scholarly journals Systematic Screening for Atrial Fibrillation in the Community: Evidence and Obstacles

2018 ◽  
Vol 7 (1) ◽  
pp. 39 ◽  
Author(s):  
Ngai-Yin Chan ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Efficiency ◽  
Screening Programme ◽  
Ageing Population ◽  
Community Screening ◽  
Systematic Screening ◽  
Predictive Values ◽  
Risk Of Mortality ◽  
The Cost ◽  
Pulse Check

With an ageing population globally, the burden of atrial fibrillation (AF) and its consequent complication of stroke and risk of mortality will continue to increase. Although opportunistic screening for AF by pulse check or ECG rhythm strip for people >65 years of age is currently recommended, data are now emerging that demonstrate the possible benefits of systematic community screening. Such screening is capable of identifying previously undiagnosed AF in 0.5–3.0 % of all those screened. The effectiveness of screening programmes will be markedly weakened by the lack of a structured downstream management pathway, making it a mandatory component in any AF screening programme for the general population. Different tools, especially smartphone-based devices, have made AF screening in the community more feasible. However, the sensitivities and positive predictive values of the current versions of automated diagnostic algorithms for AF have to be improved further to increase the cost-efficiency of screening programmes.

scholarly journals Group testing can improve the cost-efficiency of prospective-retrospective biomarker studies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Zhang ◽  
Zhiwei Zhang ◽  
Julia Krushkal ◽  
Aiyi Liu
Keyword(s):  
Cost Efficiency ◽  
Random Sampling ◽  
Sampling Design ◽  
Group Testing ◽  
Molecular Alteration ◽  
Predictive Values ◽  
Standard Design ◽  
Estimation Procedures ◽  
The Cost ◽  
Testing Design

Abstract Background Cancer treatment is increasingly dependent on biomarkers for prognostication and treatment selection. Potential biomarkers are frequently evaluated in prospective-retrospective studies in which biomarkers are measured retrospectively on archived specimens after completion of prospective clinical trials. In light of the high costs of some assays, random sampling designs have been proposed that measure biomarkers for a random sub-sample of subjects selected on the basis of observed outcome and possibly other variables. Compared with a standard design that measures biomarkers on all subjects, a random sampling design can be cost-efficient in the sense of reducing the cost of the study substantially while achieving a reasonable level of precision. Methods For a biomarker that indicates the presence of some molecular alteration (e.g., mutation in a gene), we explore the use of a group testing strategy, which involves physically pooling specimens across subjects and assaying pooled samples for the presence of the molecular alteration of interest, for further improvement in cost-efficiency beyond random sampling. We propose simple and general approaches to estimating the prognostic and predictive values of biomarkers with group testing, and conduct simulation studies to validate the proposed estimation procedures and to assess the cost-efficiency of the group testing design in comparison to the standard and random sampling designs. Results Simulation results show that the proposed estimation procedures perform well in realistic settings and that a group testing design can have considerably higher cost-efficiency than a random sampling design. Conclusions Group testing can be used to improve the cost-efficiency of biomarker studies.

scholarly journals Group Testing Can Improve the Cost-Efficiency of Prospective-Retrospective Biomarker Studies

2021 ◽  
Author(s):  
Wei Zhang ◽  
Zhiwei Zhang ◽  
Julia Krushkal ◽  
Aiyi Liu
Keyword(s):  
Cost Efficiency ◽  
Random Sampling ◽  
Sampling Design ◽  
Group Testing ◽  
Molecular Alteration ◽  
Predictive Values ◽  
Standard Design ◽  
Estimation Procedures ◽  
The Cost ◽  
Testing Design

Abstract Background: Cancer treatment is increasingly dependent on biomarkers for prognostication and treatment selection. Potential biomarkers are frequently evaluated in prospective-retrospective studies in which biomarkers are measured retrospectively on archived specimens after completion of prospective clinical trials. In light of the high costs of some assays, random sampling designs have been proposed that measure biomarkers for a random sub-sample of subjects selected on the basis of observed outcome and possibly other variables. Compared with a standard design that measures biomarkers on all subjects, a random sampling design can be cost-efficient in the sense of reducing the cost of the study substantially while achieving a reasonable level of precision.Methods: For a biomarker that indicates the presence of some molecular alteration (e.g., mutation in a gene), we explore the use of a group testing strategy, which involves physically pooling specimens across subjects and assaying pooled samples for the presence of the molecular alteration of interest, for further improvement in cost-efficiency beyond random sampling. We propose simple and general approaches to estimating the prognostic and predictive values of biomarkers with group testing, and conduct simulation studies to validate the proposed estimation procedures and to assess the cost-efficiency of the group testing design in comparison to the standard and random sampling designs.Results: Simulation results show that the proposed estimation procedures perform well in realistic settings and that a group testing design can have considerably higher cost-efficiency than a random sampling design. Conclusions: Group testing can be used to improve the cost-efficiency of biomarker studies.

