scholarly journals Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Owain D. Williams ◽  
Judith A. Dean ◽  
Anna Crothers ◽  
Charles F. Gilks ◽  
Jeff Gow
Keyword(s):  
Point Of Care ◽  
Cost Model ◽  
Cost Effective ◽  
Positive Diagnosis ◽  
Trade Offs ◽  
Self Testing ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
The Individual ◽  
The Cost

Abstract Background The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Methods A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. Results Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. Conclusions This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.

scholarly journals Peer mobilisation and HIV partner notification services among gay, bisexual, other men who have sex with men and transgender women in coastal Kenya identified a high number of undiagnosed HIV infections

2021 ◽  
Author(s):  
Maartje Dijkstra ◽  
Khamisi Mohamed ◽  
Alex Kigoro ◽  
Teresia Mumba ◽  
Shally Mahmoud ◽  
...  
Keyword(s):  
Point Of Care ◽  
Partner Notification ◽  
Hiv Infections ◽  
Transgender Women ◽  
Newly Diagnosed ◽  
Antibody Testing ◽  
Self Testing ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Introduction HIV partner notification services (HPN), peer mobilisation with HIV self-testing and acute and early HIV infection (AEHI) screening among gay, bisexual, other men who have sex with men (GBMSM) and transgender women (TGW) were assessed for acceptability, feasibility and linkage to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services. Methods Between April-August 2019, peer mobilisers mobilised clients by offering HIV oral self-tests and immediate clinic referral for clients with AEHI symptoms. Mobilised participants received clinic-based rapid antibody testing and point-of-care HIV-RNA testing. Newly diagnosed participants including those derived from HIV testing services were offered immediate ART and HPN. Partners were recruited through HPN. . Results Of 772 mobilised clients, 452 (58.5%) enrolled in the study as mobilised participants. Of these, 16 (3.5%) were HIV newly diagnosed, including 2 (0.4%) with AEHI. All but two (14/16, 87.5%) initiated ART. 35 GBMSM and TGW were offered HPN and 27 (77.1%) accepted it. Provider referral identified a higher proportion of partners tested (39/64; 60.9% vs. 5/14; 35.7%) and partners with HIV (27/39; 69.2% vs. 2/5; 40.0%) than index referral. Of 44 enrolled partners, 10 (22.7%) were newly diagnosed, including 3 (6.8%) with AEHI. All 10 (100%) initiated ART. PrEP was initiated among 24.0% (103/429) mobilised participants and 28.6% (4/14) partners without HIV. Conclusions HPN, combined with a peer mobilisation-led self-testing strategy and AEHI screening for GBMSM and TGW, appears acceptable and feasible. These strategies, especially HPN provider referral, effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP-services.

scholarly journals Cost-Effectiveness of Peer-Delivered HIV Self-Tests for MSM in Uganda

2021 ◽  
Vol 9 ◽  
Author(s):  
Stephen Okoboi ◽  
Barbara Castelnuovo ◽  
Jean-Pierre Van Geertruyden ◽  
Oucul Lazarus ◽  
Lung Vu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hiv Testing ◽  
Cost Effective ◽  
Hiv Infections ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
High Risk Population ◽  
Self Testing ◽  
The Cost

Introduction: Distribution of HIV self-testing (HIVST) kits through MSM peer networks is a novel and effective strategy to increase HIV testing coverage in this high-risk population. No study has evaluated the cost or cost effectiveness of peer distribution of HIVST strategies among MSM in sub-Saharan Africa.Methods: From June to August 2018, we conducted a pilot study of secondary MSM peer HIVST kit distribution at The AIDS Support Organization at Entebbe and Masaka. We used an ingredients approach to estimate the cost of MSM peer HIVST kit distribution relative to standard-of-care (SOC) hotspot testing using programme expenditure data reported in US dollars. The provider perspective was used to estimate incremental cost-effective ratios per HIV infection averted using the difference in HIV annual transmission rates between MSM with HIV who knew their status and were not virologically suppressed and MSM with HIV who did not know their status.Results: We enrolled 297 participants of whom 150 received MSM peer HIVST kit distribution (intervention group) and 147 received TASO standard of care HIV testing (control group). Provider cost for the intervention was $2,276 compared with $1,827 for SOC during the 3-month study period. Overall, the intervention resulted in higher HIV positivity yield (4.9 vs. 1.4%) and averted more HIV infections per quarter (0.364 vs. 0.104) compared with SOC. The cost per person tested was higher for the intervention compared to SOC ($15.90 vs. $12.40). Importantly, the cost per new HIV diagnosis ($325 vs. $914) and cost per transmission averted ($6,253 vs. $ 17,567) were lower for the intervention approach relative to SOC. The incremental cost per HIV transmission averted by the self-testing program was $1,727. The incremental cost to providers per additional HIV-positive person identified by the intervention was $147.30.Conclusion: The intervention strategy was cost-effective, and identified more undiagnosed HIV infections than SOC hotspot testing at a cost-effectiveness threshold of US $2,129. Secondary distribution of HIVST kits through peers should further be evaluated with longer duration aimed at diagnosing 95% of all persons with HIV by 2030; the first UNAIDS 95-95-95 target.

