Measuring the cost-effectiveness (CE) of therapies treating metastatic colorectal cancer (mCRC).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 405-405
Author(s):  
D. Lakdawalla ◽  
J. Penrod ◽  
R. Maclean ◽  
J. S. Humphrey ◽  
S. Seabury
Keyword(s):  
Price Elasticity ◽  
Metastatic Cancer ◽  
Revealed Preference ◽  
Primary Outcome Measure ◽  
Real World Data ◽  
Average Value ◽  
Statistical Life ◽  
Average Annual Cost ◽  
Spending Behavior ◽  
The Cost

405 Background: Traditional CE approaches often produce results that appear to be at odds with patients' (pts) behavior. Patients with terminal disease often value gains in survival much more highly than is suggested by standard CE estimates. In the context of metastatic cancer, CE classifies as cost-ineffective many therapies that pts appear to value highly. This study assesses whether CE analyses conflict with estimates of pt value for mCRC therapy. We infer pt value from the willingness to pay (WTP) of cancer pts for therapy out-of-pocket (OOP), and compare these estimates to the value implied by traditional CE. In contrast to traditional CE approaches, this study uses real-world data on pts' own WTP for therapy OOP. Methods: Revealed preference analysis is performed on retrospective claims data, including the pt OOP spending component, to infer the value metastatic cancer pts (N=13,938) place on 29 different therapies for CRC, breast, lung or head and neck cancer. The primary outcome measure is the average value placed by pts on therapy. Secondary outcomes are: utilization of therapy, total expenditures on cancer drugs, and the price elasticity of demand for therapy. Results: Utilization of therapy displays a negative but inelastic relationship with OOP spending on drugs (the estimated price elasticity is -0.007, with p<0.01). The estimated annual WTP OOP for treatment of mCRC specifically was $207,555, approximately 19 times the average annual cost of therapy ($10,775). Approximately 99% of mCRC pts value the therapy more than the cost. The analysis implies that the average mCRC pt values a statistical life year at approximately $282,000. In comparison, traditional CE analyses employed by regulators assign much lower values for a statistical life-year; for example, the UK's NICE uses a threshold of <$50,000 per year. Conclusions: Traditional economic valuations of medical treatment perform poorly in the terminal care setting, because they fail to recognize that pts place higher value on care provided at the end of life. As a result, these methods vastly understate the CE of treatment for mCRC and other terminal diseases. Use of pts' own OOP spending behavior appears to produce different conclusions for the value of therapy. [Table: see text]

ANALISA PERBANDINGAN LAPORAN KEUANGAN DAN RASIO KEUANGAN SEBAGAI ALAT UKUR KINERJA KEUANGAN PADA KOPERASI KARYAWAN SUCOFINDO (KOPERASI SUCOFINDO JAYA) TAHUN 2009 – 2011

2019 ◽  
Vol 9 (2) ◽  
pp. 35
Author(s):  
Sri Marti Pramudena
Keyword(s):  
Financial Performance ◽  
Balance Sheet ◽  
Fiscal Year ◽  
Percentage Increase ◽  
Net Worth ◽  
Average Value ◽  
Financial Position ◽  
Profitability Analysis ◽  
Equity Ratio ◽  
The Cost

