scholarly journals Evaluation of improved coloured targets to control riverine tsetse in East Africa: A Bayesian approach

2021 ◽  
Vol 15 (6) ◽  
pp. e0009463
Author(s):  
Roger D. Santer ◽  
Michael N. Okal ◽  
Johan Esterhuizen ◽  
Steve J. Torr
Keyword(s):  
Human African Trypanosomiasis ◽  
Cost Effective ◽  
Polyester Fabric ◽  
Latin Squares ◽  
General Purpose ◽  
Model Parameters ◽  
Tsetse Control ◽  
Trypanosoma Brucei Gambiense ◽  
Attract And Kill ◽  
The Difference

Background Riverine tsetse (Glossina spp.) transmit Trypanosoma brucei gambiense which causes Gambian Human African Trypanosomiasis. Tiny Targets were developed for cost-effective riverine tsetse control, and comprise panels of insecticide-treated blue polyester fabric and black net that attract and kill tsetse. Versus typical blue polyesters, two putatively more attractive fabrics have been developed: Vestergaard ZeroFly blue, and violet. Violet was most attractive to savannah tsetse using large targets, but neither fabric has been tested for riverine tsetse using Tiny Targets. Methods We measured numbers of G. f. fuscipes attracted to electrified Tiny Targets in Kenya and Uganda. We compared violets, Vestergaard blues, and a typical blue polyester, using three replicated Latin squares experiments. We then employed Bayesian statistical analyses to generate expected catches for future target deployments incorporating uncertainty in model parameters, and prior knowledge from previous experiments. Results Expected catches for average future replicates of violet and Vestergaard blue targets were highly likely to exceed those for typical blue. Accounting for catch variability between replicates, it remained moderately probable (70–86% and 59–84%, respectively) that a given replicate of these targets would have a higher expected catch than typical blue on the same day at the same site. Meanwhile, expected catches for average violet replicates were, in general, moderately likely to exceed those for Vestergaard blue. However, the difference in medians was small, and accounting for catch variability, the probability that the expected catch for a violet replicate would exceed a Vestergaard blue equivalent was marginal (46–71%). Conclusion Violet and Vestergaard ZeroFly blue are expected to outperform typical blue polyester in the Tiny Target configuration. Violet is unlikely to greatly outperform Vestergaard blue deployed in this way, but because violet is highly attractive to both riverine and savannah tsetse using different target designs, it may provide the more suitable general-purpose fabric.

How the United Kingdom Controls Pharmaceutical Prices and Spending: Learning From Its Experience

2021 ◽  
pp. 002073142199709
Author(s):  
Marc A. Rodwin
Keyword(s):  
United Kingdom ◽  
Cost Effective ◽  
Market Prices ◽  
The United Kingdom ◽  
Generic Market ◽  
Pharmaceutical Spending ◽  
The Difference ◽  
The Government ◽  
Pharmaceutical Prices ◽  
Limit Access

To control costs and improve access, nations can adopt strategies employed in the United Kingdom to control pharmaceutical prices and spending. Current policy evolved from a system created in 1957 that allowed manufacturers to set launch prices, capped manufacturers’ rates of return, and later cut list prices. These policies did not effectively control spending and had limited effects on purchase prices. The United Kingdom currently controls pharmaceutical spending in 4 ways. (a) Since 1999, it has typically paid no more than is cost-effective. (b) Since 2017, for medicines that will have a significant budget impact, National Health Service England seeks discounts from cost-effective prices or seeks to limit access for 2 years to patients with the greatest need. (c) Since 2014, statutes and a voluntary scheme have required branded manufacturers to pay the government rebates to recoup the difference between the global pharmaceutical budget and actual spending. (d) For hospitals, generics and some patented drugs are procured through competitive bidding; community pharmacies are reimbursed through a system that provides an incentive to beat average generic market prices. These policies controlled the growth of spending, with the largest effects following budget controls in 2014. Changes since 2008 have reduced savings, first by paying more than is cost-effective for cancer drugs and then by applying higher cost-effectiveness thresholds for some drugs used to treat cancer and certain other drugs.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals A Bayesian ensemble data assimilation to constrain model parameters and land-use carbon emissions

2018 ◽  
Vol 15 (9) ◽  
pp. 2909-2930 ◽  
Author(s):  
Sebastian Lienert ◽  
Fortunat Joos
Keyword(s):  
Land Use ◽  
Carbon Emissions ◽  
Latin Hypercube Sampling ◽  
Historical Period ◽  
Model Parameters ◽  
Dynamic Global Vegetation Model ◽  
Order Of Magnitude ◽  
The Difference ◽  
Wood Harvest ◽  
Global Vegetation