scholarly journals The cost of immunising at the general practice level

2009 ◽  
Vol 1 (4) ◽  
pp. 286 ◽  
Author(s):  
Nikki Turner ◽  
Paul Rouse ◽  
Stacey Airey ◽  
Helen Petousis-Harris
Keyword(s):  
General Practice ◽  
Cost Allocation ◽  
Cost Model ◽  
Cost Effective ◽  
Fee For Service ◽  
Activity Based Costing ◽  
Childhood Immunisation ◽  
Practice Nurses ◽  
The Mean ◽  
The Cost

INTRODUCTION: Childhood immunisation is one of the most cost-effective activities in health care. However, New Zealand (NZ) has failed to achieve national coverage targets. NZ general practice is the primary site of service delivery and is funded on a fee-for-service basis for delivery of immunisation events. AIM: To determine the average cost to a general practice of delivering childhood immunisation events and to develop a cost model for the typical practice. METHODS: A purposeful selection of 24 diverse practices provided data via questionnaires and a daily log over a week. Costs were modelled using activity-based costing. RESULTS: The mean time spent on an immunisation activity was 23.8 minutes, with 90.7% of all staff time provided by practice nurses. Only 2% of the total time recorded was spent on childhood immunisation opportunistic activities. Practice nurses spent 15% of their total work time on immunisation activity. The mean estimated cost per vaccination event was $25.90; however, there was considerable variability across practices. A ‘typical practice’ model was developed to better understand costs at different levels of activity. CONCLUSIONS: The current level of immunisation benefit subsidy is considerably lower than the cost of a standard vaccination event, although there is wide variability across practices. The costs of delivery exceeding the subsidy may be one reason why there is an apparently small amount of time spent on extra opportunistic activities and a barrier to increasing efforts to raise immunisation rates. KEYWORDS: Immunisation; vaccination; patient care management; cost analysis; cost allocation

Cost Comparison of Fan-Out WLP vs. Embedded Die

2011 ◽  
Vol 2011 (DPC) ◽  
pp. 001003-001018
Author(s):  
Alan Palesko ◽  
Jan Vardaman
Keyword(s):  
Cost Model ◽  
Form Factors ◽  
Cost Effective ◽  
Cost Comparison ◽  
Package Design ◽  
Supply Chain Logistics ◽  
Cost Effective Approach ◽  
Large Production ◽  
The Cost ◽  
Cost Differences

Fabricating the package after the die is placed can result in smaller form factors, increased performance, and improved supply chain logistics for OEMs. There are many different approaches for this packaging technique, but two of the most prominent are Fan-Out WLP and Embedded Die. Fan-Out WLP leverages existing semiconductor technology for a cost effective approach to achieve relatively tight package design rules. The Embedded Die strategy leverages existing PCB lamination technology for cost-reduction through scale: fabricating many small packages on large production panels. We will examine the cost differences and similarities between Fan-Out WLP and Embedded Die strategies by developing a comprehensive cost model for each technology. We will then analyze the manufacturing costs (labor, material, depreciation, yield loss, and tooling) and yield impacts across a variety of designs to demonstrate the cost differences and similarities in each packaging technology.

scholarly journals Forward Link Optimization for the Design of VHTS Satellite Networks

Electronics ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 473 ◽  
Author(s):  
Flor G. Ortiz-Gomez ◽  
Ramón Martínez ◽  
Miguel A. Salas-Natera ◽  
Andrés Cornejo ◽  
Salvador Landeros-Ayala
Keyword(s):  
Cost Model ◽  
High Capacity ◽  
Optimal Solution ◽  
Satellite Networks ◽  
Forward Link ◽  
User Terminal ◽  
Trade Offs ◽  
Service Areas ◽  
Optimum Solution ◽  
The Cost

