Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

scholarly journals The cost-effectiveness of a successful community-based obesity prevention program: The be active eat well program

Obesity ◽  
2013 ◽  
Vol 21 (10) ◽  
pp. 2072-2080 ◽  
Author(s):  
Marjory L. Moodie ◽  
Jessica K. Herbert ◽  
Andrea M. de Silva-Sanigorski ◽  
Helen M. Mavoa ◽  
Catherine L. Keating ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Obesity Prevention ◽  
Prevention Program ◽  
Community Based ◽  
The Cost ◽  
Obesity Prevention Program

scholarly journals Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold

2015 ◽  
Vol 19 (14) ◽  
pp. 1-504 ◽  
Author(s):  
Karl Claxton ◽  
Steve Martin ◽  
Marta Soares ◽  
Nigel Rice ◽  
Eldon Spackman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Effects ◽  
The Other ◽  
Opportunity Costs ◽  
Best Estimate ◽  
The Cost ◽  
The Impact ◽  
The Relationship ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

BackgroundCost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.Objectives(1) To provide a conceptual framework to define the cost-effectiveness threshold and to provide the basis for its empirical estimation. (2) Using programme budgeting data for the English NHS, to estimate the relationship between changes in overall NHS expenditure and changes in mortality. (3) To extend this mortality measure of the health effects of a change in expenditure to life-years and to QALYs by estimating the quality-of-life (QoL) associated with effects on years of life and the additional direct impact on QoL itself. (4) To present the best estimate of the cost-effectiveness threshold for policy purposes.MethodsEarlier econometric analysis estimated the relationship between differences in primary care trust (PCT) spending, across programme budget categories (PBCs), and associated disease-specific mortality. This research is extended in several ways including estimating the impact of marginal increases or decreases in overall NHS expenditure on spending in each of the 23 PBCs. Further stages of work link the econometrics to broader health effects in terms of QALYs.ResultsThe most relevant ‘central’ threshold is estimated to be £12,936 per QALY (2008 expenditure, 2008–10 mortality). Uncertainty analysis indicates that the probability that the threshold is < £20,000 per QALY is 0.89 and the probability that it is < £30,000 per QALY is 0.97. Additional ‘structural’ uncertainty suggests, on balance, that the central or best estimate is, if anything, likely to be an overestimate. The health effects of changes in expenditure are greater when PCTs are under more financial pressure and are more likely to be disinvesting than investing. This indicates that the central estimate of the threshold is likely to be an overestimate for all technologies which impose net costs on the NHS and the appropriate threshold to apply should be lower for technologies which have a greater impact on NHS costs.LimitationsThe central estimate is based on identifying a preferred analysis at each stage based on the analysis that made the best use of available information, whether or not the assumptions required appeared more reasonable than the other alternatives available, and which provided a more complete picture of the likely health effects of a change in expenditure. However, the limitation of currently available data means that there is substantial uncertainty associated with the estimate of the overall threshold.ConclusionsThe methods go some way to providing an empirical estimate of the scale of opportunity costs the NHS faces when considering whether or not the health benefits associated with new technologies are greater than the health that is likely to be lost elsewhere in the NHS. Priorities for future research include estimating the threshold for subsequent waves of expenditure and outcome data, for example by utilising expenditure and outcomes available at the level of Clinical Commissioning Groups as well as additional data collected on QoL and updated estimates of incidence (by age and gender) and duration of disease. Nonetheless, the study also starts to make the other NHS patients, who ultimately bear the opportunity costs of such decisions, less abstract and more ‘known’ in social decisions.FundingThe National Institute for Health Research-Medical Research Council Methodology Research Programme.

scholarly journals Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations

2020 ◽  
Author(s):  
Joe Botham ◽  
Amy Clark ◽  
Thomas Steare ◽  
Ruth Stuart ◽  
Sian Oram ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Personality Disorder ◽  
Economic Evaluations ◽  
Economic Evidence ◽  
Emotional Needs ◽  
Community Based Interventions ◽  
Community Based ◽  
Single Intervention ◽  
The Cost

AbstractBackgroundDiagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions.AimsTo assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.MethodSystematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings.ResultsEighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.ConclusionThere is no robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs. The review identified the strongest evidence for Dialectical Behavioural Therapy with all three identified studies indicating the intervention is likely to be cost-effective in community settings compared to treatment as usual. Further research is needed to provide robust evidence on the cost-effectiveness of community-based interventions upon which decision makers can confidently base guidelines or allocate resources.

Cost-effectiveness of AI in medicine from a clinical, technical, and economic perspective: A scoping review and a framework of analysis (Preprint)

2021 ◽  
Author(s):  
Jesus Gomez Rossi ◽  
Ben Feldberg ◽  
Joachim Krois ◽  
Falk Schwendicke
Keyword(s):  
Artificial Intelligence ◽  
Cost Effectiveness ◽  
Scientific Literature ◽  
Economic Aspects ◽  
Inclusion Criteria ◽  
Economic Perspective ◽  
Health Policy Analysis ◽  
The Cost ◽  
The Relationship ◽  
Potential Use

BACKGROUND Research and Development (R&D) of Artificial Intelligence (AI) in medicine involve clinical, technical and economic aspects. Better understanding the relationship between these dimensions seems necessary to coordinate efforts of R&D among stakeholders. OBJECTIVE To assess systematically existing literature on the cost-effectiveness of Artificial Intelligence (AI) from a clinical, technical and economic perspective. METHODS A systematic literature review was conducted to study the cost-effectiveness of AI solutions and summarised within a scoping framework of health policy analysis developed to study clinical, technical and economic dimensions. RESULTS Of the 4820 eligible studies, 13 met the inclusion criteria. Internal medicine and emergency medicine were the most studied clinical disciplines. Technical R&D aspects have not been uniformly disclosed in the studies we analysed. Monetisation aspects such as payment models assumed have not been reported in the majority of cases. CONCLUSIONS Existing scientific literature on the cost-effectiveness of AI currently does not allow to draw conclusive recommendations. Further research and improved reporting on technical and economic aspects seem necessary to assess potential use-cases of this technology, as well as to secure reproducibility of results. CLINICALTRIAL Not applicable