Abstract. A dynamic global vegetation model (DGVM) is applied in a probabilistic framework and benchmarking system to constrain uncertain model parameters by observations and to quantify carbon emissions from land-use and land-cover change (LULCC). Processes featured in DGVMs include parameters which are prone to substantial uncertainty. To cope with these uncertainties Latin hypercube sampling (LHS) is used to create a 1000-member perturbed parameter ensemble, which is then evaluated with a diverse set of global and spatiotemporally resolved observational constraints. We discuss the performance of the constrained ensemble and use it to formulate a new best-guess version of the model (LPX-Bern v1.4). The observationally constrained ensemble is used to investigate historical emissions due to LULCC (ELUC) and their sensitivity to model parametrization. We find a global ELUC estimate of 158 (108, 211) PgC (median and 90 % confidence interval) between 1800 and 2016. We compare ELUC to other estimates both globally and regionally. Spatial patterns are investigated and estimates of ELUC of the 10 countries with the largest contribution to the flux over the historical period are reported. We consider model versions with and without additional land-use processes (shifting cultivation and wood harvest) and find that the difference in global ELUC is on the same order of magnitude as parameter-induced uncertainty and in some cases could potentially even be offset with appropriate parameter choice.

scholarly journals Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

2020 ◽  
Author(s):  
Rian Snijders ◽  
Alain Fukinsia ◽  
Yves Claeys ◽  
Alain Mpanya ◽  
Epco Hasker ◽  
...  
Keyword(s):  
Human African Trypanosomiasis ◽  
Democratic Republic ◽  
Public Health Problem ◽  
Cost Effective ◽  
Active Case Finding ◽  
Active Screening ◽  
Populations At Risk ◽  
Republic Of The Congo ◽  
Cost Effective Alternative ◽  
The Cost

ABSTRACTBackgroundHuman African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease that killed thousands of people at the start of the 20th century. Today, less than 1,000 cases are reported globally, and the disease is targeted for elimination and eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study aims to compare the cost of two approaches for active HAT screening, namely the traditional mobile teams and mini mobile teams.MethodsWe estimated annual economic costs for the two active HAT screening approaches from a health care provider perspective. Cost and operational data was collected for 12 months for 1 traditional team and 3 mini teams in the health districts of Yasa Bonga and Mosango in the Kwilu province of the Democratic Republic of the Congo. The cost per person screened and per person diagnosed was calculated. Univariate sensitivity analysis was conducted on important cost drivers.ResultsThe study shows that the cost per person screened is lower for a mini team compared to a traditional team in the study setting (US$1.86 compared to US$2.08) as well as in a simulation analysis assuming both teams would operate in a setting with similar disease prevalence.DiscussionActive HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active screening campaigns. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.AUTHOR SUMMARYHuman African Trypanosomiasis (HAT) used to be a major public health problem in Sub-Saharan Africa, but the disease is becoming less frequent today as a result of sustained control efforts. Currently, the elimination of sleeping sickness is targeted as a public health problem by 2020 with interruption of transmission by 2030. To achieve these targets, a long-term commitment towards HAT control activities will be necessary with innovative disease control approaches accompanied by economic evaluations to assess their cost and cost-effectiveness in the changing context. Today, active case finding conducted through mass outreach campaigns accounts for approximately half of all identified cases in the Democratic Republic of the Congo. However, this strategy has become less efficient, with a dwindling “yield” in terms of the number of identified cases, translating to a higher cost per diagnosed HAT case. Therefore, different approaches to outreach campaigns need to be evaluated with a focus on reaching populations at risk for HAT.This article presents the costs and outcomes of two approaches to active screening: traditional mobile teams and mini mobile teams.This study shows that mini mobile teams could be a cost-effective alternative for active screening with a cost-per-person screened of US$1.86 compared to US$2.08. This approach could increase the screening coverage of populations at risk for HAT that are currently not being reached through the traditional approach. Future research is needed to evaluate the difference in HAT cases identified and treated by both approaches. This would allow a cost-effectiveness comparison of both strategies based on the cost-per-person diagnosed and treated.

scholarly journals Distilling Deep Structural Facial Relationships for FAU Intensity Estimation

2021 ◽  
Author(s):  
Yingruo Fan ◽  
Jacqueline CK Lam ◽  
Victor On Kwok Li
Keyword(s):  
Structural Characteristics ◽  
Model Performance ◽  
Training Model ◽  
Model Parameters ◽  
Intensity Estimation ◽  
Structural Relationships ◽  
Proposed Model ◽  
Comparable Performance ◽  
Knowledge Distillation ◽  
The Difference

