages suggest otherwise, leading to disadvantageous policy for some highly valuable spine care. We evaluate the variability in outcomes and cost for patients undergoing surgery for degenerative lumbar spine pathology at the individual patient-level. METHODS Retrospective analysis of prospective longitudinal spine registry data was conducted. Baseline and postoperative 1-year patient-reported outcomes (PROs) were recorded. Previously published MCID for ODI (14.9) was used. Back-related resource utilization and quality-adjusted life years (QALYs) were assessed. Variations in outcomes and cost were analyzed at population level and at the individual-patient level. RESULTS >Total 1454 patients were analyzed. There was significant improvement in PROs at postoperative 1-year (P < 0.0001). For patients demonstrating health benefit at population level, 12.5%, n = 182 of patients experienced no gain from surgery and 38%, n = 554 failed to achieve MCID. Mean 1-year QALY-gained was 0.29,18% of patients failed to report gain in QALY. For patients with 2-year follow-up, surgery resulted in 0.62 QALY-gained at average direct cost of $28,953. A wide variation in both QALY-gained and cost was observed. CONCLUSION Spine treatments that on average are cost-effective may have wide variability in value at the individual patient-level. The variability demonstrated here represents an opportunity, through registries, to identify specific care that may be less effective, and refine patient-specific care delivery and indications to drive overall group-level treatment value.

Amalgam Alternatives: Cost-Effectiveness and Value of Information Analysis

2018 ◽  
Vol 97 (12) ◽  
pp. 1317-1323 ◽  
Author(s):  
F. Schwendicke ◽  
G. Göstemeyer ◽  
M. Stolpe ◽  
J. Krois
Keyword(s):  
Cost Effectiveness ◽  
Value Of Information ◽  
Cost Effective ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
Old Patients ◽  
Minimal Impact ◽  
Permanent Molar ◽  
Credible Intervals ◽  
Meta Analyses

We aimed to assess the cost-effectiveness of amalgam alternatives—namely, incrementally placed composites (IComp), composites placed in bulk (BComp), and glass ionomer cements (GIC). In a sensitivity analysis, we also included composite inlays (CompI) and incrementally placed bulk-fills (IBComp). Moreover, the value of information (VOI) regarding the effectiveness of all strategies was determined. A mixed public-private-payer perspective in the context of Germany was adopted. Bayesian network meta-analyses were performed to yield effectiveness estimates (relative risk [RR] of failure). A 3-surfaced restoration on a permanent molar in initially 30-y-old patients was followed over patients’ lifetime using a Markov model. Restorative and endodontic complications were modeled; our outcome parameter was the years of tooth retention. Costs were derived from insurance fee items. Monte Carlo microsimulations were used to estimate cost-effectiveness, cost-effectiveness acceptability, and VOI. Initially, BComp/GIC were less costly (110.11 euros) than IComp (146.82 euros) but also more prone to failures (RRs [95% credible intervals (CrI)] were 1.6 [0.8 to 3.4] for BComp and 1.3 [0.5 to 5.6] for GIC). When following patients over their lifetime, IComp was most effective (mean [SD], 41.9 [1] years) and least costly (2,076 [135] euros), hence dominating both BComp (40.5 [1] years; 2,284 [126] euros) and GIC (41.2 years; 2,177 [126] euros) in 90% of simulations. Eliminating the uncertainty around the effectiveness of the strategies was worth 3.99 euros per restoration, translating into annual economic savings of 87.8 million euros for payers. Including CompI and IBComp into our analyses had only a minimal impact, and our findings were robust in further sensitivity analyses. In conclusion, the initial savings by BComp/GIC compared with IComp are very likely to be compensated by the higher risk of failures and costs for retreatments. CompI and IBComp do not seem cost-effective. All alternatives are likely to be inferior to amalgam. The VOI was considerable, and future studies may yield significant economic benefits.

Heterogeneity in Cost-Effectiveness Analysis

2019 ◽  
Author(s):  
Ciaran N. Kohli-Lynch ◽  
Andrew H. Briggs
Keyword(s):  
Cost Effectiveness ◽  
Decision Rules ◽  
Population Level ◽  
Cost Effective ◽  
Economic Benefits ◽  
Cost Effectiveness Analysis ◽  
Decision Makers ◽  
Effectiveness Analysis ◽  
Healthcare Interventions ◽  
Effectiveness Studies

Cost-effectiveness analysis is conducted with the aim of maximizing population-level health outcomes given an exogenously determined budget constraint. Considerable health economic benefits can be achieved by reflecting heterogeneity in cost-effectiveness studies and implementing interventions based on this analysis. The following article describes forms of subgroup and heterogeneity in patient populations. It further discusses traditional decision rules employed in cost-effectiveness analysis and shows how these can be adapted to account for heterogeneity. This article discusses the theoretical basis for reflecting heterogeneity in cost-effectiveness analysis and methodology that can be employed to conduct such analysis. Reflecting heterogeneity in cost-effectiveness analysis allows decision-makers to define limited use criteria for treatments with a fixed price. This ensures that only those patients who are cost-effective to treat receive an intervention. Moreover, when price is not fixed, reflecting heterogeneity in cost-effectiveness analysis allows decision-makers to signal demand for healthcare interventions and ensure that payers achieve welfare gains when investing in health.

scholarly journals Vaccination or mass drug administration against schistosomiasis: a hypothetical cost-effectiveness modelling comparison

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Benjamin S. Collyer ◽  
Hugo C. Turner ◽  
T. Déirdre Hollingsworth ◽  
Matt J. Keeling
Keyword(s):  
Cost Effectiveness ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Health Benefit ◽  
Population Level ◽  
Cost Effective ◽  
World Health ◽  
Transmission Model ◽  
The Cost

Abstract Background Schistosomiasis is a neglected tropical disease, targeted by the World Health Organization for reduction in morbidity by 2020. It is caused by parasitic flukes that spread through contamination of local water sources. Traditional control focuses on mass drug administration, which kills the majority of adult worms, targeted at school-aged children. However, these drugs do not confer long-term protection and there are concerns over the emergence of drug resistance. The development of a vaccine against schistosomiasis opens the potential for control methods that could generate long-lasting population-level immunity if they are cost-effective. Methods Using an individual-based transmission model, matched to epidemiological data, we compared the cost-effectiveness of a range of vaccination programmes against mass drug administration, across three transmission settings. Health benefit was measured by calculating the heavy-intensity infection years averted by each intervention, while vaccine costs were assessed against robust estimates for the costs of mass drug administration obtained from data. We also calculated a critical vaccination cost, a cost beyond which vaccination might not be economically favorable, by benchmarking the cost-effectiveness of potential vaccines against the cost-effectiveness of mass drug administration, and examined the effect of different vaccine protection durations. Results We found that sufficiently low-priced vaccines can be more cost-effective than traditional drugs in high prevalence settings, and can lead to a greater reduction in morbidity over shorter time-scales. MDA or vaccination programmes that target the whole community generate the most health benefits, but are generally less cost-effective than those targeting children, due to lower prevalence of schistosomiasis in adults. Conclusions The ultimate cost-effectiveness of vaccination will be highly dependent on multiple vaccine characteristics, such as the efficacy, cost, safety and duration of protection, as well as the subset of population targeted for vaccination. However, our results indicate that if a vaccine could be developed with reasonable characteristics and for a sufficiently low cost, then vaccination programmes can be a highly cost-effective method of controlling schistosomiasis in high-transmission areas. The population-level immunity generated by vaccination will also inevitably improve the chances of interrupting transmission of the disease, which is the long-term epidemiological goal.

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