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

2020 ◽  
Author(s):  
Shanzi Huang ◽  
Jason Ong ◽  
Wencan Dai ◽  
Xi He ◽  
Yi Zhou ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Variable Cost ◽  
Community Based ◽  
Self Testing ◽  
Hiv Test ◽  
Community Based Organization ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

Role of TQM in Sustained Business Performance in Indian Automotive Supply Chain

2018 ◽  
pp. 121-143 ◽  
Author(s):  
Sanjiv Narula ◽  
Satwinder Pal ◽  
Vinay Saini ◽  
Prabhat Saxena ◽  
Ajay Goyal ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Business Performance ◽  
Primary Data ◽  
Total Quality ◽  
Business Sustainability ◽  
Automotive Supply Chain ◽  
The Cost ◽  
Automotive Supply ◽  
The Relationship

This chapter creates a place in which TQM (total quality management) differs from business sustainability. Management can focus themselves more accurately when they understand the missing link between these two aspects. It also helps to reduce and eliminate certain wastes related to cost and efficiency and helps to produce better quality with minimum waste. In this study, a TQM framework is developed according to a comprehensive literature review: primary data collection through a structured questionnaire and interview of performers/nonperformers at various levels in different organizations. Analysis of data is used to establish the relationship between attributes of TQM and business sustainability. TQM enhances the cost effectiveness while helping suppliers to produce enhanced quality to their customers and with minimum efforts and lesser rejection. Analysis of data is used to establish the relationship between attributes of TQM and cost effectiveness in an organization.

scholarly journals Effect of the scale of production on the cost-effectiveness of milk production systems belonging to the “Balde Cheio” program

2018 ◽  
Vol 39 (3) ◽  
pp. 1211
Author(s):  
Flávio De Moraes ◽  
Marcos Aurélio Lopes ◽  
Francisval De Melo Carvalho ◽  
Afonso Aurélio de Carvalho Peres ◽  
Fábio Raphael Pascoti Bruhn ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Labor Force ◽  
Milk Production ◽  
Large Scale ◽  
Unit Cost ◽  
Small Scale ◽  
Total Cost ◽  
Medium Scale ◽  
Return On Capital ◽  
The Cost

This study investigates the cost-effectiveness of 20 demonstration units (DUs) belonging to the "Balde Cheio" program. The units in question are from the state of Rio de Janeiro, Brazil, dating from January to December 2011, and are sorted according to the scale of production (small, medium and large). The data were analyzed using Predictive Analytical software (PASW) 18.0. The scale of production influenced the total cost of milk production, and therefore profitability and cost-effectiveness. The large-scale stratum showed the lowest total unit cost. The positive results in medium and large scales in milk production lead to optimal conditions for long-term production, with the capitalization of cowmen. The items regarding the effective operating cost (EOC) with the biggest influence on the costs of dairy activity in the small scale stratum were food, energy and miscellaneous expenses. In the medium scale, these were food, labor force, and miscellaneous expenses. Finally, in the large scale, they were food, labor force and energy. In the small and large scale, the items regarding the total cost with the biggest influence on the costs of dairy activity were food, labor force, and return on capital, while in the medium scale, they were food, return on capital, and labor force. The average break-even point of 14 of the DUs was higher than the average daily production.

scholarly journals Cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening

2019 ◽  
Vol 30 (3) ◽  
pp. 543-552
Author(s):  
João Firmino-Machado ◽  
Djøra I Soeteman ◽  
Nuno Lunet
Keyword(s):  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cost Effective ◽  
Effective Strategy ◽  
Face To Face ◽  
Provider Perspectives ◽  
Phone Calls ◽  
The Cost

Abstract Background Cervical cancer screening is effective in reducing mortality, but adherence is generally low. We aimed to investigate the cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening in Portugal. Methods We developed a decision tree model to compare the cost-effectiveness of four competing interventions to increase adherence to cervical cancer screening: (i) a written letter (standard-of-care); (ii) automated short message service text messages (SMS)/phone calls/reminders; (iii) automated SMS/phone calls/reminders + manual phone calls; (iv) automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. The main outcome measure was cost per quality-adjusted life year (QALY) measured over a 5-year time horizon. Costs were calculated from the societal and provider perspectives. Results From the societal perspective, the optimal strategy was automated SMS/phone calls/reminders, below a threshold of €8171 per QALY; above this and below €180 878 per QALY, the most cost-effective strategy was automated SMS/phone calls/reminders + manual phone calls and above this value automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. From the provider perspective, the ranking of the three strategies in terms of cost-effectiveness was the same, for thresholds of €2756 and €175 463 per QALY, respectively. Conclusions Assuming a willingness-to-pay threshold of one time the national gross domestic product (€22 398/QALY), automated SMS/phone calls/reminders + manual phone calls is a cost-effective strategy to promote adherence to cervical cancer screening, both from the societal and provider perspectives.

scholarly journals Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Amanuel Yigezu ◽  
Senait Alemayehu ◽  
Shallo Daba Hamusse ◽  
Getachew Teshome Ergeta ◽  
Damen Hailemariam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Addis Ababa ◽  
Unit Cost ◽  
Hiv Positive ◽  
Testing Methods ◽  
Voluntary Counseling ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
The Cost ◽  
Hiv Seropositive

Abstract Background Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.

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