<div> <div> <div> <p>Facial emotions are expressed through a combination of facial muscle movements, namely, the Facial Action Units (FAUs). FAU intensity estimation aims to estimate the intensity of a set of structurally dependent FAUs. Contrary to the existing works that focus on improving FAU intensity estimation, this study investigates how knowledge distillation (KD) incorporated into a training model can improve FAU intensity estimation efficiency while achieving the same level of performance. Given the intrinsic structural characteristics of FAU, it is desirable to distill deep structural relationships, namely, DSR-FAU, using heatmap regression. Our methodology is as follows: First, a feature map-level distillation loss was applied to ensure that the student network and the teacher network share similar feature distributions. Second, the region-wise and channel-wise relationship distillation loss functions were introduced to penalize the difference in structural relationships. Specifically, the region-wise relationship can be represented by the structural correlations across the facial features, whereas the channel-wise relationship is represented by the implicit FAU co-occurrence dependencies. Third, we compared the model performance of DSR-FAU with the state-of-the-art models, based on two benchmarking datasets. Our proposed model achieves comparable performance with other baseline models, though requiring a lower number of model parameters and lower computation complexities. </p> </div> </div> </div>

scholarly journals Cost-effective surveillance of invasive species using info-gap theory

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yang Liu ◽  
Penghao Wang ◽  
Melissa L. Thomas ◽  
Dan Zheng ◽  
Simon J. McKirdy
Keyword(s):  
Invasive Species ◽  
Native Species ◽  
Cost Effective ◽  
Expert Assessment ◽  
Parameter Estimates ◽  
Model Parameters ◽  
Surveillance Systems ◽  
Effective Manner ◽  
Novel Method ◽  
Population Threshold

AbstractInvasive species can lead to community-level damage to the invaded ecosystem and extinction of native species. Most surveillance systems for the detection of invasive species are developed based on expert assessment, inherently coming with a level of uncertainty. In this research, info-gap decision theory (IGDT) is applied to model and manage such uncertainty. Surveillance of the Asian House Gecko, Hemidactylus frenatus Duméril and Bibron, 1836 on Barrow Island, is used as a case study. Our research provides a novel method for applying IGDT to determine the population threshold ($$K$$ K ) so that the decision can be robust to the deep uncertainty present in model parameters. We further robust-optimize surveillance costs rather than minimize surveillance costs. We demonstrate that increasing the population threshold for detection increases both robustness to the errors in the model parameter estimates, and opportuneness to lower surveillance costs than the accepted maximum budget. This paper provides guidance for decision makers to balance robustness and required surveillance expenditure. IGDT offers a novel method to model and manage the uncertainty prevalent in biodiversity conservation practices and modelling. The method outlined here can be used to design robust surveillance systems for invasive species in a wider context, and to better tackle uncertainty in protection of biodiversity and native species in a cost-effective manner.

scholarly journals Summertime canopy albedo is sensitive to forest thinning

2013 ◽  
Vol 10 (9) ◽  
pp. 15373-15414 ◽  
Author(s):  
J. Otto ◽  
D. Berveiller ◽  
F.-M. Bréon ◽  
N. Delpierre ◽  
G. Geppert ◽  
...  
Keyword(s):  
Forest Management ◽  
Tree Species ◽  
Structural Changes ◽  
Near Infrared ◽  
Canopy Structure ◽  
Model Parameters ◽  
Transfer Model ◽  
Forest Thinning ◽  
Crown Volume ◽  
The Difference

Abstract. Despite an emerging body of literature linking canopy albedo to forest management, understanding of the process is still fragmented. We combined a stand-level forest gap model with a canopy radiation transfer model and satellite-derived model parameters to quantify the effects of forest thinning, that is removing trees at a certain time during the forest rotation, on summertime canopy albedo. The effects of different forest species (pine, beech, oak) and four thinning strategies (light to intense thinning regimes) were examined. During stand establishment, summertime canopy albedo is driven by tree species. In the later stages of stand development, the effect of tree species on summertime canopy albedo decreases in favour of an increasing influence of forest thinning on summertime canopy albedo. These trends continue until the end of the rotation where thinning explains up to 50% of the variance in near-infrared canopy albedo and up to 70% of the variance in visible canopy albedo. More intense thinning lowers the summertime shortwave albedo in the canopy by as much as 0.02 compared to unthinned forest. The structural changes associated with forest thinning can be described by the change in LAI in combination with crown volume. However, forests with identical canopy structure can have different summertime albedo values due to their location: the further north a forest is situated, the more the solar zenith angle increases and thus the higher is the summertime canopy albedo, independent of the wavelength. Despite the increase of absolute summertime canopy albedo values with latitude, the difference in canopy albedo between managed and unmanaged forest decreases with increasing latitude. Forest management thus strongly altered summertime forest albedo.

scholarly journals A study to assess functional outcome of cemented and uncemented total hip replacement in a tertiary care center