scholarly journals Screening for atrial fibrillation: a call for evidence

2019 ◽  
Vol 41 (10) ◽  
pp. 1075-1085 ◽  
Author(s):  
Nicholas R Jones ◽  
Clare J Taylor ◽  
F D Richard Hobbs ◽  
Louise Bowman ◽  
Barbara Casadei
Keyword(s):  
Atrial Fibrillation ◽  
Health Care Professionals ◽  
Anticoagulation Therapy ◽  
Current Evidence ◽  
Systematic Screening ◽  
Detection Rates ◽  
Diagnostic Pathways ◽  
Cost Implications ◽  
The Cost ◽  
Changing Demographics

Abstract Atrial fibrillation (AF) is the most common cardiac arrhythmia and prevalence is predicted to double over the next 30 years due to changing demographics and the rise in prevalence of risk factors such as hypertension and diabetes. Atrial fibrillation is associated with a five-fold increased stroke risk, but anticoagulation in eligible patients can reduce this risk by around 65%. Many people with AF currently go undetected and therefore untreated, either because they are asymptomatic or because they have paroxysmal AF. Screening has been suggested as one approach to increase AF detection rates and reduce the incidence of ischaemic stroke by earlier initiation of anticoagulation therapy. However, international taskforces currently recommend against screening, citing the cost implications and uncertainty over the benefits of a systematic screening programme compared to usual care. A number of large randomized controlled trials have commenced to determine the cost-effectiveness and clinical benefit of screening using a range of devices and across different populations. The recent AppleWatch study demonstrates how advances in technology are providing the public with self-screening devices that are increasingly affordable and accessible. Health care professionals should be aware of the implications of these emerging data for diagnostic pathways and treatment. This review provides an overview of the gaps in the current evidence and a summary of the arguments for and against screening.

scholarly journals Assessment of the CHA2DS2-VASc Score for the Prediction of Death in Elderly Patients With Coronary Artery Disease and Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Yangxun Wu ◽  
Guanyun Wang ◽  
Lisha Dong ◽  
Liu'an Qin ◽  
Jian Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
The Elderly ◽  
Predictive Values ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Artery Disease

Purpose: Coronary artery disease (CAD) and atrial fibrillation (AF) often coexist and lead to a much higher risk of mortality in the elderly population. The aim of this study was to investigate whether the CHA2DS2-VASc score could predict the risk of death in elderly patients with CAD and AF.Methods: Hospitalized patients aged ≥65 years with a diagnosis of CAD and AF were recruited consecutively. Patients were divided into 5 groups according to the CHA2DS2-VASc score (≤2, =3, =4, =5, and ≥6). At least a 1-year follow-up was carried out for the assessment of all-cause death.Results: A total of 1,579 eligible patients were recruited, with 582 all-cause deaths (6.86 per 100 patient-years) occurring during a follow-up of at least 1 year. With the increase in the CHA2DS2-VASc score, the 1-year and 5-year survival rate decreased (96.4% vs. 95.7% vs. 94.0% vs. 86.5% vs. 85.7%, respectively, P < 0.001; 78.4% vs. 68.9% vs. 64.6% vs. 55.5% vs. 50.0%, respectively, P < 0.001). Compared with the patients with CHA2DS2-VASc score <5, for patients with CHA2DS2-VASc score ≥5, the adjusted hazard ratio for death was 1.78 (95% CI: 1.45–2.18, P < 0.001). The predictive values of the CHA2DS2-VASc score ≥5 for in-hospital (C-index = 0.66, 95% CI: 0.62–0.69, P < 0.001), 1-year (C-index = 0.65, 95% CI: 0.63–0.67, P < 0.001) and 5-year (C-index = 0.60, 95% CI: 0.59–0.61, P < 0.001) death were in comparable.Conclusion: In elderly patients with concomitant CAD and AF, the CHA2DS2-VASc score can be used to predict death with moderate accuracy.

