The Relative Cost Effectiveness of In-Service Approaches in Remote, Sparsely Populated Schools

This article provides an analysis of data obtained from the first 2 years of Project SPECTRE, a federally funded in-service training program for regular classroom teachers drawn from southern Nevada's remote, sparsely populated schools. Project SPECTRE was designed to assess the relative cost effectiveness of four types of in-service approaches, including instruction through independent study, by master teachers employed by the school district and by university instructors either on the university campus or on site. The 2-year results indicate that direct instruction of any sort produces gains in knowledge acquisition significantly superior to those obtained through independent study. In spite of its relatively lower initial costs, independent study was also found to be less cost effective than the direct-instructional approaches. Finally, of the three direct-instructional approaches, using university personnel in remote sites was found to be the most cost effective, followed, respectively, by the master-teacher and university-campus approaches.

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A Generic Simulation Model of the Relative Cost-Effectiveness of ICU Versus Step-Down (IMCU) Expansion

Journal of Intensive Care Medicine ◽

10.1177/0885066617737303 ◽

2017 ◽

Vol 35 (2) ◽

pp. 191-202

Author(s):

Amin Mahmoudian-Dehkordi ◽

Somayeh Sadat

Keyword(s):

Intensive Care ◽

Cost Effectiveness ◽

Simulation Model ◽

Cost Effective ◽

Capacity Expansion ◽

Baseline Scenario ◽

Relative Cost ◽

Relative Cost Effectiveness ◽

Step Down

Background: Many jurisdictions are facing increased demand for intensive care. There are two long-term investment options: intensive care unit (ICU) versus step-down or intermediate care unit (IMCU) capacity expansion. Relative cost-effectiveness of the two investment strategies with regard to patient lives saved has not been studied to date. Methods: We expand a generic system dynamics simulation model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to estimate the long-term effects of expanding ICU versus IMCU beds on patient lives saved under a common assumption of 2.1% annual increase in hospital arrivals. Two alternative policies of expanding ICU by two beds versus introducing a two-bed IMCU are compared over a ten-year simulation period. Russel equation is used to calculate total cost of patients’ hospitalization. Using two possible values for the ratio of ICU to IMCU cost per inpatient day and four possible values for the percentage of patients transferred from ICU to IMCU found in the literature, nine scenarios are compared against the baseline scenario of no capacity expansion. Results: Expanding ICU capacity by two beds is demonstrated as the most cost-effective scenario with an incremental cost-effectiveness ratio of 3684 (US $) per life saved against the baseline scenario. Sensitivity analyses on the mortality rate of patients in IMCU, direct transfer of IMCU-destined patients to the ward upon completing required IMCU length of stay in the ICU, admission of IMCU patient to ICU, adding two ward beds, and changes in hospital size do not change the superiority of ICU expansion over other scenarios. Conclusions: In terms of operational costs, ICU beds are more cost effective for saving patients than IMCU beds. However, capital costs of setting up ICU versus IMCU beds should be considered for a complete economic analysis.

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Cost-Effectiveness of Pharmacological Interventions for Smoking Cessation: A Literature Review and a Decision Analytic Analysis

Medical Decision Making ◽

10.1177/027298902237708 ◽

2002 ◽

Vol 22 (1_suppl) ◽

pp. 26-37 ◽

Cited By ~ 73

Author(s):

Fujian Song ◽

James Raftery ◽

Paul Aveyard ◽

Chris Hyde ◽

Pelham Barton ◽

...

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Cost Effective ◽

Decision Analytic Model ◽

Relative Cost ◽

Pharmacological Interventions ◽

Relative Cost Effectiveness ◽

Life Years ◽

The Uk ◽

The Cost

To evaluate the relative cost-effectiveness of nicotine replacement therapy (NRT) and bupropion SR for smoking cessation, the authors reviewed published studies and developed a decision analytic model from the UK National Health Services perspective. Irrespective of the methods or assumptions involved, the results of published studies consistently indicated that NRT for smoking cessation is cost-effective. No published studies have evaluated the relative cost-effectiveness of bupropion SR for smoking cessation. The results of the decision analyses indicated that, as compared with advice or counseling alone, the incremental cost per life-years saved is about $1,441~$3,455 for NRT, $920~$2,150 for bupropion SR, and $1,282~$2,836 for NRT plus bupropion SR. The cost-effectiveness of adding NRT and bupropion SR to advice or counseling for smoking cessation is better than many other accepted health care interventions.

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Valuing knowledge of the cost and cost-effectiveness of medicines

The Psychiatrist ◽

10.1192/pb.bp.110.030155 ◽

2010 ◽

Vol 34 (9) ◽

pp. 369-370

Author(s):

Sarah Byford ◽

Iris Molosankwe

Keyword(s):

Cost Effectiveness ◽

Health Service ◽

Psychotropic Medication ◽

Cost Effective ◽

Cost Data ◽

Relative Cost ◽

Prescribing Practices ◽

Relative Cost Effectiveness ◽

The Uk ◽

The Cost

SummaryKnowledge of the cost of pharmaceuticals is an important step towards cost-effective prescribing, yet evidence presented by Singh and colleagues highlights a lack of awareness of the cost of psychotropic medication among doctors in one NHS foundation trust and failures in the dissemination of cost data. These findings support the existence of substantial barriers to the success of cost-effective prescribing strategies in the UK. The next, and more challenging step, is to explore knowledge of the relative cost-effectiveness of pharmaceuticals, since knowledge of cost alone is inadequate to ensure prescribing practices make a meaningful constribution to the efficient use of scarce health service resources.

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