This study aims to determine the financial position and financial performance Cooperative Sucofindo Jaya (KOPSUCOFINDO JAYA) from fiscal year 2009-2011 through a comparative analysis / comparisons and ratio analysis. From the research, the authors obtained a picture that results of the financial position and financial performance of KOPSUCOFINDO JAYA as follows: (1) To Horizontal Analysis of the Balance Sheet shows the overall unfavorable developments as the rise of short-term debt experienced a greater percentage increase than the increase in current assets (2) For Horizontal Analysis of the SHU, SHU in 2010 an increase of 125.38% compared to 2009 and in 2011 increased by 282.47% compared to 2009, but this increase was not followed by a reduction in the burden of cost of goods, especially business and this increase was obtained from the contribution percentage increase in other income. (3) For Vertical Analysis of the Balance Sheet shows that in terms of assets, current assets are assets that make up the largest component but also cause considerable investment value embedded in current assets and also showed asset turnover, receivables turnover and working capital is very low under 1 times. (4) For the SHU Vertical analysis shows that income JAYA KOPSUCOFINDO more than 85% absorbed in the Cost of Goods. (5) For liquidity analysis showed that highly liquid KOPSUCOFINDO JAYA obtain an average value above 400%. (6) For solvency analysis shows that the performance is not good / not solvable because the results of the analysis LITA average of above 95%, Total Debt to Equity Ratio in the top 2.000%, and Net Worth Debt Ratio to average below 4%. (7) For activity ratios indicate that the performance is not good for Turnover of Assets value of 1 times. (8) For the rentability analysis KOPSUCOFINDO JAYA show results for ROA of 0.86% (2009), 1.31% (2010), 1.18% (2011), ROE in 2009 is 14.81%, 26.43% in 2010 and 2011 amounted to 31.11%, for the ROI of 0.56% in 2009, in 2010 was 0.96% and by 0.93% in 2011. (9) For the analysis of profitability, for the analysis of GPM in 2009 amounted to 1.49%, in 2010 of 2.31% and 3.92% in 2011. As for the analysis of NPM in 2009 amounted to 0.97%, in 2010 by 1.70% and by 3.10% in 2011. Keywords:  Cooperative Financial Performance, horizontal analysis, vertical analysis, Analysis of Liquidity, Solvency Analysis, Activity Analysis, Profitability Analysis, profitability analysis

scholarly journals The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarina R. Isenberg ◽  
Christopher Meaney ◽  
Peter May ◽  
Peter Tanuseputro ◽  
Kieran Quinn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Metastatic Cancer ◽  
Estimating Equation ◽  
Population Based ◽  
Future Research ◽  
Chronic Obstructive ◽  
Discharge Abstract Database ◽  
High Involvement ◽  
Hospitalization Costs ◽  
The Cost

Abstract Background Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Methods Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. Results There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). Conclusions Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.

A Scalable Redefined Stochastic Blockmodel

2021 ◽  
Vol 15 (3) ◽  
pp. 1-28
Author(s):  
Xueyan Liu ◽  
Bo Yang ◽  
Hechang Chen ◽  
Katarzyna Musial ◽  
Hongxu Chen ◽  
...  
Keyword(s):  
Large Scale ◽  
Network Science ◽  
Learning Algorithm ◽  
State Of The Art ◽  
Real World Data ◽  
Computational Overhead ◽  
Stochastic Blockmodel ◽  
Np Hard Problem ◽  
Large Scale Networks ◽  
The Cost

Stochastic blockmodel (SBM) is a widely used statistical network representation model, with good interpretability, expressiveness, generalization, and flexibility, which has become prevalent and important in the field of network science over the last years. However, learning an optimal SBM for a given network is an NP-hard problem. This results in significant limitations when it comes to applications of SBMs in large-scale networks, because of the significant computational overhead of existing SBM models, as well as their learning methods. Reducing the cost of SBM learning and making it scalable for handling large-scale networks, while maintaining the good theoretical properties of SBM, remains an unresolved problem. In this work, we address this challenging task from a novel perspective of model redefinition. We propose a novel redefined SBM with Poisson distribution and its block-wise learning algorithm that can efficiently analyse large-scale networks. Extensive validation conducted on both artificial and real-world data shows that our proposed method significantly outperforms the state-of-the-art methods in terms of a reasonable trade-off between accuracy and scalability. 1

CHANGES IN THE TECHNICAL AND TECHNOLOGICAL LEVEL OF STEAM CULTIVATORS IN THE XXI CENTURY

2021 ◽  
Vol 2 (143) ◽  
pp. 174-183
Author(s):  
Andrey Yu. Nesmiyan ◽  
◽  
Anastasiya S. Kaymakova ◽  
Yuliya S. Tsench ◽  
Keyword(s):  
Weighted Average ◽  
Specific Weight ◽  
Research Purpose ◽  
Utilization Rate ◽  
Average Value ◽  
Technological Level ◽  
Short Test ◽  
Specific Material ◽  
The Cost

