scholarly journals Antimicrobial resistance detection in Southeast Asian hospitals is critically important from both patient and societal perspectives, but what is its cost?

2021 ◽  
Vol 1 (10) ◽  
pp. e0000018
Author(s):  
Tamalee Roberts ◽  
Nantasit Luangasanatip ◽  
Clare L. Ling ◽  
Jill Hopkins ◽  
Risara Jaksuwan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Unit Cost ◽  
Population Level ◽  
Cost Effective ◽  
Research Unit ◽  
Microbiology Laboratory ◽  
Medicine Research ◽  
Capital Costs ◽  
Laboratory Capacity ◽  
The Cost

Antimicrobial resistance (AMR) is a major threat to global health. Improving laboratory capacity for AMR detection is critically important for patient health outcomes and population level surveillance. We aimed to estimate the financial cost of setting up and running a microbiology laboratory for organism identification and antimicrobial susceptibility testing as part of an AMR surveillance programme. Financial costs for setting up and running a microbiology laboratory were estimated using a top-down approach based on resource and cost data obtained from three clinical laboratories in the Mahidol Oxford Tropical Medicine Research Unit network. Costs were calculated for twelve scenarios, considering three levels of automation, with equipment sourced from either of the two leading manufacturers, and at low and high specimen throughput. To inform the costs of detection of AMR in existing labs, the unit cost per specimen and per isolate were also calculated using a micro-costing approach. Establishing a laboratory with the capacity to process 10,000 specimens per year ranged from $254,000 to $660,000 while the cost for a laboratory processing 100,000 specimens ranged from $394,000 to $887,000. Excluding capital costs to set up the laboratory, the cost per specimen ranged from $22–31 (10,000 specimens) and $11–12 (100,000 specimens). The cost per isolate ranged from $215–304 (10,000 specimens) and $105–122 (100,000 specimens). This study provides a conservative estimate of the costs for setting up and running a microbiology laboratory for AMR surveillance from a healthcare provider perspective. In the absence of donor support, these costs may be prohibitive in many low- and middle- income country (LMIC) settings. With the increased focus on AMR detection and surveillance, the high laboratory costs highlight the need for more focus on developing cheaper and cost-effective equipment and reagents so that laboratories in LMICs have the potential to improve laboratory capacity and participate in AMR surveillance.

scholarly journals Economic evaluation of Health Extension Program packages in Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246207
Author(s):  
Lelisa Fekadu Assebe ◽  
Wondesen Nigatu Belete ◽  
Senait Alemayehu ◽  
Elias Asfaw ◽  
Kora Tushune Godana ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Prevention And Control ◽  
Unit Cost ◽  
Family Health ◽  
Cost Effective ◽  
Health Extension Program ◽  
Per Capita ◽  
The Cost ◽  
And Control ◽  
Extension Program

Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. All costs were collected in Ethiopian birr and converted to United States dollars (US$) using the average exchange rate for 2018 (US$1 = 27.67 birr). Both costs and health outcomes were discounted by 3%. Result The average unit cost of providing selected hygiene and sanitation, family health, and disease prevention and control services with the HEP was US$0.70, US$4.90, and US$7.40, respectively. The major cost driver was drugs and supplies, accounting for 53% and 68%, respectively, of the total cost. The average annual cost of delivering all the selected interventions was US$9,897. All interventions fall within 1 times GDP per capita per LYG, indicating that they are very cost-effective (ranges: US$22–$295 per LYG). Overall, the HEP is cost-effective by investing US$77.40 for every LYG. Conclusion The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services.

San Diego Field Operational Test of Smart Call Boxes: Technical Aspects

1997 ◽  
Vol 1603 (1) ◽  
pp. 27-33 ◽  
Author(s):  
James H. Banks ◽  
Patrick A. Powell
Keyword(s):  
System Integration ◽  
Solar Power ◽  
Effective Means ◽  
Cost Effective ◽  
Test System ◽  
Incident Detection ◽  
Capital Costs ◽  
Operational Test ◽  
Field Operational Test ◽  
The Cost

Smart call boxes are devices similar to those used as emergency call boxes in California. The basic call box consists of a microprocessor, a cellular transceiver, and a solar power source. The smart call box system also includes data-collection devices, call-box maintenance computers, and data recording systems at a central location. The goal of the smart call box field operational test (FOT) was to demonstrate that smart call boxes are feasible and cost-effective means of processing and transmitting data for tasks such as traffic census, incident detection, hazardous weather reporting, changeable message sign control, and video surveillance. The objective of the FOT evaluation was to determine the cost-effectiveness of smart call boxes, but because of schedule slippage the evaluation focused on only functional adequacy and capital costs. The concept for the smart call box system was found to be feasible but not necessarily optimal for the tasks involved. System integration was a major problem. Also, the number of external devices that can be attached to a single call box while maintaining the economic advantages of the system is restricted by wiring costs and limitations of the solar power supply. Test system performance was mixed. One subtest was canceled before the installation of equipment, functional systems were produced for only three of the four remaining subtests, and reliable operation was observed in only one case. In most cases, system costs will be dominated by the expense of installing wiring. Consequently, smart call boxes will be cost-effective compared with hardwire systems at many sites but may not be cost-effective compared with alternative wireless systems.