2019 ◽  
Vol 5 (5) ◽  
pp. 828
Author(s):  
Kunal Ajitkumar Shah ◽  
Mohan Madhav Desai
Keyword(s):  
Functional Outcome ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Cost Effective ◽  
Harris Hip Score ◽  
Total Hip ◽  
Vas Score ◽  
Group A ◽  
The Difference ◽  
Group B

<p class="abstract"><strong>Background:</strong> Total hip replacement (THR) is the most successful and cost effective treatment with aim of pain relief and functional rehabilitation for hip disorders. As the implant designs of THR have evolved over time, the functional outcome and survivorship has improved. Even after so many advancements, it remains unclear that which implants are better, uncemented or cemented. Hence, we took up this study to analyze which of the uncemented or cemented THR have better functional outcome.</p><p class="abstract"><strong>Methods:</strong> This was a longitudinal study conducted during 2014 to 2018. Hundred cases were randomized into groups of 50 each. All patients with age between 55-80 years in whom THR was indicated were included in the study. Uncemented THR was done in Group A and cemented THR was done in Group B. Patients were followed up at 12 weeks, 6 months, 12 months, and 3 years. At follow-up, functional examination in terms of visual analogue scale (VAS) score and Harris hip score (HHS) was done.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of patients in Group A (uncemented) and Group B (cemented) was 62.5 years and 60 years respectively. We found that the difference of VAS score and HHS between Group A and B was statistically significant at 12 weeks and 6 months. The difference of VAS and HHS scores between Group A and B at 12 months and 3 years was not significant.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that cemented THR has better functional outcome at short term. They are cost effective option at age ≥55-60 years.</p>

Are SSRIs a Cost-Effective Alternative to Tricyclics?

1996 ◽  
Vol 168 (4) ◽  
pp. 404-409 ◽  
Author(s):  
Matthew Hotopf ◽  
Glyn Lewis ◽  
Charles Normand
Keyword(s):  
Cost Effectiveness ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Cost Effective ◽  
Drop Out ◽  
Attrition Rates ◽  
The Difference ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Cost ◽  
Effectiveness Studies

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclics. Reports have suggested that SSRIs are cost-effective because they are better tolerated and safer in overdose.MethodA systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRIs and tricyclic antidepressants (TCAs).ResultsNone of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs drop out of RCTs. Cost-effectiveness studies have been based on crude ‘modelling’ approaches and over-estimate the difference in attrition rates and the cost of treatment failure. It appears impossible to evaluate the economic aspects of suicide because of its rarity.ConclusionsThere is no evidence to suggest that SSRIs are more cost-effective than TCAs. The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.

Abstract 3774: Cost Effectiveness Of Enoxaparin In Patients With ST-elevation Myocardial Infarction: Results From EXTRACT-TIMI 25

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zefeng Zhang ◽  
Paul Kolm ◽  
Wei Zhang ◽  
Edward Ewen ◽  
Claudine Jurkovitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Unfractionated Heparin ◽  
Cost Effective ◽  
St Elevation Myocardial Infarction ◽  
Published Data ◽  
Outpatient Procedures ◽  
Life Years ◽  
St Elevation ◽  
The Difference

Background: The efficacy of enoxaparin versus unfractionated heparin in the setting of ST-elevation myocardial infarction (STEMI) has been demonstrated in EXTRACT-TIMI 25, with 17% reductions in relative risk in the primary endpoint of death or nonfatal recurrent myocardial infarction (MI) (p<0.0001). This study considers the cost effectiveness of enoxaparin versus unfractionated heparin with fibrinolysis based on EXTRACT-TIMI 25. Methods: The ITT population of 20,479 patients from 48 countries were monitored for clinical and adverse events during the index hospitalization and through 30 days. Trial-wide resource utilization from all participating countries was used in the analysis while all costs were based on 2004 US costs. Medicare Fee Schedule was used for outpatient procedures and DRGs were applied for index and subsequent hospitalizations costs. Lost life years associated with 30-day in-trial events (death, MI and stroke) were estimated from published data from Framingham. Results: Overall, costs of index hospitalizations and outpatient procedures were lower, while costs for the subsequent hospitalization were higher for the enoxaparin patients. Total 30 days’ costs remained lower for enoxaparin, although the difference did not reach significance. Life years lost were significantly less with enoxaparin. For lifetime, when costs beyond the trial period were considered, the costs of enoxaparin in patients with STEMI were $506 higher, and the incremental cost-effectiveness ratio of enoxaparin compared to UFH was $4,369 per life year gained, with 99.9% of estimates falling below the $50,000 per life year gained threshold. Conclusions: Enoxaparin is effective in reducing mortality or nonfatal MI, and is highly cost-effective strategy in the US settings for the treatment of STEMI patients.

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