Most modern agricultural machines and tools consist of components, the main parameters, design features of which were justified in the first half of the twentieth century. Slowly and evolutionarily, these technical means are developing. (Research purpose) The research purpose is in identifying general trends in the technical and technological level of steam cultivators in the first quarter of the XXI century. (Materials and Methods) For the study there was analyzed the data of the short test reports of the selected machines. The production of steam cultivators in the Russian Federation is gradually increasing. (Results and discussion) For ten years of the beginning of the XXI century, only 27 machines were provided for testing, and from 2014 to 2017 – more than 40, while for "old" cultivators, the weighted average value of the tractor traction class was 2.8, for new ones it is about of four. For the study period (on average 10 years) the quality of soil cultivation in terms of such parameters as deviation from the specified depth of cultivation, crumbling and combing of the field surface has not changed much. The productivity of cultivator units increased by 7-21 percents, which is explained not only by an increase in the power of tractors, but also by an increase in the utilization rate of charge time on average from 0.72 to 0.77. The specific weight of the "new" cultivators was on average 22 kilogram-meters less than that of the "old" analogues, which can be explained by the evolution of their designs. (Conclusions) Increasing the class of tractors by one "level" the specific material consumption of the cultivators aggregated with them increases by about 58 kilogram-meters for both "old" and " new " cultivators. With an increase in the width of the tools from 4 to 16 meters, their weight will increase by 8 times, which affects the cost and operational and environmental characteristics of wide-reach cultivators.

scholarly journals Railway and road discrete choice model for foreign trade freight between Antioquia and the Port of Cartagena

2016 ◽  
Vol 36 (3) ◽  
pp. 22 ◽  
Author(s):  
Juan Diego Pineda Jaramillo ◽  
Iván Reinaldo Sarmiento Ordosgoitia ◽  
Jorge Eliécer Córdoba Maquilón
Keyword(s):  
Qualitative Research ◽  
Discrete Choice ◽  
Logit Model ◽  
Choice Model ◽  
Stated Preference ◽  
Revealed Preference ◽  
Freight Transportation ◽  
Multinomial Logit Model ◽  
Discrete Choice Model ◽  
The Cost

Most Colombian freight is transported on roads with barely acceptable conditions, and although there is a speculation about the need for a railway for freight transportation, there is not a study in Colombia showing the variables that influence the modal choice by the companies that generate freight transportation. This article presents the calculation of demand for a hypothetical railway through a discrete choice model. It begins with a qualitative research through focus group techniques to identify the variables that influence the choice of persons responsible for the transportation of large commercial companies in Antioquia (Colombia). The influential variables in the election were the cost and service frequency, and these variables were used to apply a Stated Preference (SP) and Revealed Preference (RP) survey, then to calibrate a Multinomial Logit Model (MNL), and to estimate the influence of each of them. We show that the probability of railway choice by the studied companies varies between 67% and 93%, depending on differences in these variables.

Results of experimental work on the application of the aquacrop rotation practice in fish ponds in Iraq

2021 ◽  
pp. 56-67
Author(s):  
Farhan Yasin Hamed Farhan Yasin Hamed ◽  
Lydia Mikhailovna Vasilyeva ◽  
Natalia Viktorovna Sudakova ◽  
Ali Attala Muheisin ◽  
Adelia Zakirovna Anokhina
Keyword(s):  
Crop Rotation ◽  
Production Efficiency ◽  
Crop Yields ◽  
Fish Farming ◽  
Fish Ponds ◽  
Average Value ◽  
Fish Breeding ◽  
Feed Costs ◽  
The Cost ◽  
Fish Productivity