The concept of geostationary VHTS (Very High Throughput Satellites) is based on multibeam coverage with intensive frequency and polarization reuse, in addition to the use of larger bandwidths in the feeder links, in order to provide high capacity satellite links at a reduced cost per Gbps in orbit. The dimensioning and design of satellite networks based on VHTS imposes the analysis of multiple trade-offs to achieve an optimal solution in terms of cost, capacity, and the figure of merit of the user terminal. In this paper, we propose a new method for sizing VHTS satellite networks based on an analytical expression of the forward link CINR (Carrier-to-Interference-plus-Noise Ratio) that is used to evaluate the trade-off of different combinations of system parameters. The proposed method considers both technical and commercial requirements as inputs, including the constraints to achieve the optimum solution in terms of the user G/T, the number of beams, and the system cost. The cost model includes both satellite and ground segments. Exemplary results are presented with feeder links using Q/V bands, DVB-S2X and transmission methods based on CCM and VCM (Constant and Variable Coding and Modulation, respectively) in two scenarios with different service areas.

Analytic Evaluation of Engine NVH Robustness Due to Manufacturing Variations

2005 ◽  
Author(s):  
John J. Batteh ◽  
Michael M. Tiller
Keyword(s):  
Combustion Process ◽  
Cost Effective ◽  
Product Development Process ◽  
Large Engine ◽  
Engine Torque ◽  
Cycle Simulation ◽  
Noise Vibration ◽  
The Individual ◽  
The Cost ◽  
Noise Factors

In an effort to improve quality, shorten engine development times, and reduce costly and time-consuming experimental work, analytic modeling is being used upstream in the product development process to evaluate engine robustness to noise factors. This paper describes a model-based method for evaluating engine NVH (Noise, Vibration, and Harshness) robustness due to manufacturing variations for a statistically significant engine population. A brief discussion of the cycle simulation model and its capabilities is included. The methodology consists of Monte Carlo simulations involving several noise factors to obtain the crank-angle resolved response of the combustion process and Fourier analysis of the resulting engine torque. Further analysis of the Fourier results leads to additional insights regarding the relative importance of and sensitivity to the individual noise factors. While the cost and resources required to experimentally evaluate a large engine population can be prohibitive, the analytical modeling proved to be a cost-effective way of analyzing the engine robustness taking into account manufacturing process capability.

scholarly journals Marketing Energy Conservation to Homeowners: An Action Program from Public Policy Research

1984 ◽  
Vol 3 (1) ◽  
pp. 149-166 ◽  
Author(s):  
William Rudelius ◽  
Richard Weijo ◽  
Gary Dodge
Keyword(s):  
Energy Conservation ◽  
Energy Savings ◽  
Policy Research ◽  
Cost Effective ◽  
Marketing Strategies ◽  
Public Expenditures ◽  
Fixed Amount ◽  
Public Policy Research ◽  
Trade Offs ◽  
The Individual

Energy conservation appeals to homeowners stressing patriotism and social responsibility have not worked. The authors believe that more precise information for the homeowner showing the specific dollar costs and savings for various energy actions will stimulate meaningful, beneficial trade-offs for the individual. They further believe that broadly conceived, publicly sponsored marketing strategies can help individual consumers make more informed energy-conservation choices from among the continuous, seasonal, and one-time actions available to them. If public policymakers focus efforts on the most cost-effective, energy-saving actions for households, the community will receive the greatest energy savings for a fixed amount of public expenditures.

scholarly journals Recommendations for performance optimizations when using GATK3.8 and GATK4

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jacob R Heldenbrand ◽  
Saurabh Baheti ◽  
Matthew A Bockol ◽  
Travis M Drucker ◽  
Steven N Hart ◽  
...  
Keyword(s):  
Large Population ◽  
Variant Calling ◽  
Cost Effective ◽  
Performance Improvements ◽  
Computational Performance ◽  
Trade Offs ◽  
Genome Analysis Toolkit ◽  
The Cost ◽  
Multiple Samples ◽  
Parameter Values

