Cost-benefit analysis of introducing next-generation sequencing (metagenomic) pathogen testing in the setting of pyrexia of unknown origin

Abstract Even well into the 21st century, infectious diseases still account for most causes of fever of unknown origin (FUO). Advances in molecular technologies, including broad-range PCR of the 16S rRNA gene followed by Sanger sequencing, multiplex PCR assays, and more recently, next-generation sequencing (NGS) applications, have transitioned from research methods to more commonplace in some clinical microbiology laboratories. They have the potential to supplant traditional microbial identification methods and antimicrobial susceptibility testing. Despite the remaining challenges with these technologies, publications in the past decade justify excitement about the potential to transform FUO investigations. We discuss available evidence using these molecular methods for FUO evaluations, including potential cost-benefits and future directions.

Download Full-text

The Evolution of Integrated Assessment: Developing the Next Generation of Use-Inspired Integrated Assessment Tools

Annual Review of Resource Economics ◽

10.1146/annurev-resource-110119-030314 ◽

2020 ◽

Vol 12 (1) ◽

pp. 471-487

Author(s):

Karen Fisher-Vanden ◽

John Weyant

Keyword(s):

Integrated Assessment ◽

Cost Benefit Analysis ◽

Coupled Model ◽

Cost Benefit ◽

Process Models ◽

Assessment Tools ◽

Benefit Analysis ◽

Next Generation ◽

Emissions Scenarios ◽

Temporal And Spatial

In this review, we attempt to describe the evolution of integrated assessment modeling research since the pioneering work of William Nordhaus in 1994, highlighting a number of challenges and suggestions for moving the field forward. The field has evolved from global aggregate models focused on cost-benefit analysis to detailed process models used to generate emissions scenarios and to coupled model frameworks for impact analyses. The increased demand for higher sectoral, temporal, and spatial resolution to conduct impact analyses has led to a number of challenges both computationally and conceptually. Overcoming these challenges and moving the field forward will require not only greater efforts in model coupling software and translational tools, the incorporation of empirical findings into integrated assessment models, and intermethod comparisons but also the expansion and better coordination of multidisciplinary researchers in this field through better training of the next generation of integrated assessment scholars and expanding the community of practice.

Download Full-text

Collaborative Robotics in Metrology: The Next Generation Technician?

10.51843/wsproceedings.2021.08 ◽

2021 ◽

Author(s):

William Miller ◽

Keyword(s):

Cost Benefit Analysis ◽

Cost Benefit ◽

Robot Programming ◽

Improve Quality ◽

Benefit Analysis ◽

Next Generation ◽

Collaborative Robotics ◽

Viable Solution ◽

Commercial Off The Shelf ◽

Programming Knowledge

Collaborative robots (COBOTs) are robots designed to safely work with people and have made significant strides in next generation applications, making them metrology ready. The ability to record and repeat movements, integrate sensors, reduce cost, improve quality, provide process sustainment, decrease attrition, improve throughput, and not require benefits packages, all in one system, can seem like a dream. COBOTs have developed to a level where they have become a viable solution with ROIs within months. The need for elaborate robot programming knowledge and specialized machining has been replaced with commercial off the shelf (COTS) resources that quickly provide solutions. How to manage a COBOT metrology laboratory, address personnel concerns, cost benefit analysis, and accreditation concerns, along with how to integrate COBOT capabilities are the basis of discussion for this paper.

Download Full-text

A Cost-Benefit Analysis on the Research Infrastructure for the Next-generation Network Computing Platform

10.14257/astl.2014.66.01 ◽

2014 ◽

Author(s):

Dae Ho Kim

Keyword(s):

Cost Benefit Analysis ◽

Cost Benefit ◽

Research Infrastructure ◽

Next Generation Network ◽

Benefit Analysis ◽

Next Generation ◽

Network Computing ◽

Computing Platform ◽

Generation Network

Download Full-text

PMD156 - NEXT GENERATION SEQUENCING: BENEFIT ANALYSIS TO SUPPORT A STRATEGIC ADOPTION MODEL IN THE ITALIAN NHS

Value in Health ◽

10.1016/j.jval.2018.09.1605 ◽

2018 ◽

Vol 21 ◽

pp. S269-S270

Author(s):

A. Baggi ◽

D. Bellavista ◽

G. Bonetti ◽

M. Dionisi ◽

J.M. Franzini ◽

...

Keyword(s):

Next Generation Sequencing ◽

Benefit Analysis ◽

Next Generation ◽

Adoption Model ◽

Generation Sequencing

Download Full-text

680. The Use of Plasma Next-Generation Sequencing Test in the Management of Immunocompetent and Immunocompromised Patients – A Single Center Retrospective Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.872 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S393-S394

Author(s):

Denise Marie A Francisco ◽

Laila Woc-colburn ◽

Travis J Carlson ◽

Todd Lasco ◽

Miriam B Barrett ◽

...

Keyword(s):

Retrospective Study ◽

Next Generation Sequencing ◽

Organ Transplant ◽

Unknown Origin ◽

Solid Organ ◽

Immunocompromised Patients ◽

Rapid Diagnostics ◽

Next Generation ◽

Generation Sequencing ◽

Hiv Aids

Abstract Background Microbiological culture data is a longstanding gold standard in diagnostics. Unfortunately, yield from cultures have been inconsistent and slow, prompting the need for newer tests including the plasma-based next-generation sequencing (NGS) tool. This study aims to describe the use of NGS and the corresponding change in management. Methods A descriptive retrospective study was done on hospitalized adults at CHI-Baylor St. Luke’s in Houston, Texas with NGS tests from Jan 1, 2017 to Dec 31, 2018. Graph 1 - Next Generation Sequencing Test Breakdown Results There were 167 NGS tests performed. Most patients were non-Hispanic (n=129) Caucasian (n=106) males (n=116) with a mean age of 52. Furthermore, 61 were immunocompromised patients [solid organ transplant (n=30), HIV-AIDS (n=14) and rheumatology patients on immunosuppression (n=12)]. During the study, the hospital staff prepared a list of indications for NGS testing including: systemic or deep seated infection where a biopsy or other workup is negative or not possible (n=50), fever of unknown origin (n=26), culture negative endocarditis (n=15), HIV/AIDS with fever (n=10), transplant patient with fever (n=5). There were 60 cases where the indications were not on this list (36%). Results showed that 118/167 (71%) were positive. The most common organisms identified were gram-negative bacteria (54/118; 46%) followed by viruses (49/118; 42%), gram-positive bacteria (48/118; 41%), fungi (16/118; 14%), atypical bacteria (9/118; 8%), mycobacterium (4/118; 3%), and parasites (4/118; 3%). Blood cultures were concurrently obtained in 148/167 (89%) of the cases and returned negative in 137/148 (93%) of cases. In terms of change of management, the largest change was found in glycopeptide use (36 fewer patients after NGS results). Next was on anti-mycobacterial drugs where 27 were added among 8 instances. Only 36 patients were taken off antibiotics, even though 49 patients had negative results. In total, 120 out of 160 cases had antibiotic changes. Table 1 - Demographic and Laboratory Characteristics Graph 2 - Change in Number of Antibiotics (Total: Before and After) Graph 3 - Indications for Testing and Change in Number of Antibiotics Conclusion We observed a large decrease in glycopeptide use after NGS results which suggests physicians’ comfort in withdrawing MRSA coverage. In addition, anti-mycobacterial coverage increased corresponding to early mycobacterial detection with NGS. This study highlights the importance of clinical judgement in the age of rapid diagnostics. Disclosures All Authors: No reported disclosures

Download Full-text