The use of the crop rotation method in fish farming makes it possible to increase fish productivity and crop yields in ponds. In the countries of the Middle East, in recent years, the Aqua Crop rotation practice has been developing, in particular, the consistent cultivation of fish and rice in fish ponds, which allows eliminating the contradictions between these crops and increasing production efficiency. In Iraq, an experiment was carried out on the variable cultivation of rice and carp in fish ponds for four years, with the aim of introducing this practice into the country’s agriculture. Four ponds, each with an area of 7.5 hectares, were involved. The research was carried out in two variants: in experiment No.1 rice was grown in the first year, fish in the second, then rice again and in the fourth year — fish, in the second experiment, on the contrary, at the beginning of the fish, then rice, etc. The fish-breeding season lasted 9 months (March to November). Fish-breeding indicators were studied in detail: survival rate, feed costs, fish productivity, the results of rice cultivation were judged by yield. In addition, indicators of economic efficiency were determined according to a simplified scheme. The results indicate that, in general, fish-breeding indicators turned out to be higher when growing fish in ponds after rice, so fish productivity increased by almost 30% with an average value of 3.9 t/ha, feed costs decreased, while rice yield increased by 15–16% and averaged 3.6 t/ha. The best fish-breeding indicators were obtained in the second experiment after rice was grown in the ponds for two years. Economic calculations confirmed the advantages of using the aquacrop rotation practice, so in the second experiment the cost of marketable fish decreased by 10%, and the profitability increased by almost 30%.

Abstract W P273: The Cost-Effectiveness of Telestroke Varies by Implementation Cost and Stroke Severity: Real World Data From a Pacific Northwest Network

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Elizabeth Baraban ◽  
Richard Nelson ◽  
Alexandra Lesko ◽  
Jennifer Majersik ◽  
Archit Bhatt ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pacific Northwest ◽  
Real World ◽  
Cost Effective ◽  
Stroke Severity ◽  
Real World Data ◽  
World Data ◽  
Life Years ◽  
Implementation Costs ◽  
The Cost

Objective: An obstacle for community hospitals in joining a telestroke network is often the cost of implementation. Yet, previous analyses examining the cost and cost-effectiveness have only used estimates from the literature. Using real-world data from a Pacific Northwest telestroke network, we examined the cost-effectiveness of telestroke for spokes by level of financial responsibility for these costs and how this changes with patient stroke severity. Methods: We constructed a decision analytic model and parameterized it using patient-level clinical and financial data from the Providence Telestroke Network (PTN) pre and post telestroke implementation. Data included patients presenting at 17 spokes within 4.5 hours of symptom onset. Probability inputs included observed IV-tPA treatment rates, transfer status and hospital costs and reimbursements. Effectiveness, measured as quality-adjusted life years (QALYs), and cost per patient were used to calculate incremental cost effectiveness ratios (ICERs). ICER’s of <$50,000-$120,000/QALY are considered cost-effective. Outcomes were generated overall and separately by admit NIHSS, defined as low (0-10), medium (11-20) and high (>20) and percentage of implementation costs paid by spokes (0%, 50%, 100%). Results: Data for 594 patients, 105 pre- and 489 post-implementation, were included. See Table 1. Conclusions: Our results support previous theoretic models showing good value, overall. However, costs and ICERs varied by stroke severity, with telestroke being most cost-effective for severe strokes. Telestroke was least cost effective if spokes paid for half or more of implementation costs.

Abstract 16: Economic Cost of Type 2 Diabetes Attributable to Physical Inactivity in the United States in 2012

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Priyank P Shah ◽  
Fayez Shamoon ◽  
Mahesh Bikkina ◽  
Harold Kohl
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Physical Inactivity ◽  
Leisure Time ◽  
Sensitivity Analyses ◽  
Physical Activity Guidelines ◽  
Average Annual Cost ◽  
The Cost ◽  
The U.S