Is High-Flux Dialysis Cost-Effective?

1993 ◽  
Vol 9 (1) ◽  
pp. 85-96 ◽  
Author(s):  
John C. Hornberger ◽  
Alan M. Garber ◽  
Michael E. Chernew
Keyword(s):  
Cost Effectiveness ◽  
Hospital Admissions ◽  
Unit Cost ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Maintenance Hemodialysis ◽  
Dialysis Session ◽  
High Flux ◽  
Endstage Renal Disease ◽  
The Cost

AbstractHigh-flux dialysis is a new method for providing routine-maintenance hemodialysis to patients with endstage renal disease. It promises to shorten the duration of the dialysis session, but poses potential clinical risks to patients and financial risks to dialysis centers because of the high unit cost of purchasing new dialysis equipment. We retrospectively evaluated the cost-effectiveness of high-flux dialysis compared to conventional dialysis in a hospital-based center. The center provided only conventional dialysis until March 1989, when it initiated high-flux dialysis. The estimated annual costs of treatment were US $31,249 (high-flux) and $32,562 (conventional). The rate of hospital admissions was almost identical in both groups (conventional, 1.29 admissions per year; high-flux, 1.24 admissions per year; p = 0.23). Predicted prolongation of life expectancy with high-flux dialysis was significantly higher after statistical adjustment for observable patient characteristics (1.8 to 4.5 years; p <0.01). The cost-effectiveness ratio was $28,188 per life-year saved for high-flux compared to conventional dialysis. These findings suggest that the added capital expense of purchasing high-flux equipment can be justified from the perspective of its societal cost-effectiveness.

scholarly journals Analysis of Cost-Effectiveness of Trametinib Plus Dabrafenib as First-Line Therapy for Metastatic BRAF V600-Mutated Melanoma in China

2021 ◽  
Author(s):  
Guojun Sun ◽  
Jingwen Wang ◽  
Xiaoying Zhou ◽  
Zhichao Hu ◽  
Zuojun Dong
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Transition Probabilities ◽  
Unit Cost ◽  
Cost Effective ◽  
First Line Therapy ◽  
Life Years ◽  
Melanoma Patients ◽  
The Cost

Abstract Background: Treatment with trametinib plus dabrafenib for patients exhibiting metastatic BRAF V600-mutated melanoma has been approved in China.Method: We developed a Markov model to evaluate and compare the cost-effectiveness of trametinib plus dabrafenib against vemurafenib. Information on clinical situations, the rate of adverse reactions, follow-up treatments, and estimated transition probabilities were derived from the results of a clinical trial that compared treatment with trametinib plus dabrafenib against vemurafenib alone. A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess the influence of uncertainty on the key model.Result: Treatment with trametinib plus dabrafenib for one patient in the treatment period was estimated to cost CNY 332 294, and yield a total gain of 16.6 quality-adjusted life years (QALYs). Compared with vemurafenib, treatment involving trametinib plus dabrafenib yielded additional 3.96 QALYs, resulting in a unit cost-effectiveness of CNY 27 460 per QALY. Sensitivity analysis shows that the results are reliable.Conclusion：From the perspective of China's health system, applying China's per-capita GDP in 2020 as the threshold of willingness-to-pay, it is cost-effective to treat metastatic melanoma patients exhibiting BRAF V600 mutation with dabrafenib plus trametinib.

scholarly journals Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

2020 ◽  
Author(s):  
Abdene Kaso ◽  
Alemayehu Hailu
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Unit Cost ◽  
Diagnostic Testing ◽  
Cost Effective ◽  
Smear Microscopy ◽  
Health Providers ◽  
Tree Model ◽  
Long Time ◽  
The Cost

Abstract Background Early diagnosis is one of the pillars of the TB (TB) control, and there are strong efforts to detect and treat cases in Ethiopia. Smear microscopy testing has been a routine test for the diagnosis of pulmonary TB in resource-constrained settings for a long time. Recently, many countries, including Ethiopia, are scaling up the use of GeneXpert without a precise evaluation of the cost and cost-effectiveness of this technology. Therefore, this study aimed to evaluate the cost-effectiveness of GeneXpert compared to smear microscopy tests for the diagnosis of TB patients in Ethiopia. Methods We develop a decision tree model using TreeAge Pro 2020 software. The model accounts for the prevalence and incidence of TB in the study area. The costs were estimated from the health providers' perspective in one year (in 2017/18). We applied an ingredients-based costing approach to identify, measure, and evaluate the smear microscopy cost and GeneXpert. We employed the 'proportion of cases detected' as an outcome measure of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the changes in cost and change effectiveness. One way and probabilistic sensitivity analysis were done by varying different input parameters. All costs and ICER are reported in 2018 US$. Results The unit cost per test for GeneXpert and smear microscopy testing was US$12.9 and $3.1, respectively. The average cost of testing using GeneXpert was $113.0 and $3.3 for smear microscopy. The cost of the cartridge ($10.7) was the primary (83%) parameter influencing the overall cost of GeneXpert, while it was the cost of reagent and consumables $1.28 (41%) for the smear microscopy. The ICER for GeneXpert strategy was $729.8 per new TB cases detected compared to smear microscopy. The sensitivity analysis indicates that TB prevalence was the most influential parameter on the ICER. Conclusion The present study indicates that testing all individuals with suspected TB using GeneXpert is a very cost-effective strategy compared to smear microscopy, and therefore, it can be part of the routine diagnostic testing strategy in Ethiopia.