Abstract Background Use of the Genome Analysis Toolkit (GATK) continues to be the standard practice in genomic variant calling in both research and the clinic. Recently the toolkit has been rapidly evolving. Significant computational performance improvements have been introduced in GATK3.8 through collaboration with Intel in 2017. The first release of GATK4 in early 2018 revealed rewrites in the code base, as the stepping stone toward a Spark implementation. As the software continues to be a moving target for optimal deployment in highly productive environments, we present a detailed analysis of these improvements, to help the community stay abreast with changes in performance. Results We re-evaluated multiple options, such as threading, parallel garbage collection, I/O options and data-level parallelization. Additionally, we considered the trade-offs of using GATK3.8 and GATK4. We found optimized parameter values that reduce the time of executing the best practices variant calling procedure by 29.3% for GATK3.8 and 16.9% for GATK4. Further speedups can be accomplished by splitting data for parallel analysis, resulting in run time of only a few hours on whole human genome sequenced to the depth of 20X, for both versions of GATK. Nonetheless, GATK4 is already much more cost-effective than GATK3.8. Thanks to significant rewrites of the algorithms, the same analysis can be run largely in a single-threaded fashion, allowing users to process multiple samples on the same CPU. Conclusions In time-sensitive situations, when a patient has a critical or rapidly developing condition, it is useful to minimize the time to process a single sample. In such cases we recommend using GATK3.8 by splitting the sample into chunks and computing across multiple nodes. The resultant walltime will be nnn.4 hours at the cost of $41.60 on 4 c5.18xlarge instances of Amazon Cloud. For cost-effectiveness of routine analyses or for large population studies, it is useful to maximize the number of samples processed per unit time. Thus we recommend GATK4, running multiple samples on one node. The total walltime will be ∼34.1 hours on 40 samples, with 1.18 samples processed per hour at the cost of $2.60 per sample on c5.18xlarge instance of Amazon Cloud.

scholarly journals Potential interactions between the pathways to diagnosis of HIV and other STIs and HIV self-testing: insights from a qualitative study of gay, bisexual and other men who have sex with men in Singapore

2020 ◽  
pp. sextrans-2020-054623
Author(s):  
Rayner Kay Jin Tan ◽  
Yin Ying Chan ◽  
Muhamad Alif Bin Ibrahim ◽  
Lai Peng Ho ◽  
Oliver Zikai Lim ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Perceived Risk ◽  
Partner Notification ◽  
Barriers And Facilitators ◽  
Perceived Severity ◽  
Sti Testing ◽  
Self Testing ◽  
Sex With Men ◽  
Stis And Hiv ◽  
The Cost

ObjectivesThis study draws on qualitative insights on the barriers and facilitators to HIV testing, as well as perceptions of HIV self-testing (HIVST), to propose a framework to understand not only the benefits but also potential knock-on implications of introducing HIVST in the context of other STI testing.MethodsWe conducted semistructured, in-depth interviews with 30 gay, bisexual and other men who have sex with men aged 18 and 39 years old in Singapore. Interview topics included barriers and facilitators to HIV and other STI testing, as well as perceptions of HIVST. Interviews were audio-recorded, transcribed, coded and analysed using thematic analysis.ResultsFor HIV testing, participants cited the perceived risk of acquiring, susceptibility to and symptoms of HIV as internal motivators, while social influence and accessibility of HIV testing services were external motivators. For STI testing, perceived symptoms and partner notification of STI were reported as internal and external motivators, respectively. Availability of bundle tests, starting a new relationship and instances of mandatory testing motivated both simultaneous HIV and other STI testing. The fear of a positive diagnosis and lack of confidentiality were cited as internal and external barriers to HIV testing, respectively, while low perceived severity of other STI and the cost of STI tests were cited as internal and external barriers to other STI testing, respectively. We identified pathways to HIV and other STI testing and discussed how the introduction of HIVST may reduce opportunities for other STI testing.ConclusionsThe findings of this study suggest that introducing HIVST might weaken linkages to other STI testing if alternative strategies of promoting other STI testing are not simultaneously implemented. We recommend that future interventions address both the risks of HIV and other STI simultaneously, and that structural interventions promoting HIV and other STI preventions be balanced accordingly.

Cost-Effectiveness Analysis of Treatment for Esophageal Varices in Japan

1987 ◽  
Vol 3 (4) ◽  
pp. 575-586 ◽  
Author(s):  
Akira Sasaki ◽  
John M. Eisenberg
Keyword(s):  
Cost Effectiveness ◽  
Esophageal Varices ◽  
Ethical Issues ◽  
Japanese Literature ◽  
Cost Effective ◽  
Injection Sclerotherapy ◽  
Endoscopic Injection ◽  
Trade Offs ◽  
Cost Effective Treatment ◽  
The Cost

AbstractWe analyzed the cost-effectiveness of nonemergent treatment for esophageal varices commonly used in Japan (endoscopic injection sclerotherapy, nonshunting direct interruption procedure, and selective shunt). We assessed the cost per survivor from the perspective of the Japanese government and other payors. Epidemiologic and economic data from published Japanese literature and from Japanese hospital-cost information were applied in decision analysis. While sclerotherapy is the most cost-effective treatment, the popular surgical procedures save the most lives, thus raising difficult ethical issues regarding trade-offs of cost and quality.

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