Objective: Type 2 diabetes has grown to epidemic proportions in the U.S. and physical activity levels in the population continues to remain low, although it is a major primary preventive strategy for diabetes. The objectives of this study were to estimate the direct medical costs of type 2 diabetes attributable to not meeting physical activity Guidelines and to physical inactivity in the U.S. in 2012. Methods: This was a cross sectional study that used physical activity prevalence data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Estimates of relative risk of type 2 diabetes for subjects not engaging in any leisure time physical activity and those not meeting physical activity guidelines were obtained for multiple studies published in the literature. Using the prevalence of not meeting physical activity guidelines, physical inactivity and the respective relative risks, the population attributable risk percentage (PAR%) for type 2 diabetes was estimated by Levin’s formula. These data were combined with the prevalence and cost data of type 2 diabetes (in 2012) to estimate the cost of type 2 diabetes attributable to not meeting physical activity Guidelines, and to physical inactivity in 2012. Sensitivity analyses were done for i) varying the prevalence of not meeting physical activity guidelines from 30-70%, and ii) varying the average annual cost of type 2 diabetes from $4394 (for person less than 45 years of age) to $11825 (for person greater than 65 years of age). Results: The prevalence of U.S. population meeting physical activity guidelines and engaging in no leisure time activity was 50% and 30% respectively in 2012. The average annual cost attributable to type 2 diabetes in the US, was $7888 per person. The cost of type 2 diabetes in the U.S. in 2012, attributable to not meeting physical activity guidelines was estimated to be $18.6 billion, and that attributable to physical inactivity was estimated to be $5.9 billion. Based on sensitivity analyses, these estimates ranged from $10.36 billion to $27.9 billion for not meeting physical activity guidelines and $3.3 billion to $8.87 billion for physical inactivity in the year 2012. Conclusions: This study shows that billions of dollars could be saved annually just in terms of type 2 diabetes cost in the U.S., if the entire adult population was active enough to meet physical activity guidelines. Physical activity promotion, particularly at the environmental and policy level should be a priority in the population.

scholarly journals Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

2019 ◽  
Vol 14 (4) ◽  
pp. 490-500 ◽  
Author(s):  
Nadia Pillai ◽  
Judith E Lupatsch ◽  
Mark Dusheiko ◽  
Matthias Schwenkglenks ◽  
Michel Maillard ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Health System ◽  
Real World ◽  
Transition Probabilities ◽  
Cost Effective ◽  
Real World Data ◽  
World Data ◽  
The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics &gt;2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

Novel quality improvement method to reduce cost while improving the quality of patient care: retrospective observational study

2020 ◽  
Vol 29 (7) ◽  
pp. 586-594
Author(s):  
Kedar S Mate ◽  
Jeffrey Rakover ◽  
Kay Cordiner ◽  
Amy Noble ◽  
Noura Hassan
Keyword(s):  
Quality Improvement ◽  
Management Strategies ◽  
Scale Up ◽  
Primary Outcome Measure ◽  
Cost Of Care ◽  
Improve Efficiency ◽  
Management Board ◽  
Number Of Patients ◽  
Lean Accounting ◽  
The Cost

BackgroundHealthcare cost management strategies are limited in number and resource intensive. Budget constraints in the National Health Service Scotland (NHS Scotland) apply pressure on regional health boards to improve efficiency while preserving quality.MethodsWe developed a technical method to assist health systems to reduce operating costs, called continuous value management (CVM). Derived from lean accounting and employing quality improvement (QI) methods, the approach allows for management to reduce or repurpose resources to improve efficiency. The primary outcome measure was the cost per patient admitted to the ward in British pounds (£).InterventionsThe first step of CVM is developing a standard care model. Teams then track system performance weekly using a tool called the ‘box score’, and improve performance using QI methods with results displayed on a visual management board. A 29-bed inpatient respiratory ward in a mid-sized hospital in NHS Scotland pilot tested the method.ResultsWe included 5806 patients between October 2016 and May 2018. During the 18-month pilot, the ward realised a 21.8% reduction in cost per patient admitted to the ward (from an initial average level of £807.70 to £631.50 as a new average applying Shewhart control chart rules, p<0.0001), and agency nursing spend decreased by 30.8%. The ward realised a 28.9% increase in the number of patients admitted to the ward per week. Other quality measures (eg, staff satisfaction) were sustained or improved.ConclusionCVM methods reduced the cost of care while improving quality. Most of the reduction came by way of reduced bank nursing spend. Work is under way to further test CVM and understand leadership behaviours supporting scale-up.

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