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.

Performance and Upgrading Alternatives for Water Pollution Control Plants Discharging to Severn Sound

1995 ◽  
Vol 30 (4) ◽  
pp. 593-606
Author(s):  
Stephen G. Nutt
Keyword(s):  
Water Pollution ◽  
Total Phosphorus ◽  
Pollution Control ◽  
Capital Investment ◽  
Cost Effective ◽  
Phosphorus Loading ◽  
Water Pollution Control ◽  
Capital Costs ◽  
Load Limit ◽  
The Cost

Abstract Discharges from municipal water pollution control plants have been identified as major point source inputs of phosphorus to Severn Sound. For the 2-year period 1989–90, the estimated total phosphorus loading from eight water pollution control plants discharging directly or indirectly to Severn Sound exceeded 6,200 kg/year. A review of options available and the relative costs of reducing total phosphorus loadings from these facilities was conducted. It was found that a 59% reduction could be achieved by process modifications at relatively small capital costs. Further improvements would require major capital investment. Large differences in the cost per kg of phosphorus removed were identified between plants. The cost data suggest that it would be more cost effective to impose more stringent effluent limits at some plants than at others. The most cost-effective strategy depends on the total phosphorus load limit which must be achieved to maintain the desired receiving water quality; however, this strategy may not involve the application of the same effluent limits at all facilities discharging to Severn Sound.

scholarly journals Effects of Height and Plan Geometry on the Costs of Tunnel Form Residential Buildings

2018 ◽  
Vol 49 (1) ◽  
pp. 29-37
Author(s):  
Zeynep Yeşim İlerisoy ◽  
Mehmet Emin Tuna
Keyword(s):  
Architectural Design ◽  
Residential Buildings ◽  
Unit Cost ◽  
Accurate Determination ◽  
Cost Effective ◽  
Two Dimensions ◽  
Design Phase ◽  
Construction Costs ◽  
Housing Projects ◽  
The Cost

Tunnel form systems, which are industrialised construction systems developed in the last century, are widely used in reinforced concrete projects. Accurate determination of the costs of the building properties in the design phases of construction with the tunnel form system can lead to lower construction costs. The purpose of this study is to examine the cost variations resulting from changes in geometrical characteristics of buildings in the architectural design phase. The research was carried out on residential projects, which have the biggest share in the construction sector. Six housing projects with different plan geometries were designed, and these projects were examined for nine different numbers of floors. The study aims to reveal the extent to which both the plan shape and the number of floors influence the building costs. During the design phase, recommendations are given for reducing the building costs and finding the optimal form. It has been shown that tunnel form projects are not cost-effective in low-rise buildings and after a certain height. Furthermore, when different geometries are examined, the most economical cost is obtained in square form, and the cost increases as the two dimensions in plan plane move away from each other. As a result, the data obtained from this study will provide a better assessment of the relationship between building properties and unit cost in buildings constructed with tunnel form systems.

The IBM-PC in electron microscopy

1996 ◽  
Vol 54 ◽  
pp. 612-613
Author(s):  
James F. Mancuso
Keyword(s):  
Head Start ◽  
Image Acquisition ◽  
Cost Effective ◽  
Financial Applications ◽  
Number Of Factors ◽  
Instrument Control ◽  
The Cost ◽  
Training And Support ◽  
Control Image ◽  
Ibm Pc

IBM PC compatible computers are widely used in microscopy for applications ranging from control to image acquisition and analysis. The choice of IBM-PC based systems over competing computer platforms can be based on technical merit alone or on a number of factors relating to economics, availability of peripherals, management dictum, or simple personal preference.IBM-PC got a strong “head start” by first dominating clerical, document processing and financial applications. The use of these computers spilled into the laboratory where the DOS based IBM-PC replaced mini-computers. Compared to minicomputer, the PC provided a more for cost-effective platform for applications in numerical analysis, engineering and design, instrument control, image acquisition and image processing. In addition, the sitewide use of a common PC platform could reduce the cost of training and support services relative to cases where many different computer platforms were used. This could be especially true for the microscopists who must use computers in both the laboratory and the office.

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