scholarly journals Group Testing Can Improve the Cost-Efficiency of Prospective-Retrospective Biomarker Studies

2020 ◽  
Author(s):  
Wei Zhang ◽  
Zhiwei Zhang ◽  
Julia Krushkal ◽  
Aiyi Liu
Keyword(s):  
Cost Efficiency ◽  
Random Sampling ◽  
Sampling Design ◽  
Group Testing ◽  
Molecular Alteration ◽  
Predictive Values ◽  
Standard Design ◽  
Estimation Procedures ◽  
The Cost ◽  
Testing Design

Abstract Background: Cancer treatment is increasingly dependent on biomarkers for prognostication and treatment selection. Potential biomarkers are frequently evaluated in prospective-retrospective studies in which biomarkers are measured retrospectively on archived specimens after completion of prospective clinical trials. In light of the high costs of some assays, random sampling designs have been proposed that measure biomarkers for a random sub-sample of subjects selected on the basis of observed outcome and possibly other variables. Compared with a standard design that measures biomarkers on all subjects, a random sampling design can be cost-efficient in the sense of reducing the cost of the study substantially while achieving a reasonable level of precision.Methods: For a biomarker that indicates the presence of some molecular alteration (e.g., mutation in a gene), we explore the use of a group testing strategy, which involves physically pooling specimens across subjects and assaying pooled samples for the presence of the molecular alteration of interest, for further improvement in cost-efficiency beyond random sampling. We propose simple and general approaches to estimating the prognostic and predictive values of biomarkers with group testing, and conduct simulation studies to validate the proposed estimation procedures and to assess the cost-efficiency of the group testing design in comparison to the standard and random sampling designs.Results: Simulation results show that the proposed estimation procedures perform well in realistic settings and that a group testing design can have considerably higher cost-efficiency than a random sampling design. Conclusions: Group testing can be used to improve the cost-efficiency of biomarker studies.

A generalized fuzzy cost efficiency model

2020 ◽  
Vol 54 (6) ◽  
pp. 1775-1791
Author(s):  
Nazila Aghayi ◽  
Samira Salehpour
Keyword(s):  
Cost Efficiency ◽  
Minimum Cost ◽  
Extensive Literature ◽  
Data Envelopment ◽  
Fuzzy Environment ◽  
Decision Making Unit ◽  
Production Possibility Set ◽  
Fuzzy Cost ◽  
The Cost ◽  
Generalized Cost

The concept of cost efficiency has become tremendously popular in data envelopment analysis (DEA) as it serves to assess a decision-making unit (DMU) in terms of producing minimum-cost outputs. A large variety of precise and imprecise models have been put forward to measure cost efficiency for the DMUs which have a role in constructing the production possibility set; yet, there’s not an extensive literature on the cost efficiency (CE) measurement for sample DMUs (SDMUs). In an effort to remedy the shortcomings of current models, herein is introduced a generalized cost efficiency model that is capable of operating in a fuzzy environment-involving different types of fuzzy numbers-while preserving the Farrell’s decomposition of cost efficiency. Moreover, to the best of our knowledge, the present paper is the first to measure cost efficiency by using vectors. Ultimately, a useful example is provided to confirm the applicability of the proposed methods.

Stroke Prevention in Non-Valvular Atrial Fibrillation

1997 ◽  
Vol 17 (03) ◽  
pp. 166-169
Author(s):  
Judith O’Brien ◽  
Wendy Klittich ◽  
J. Jaime Caro
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Care Home ◽  
Relevant Literature ◽  
Clinical Trial Data ◽  
Outcome Data ◽  
Sensitivity Analyses ◽  
Bleeding Events ◽  
Discharge Data ◽  
The Cost

SummaryDespite evidence from 6 major clinical trials that warfarin effectively prevents strokes in atrial fibrillation, clinicians and health care managers may remain reluctant to support anticoagulant prophylaxis because of its perceived costs. Yet, doing nothing also has a price. To assess this, we carried out a pharmacoe-conomic analysis of warfarin use in atrial fibrillation. The course of the disease, including the occurrence of cerebral and systemic emboli, intracranial and other major bleeding events, was modeled and a meta-analysis of the clinical trials and other relevant literature was carried out to estimate the required probabilities with and without warfarin use. The cost of managing each event, including acute and subsequent care, home care equipment and MD costs, was derived by estimating the cost per resource unit, the proportion consuming each resource and the volume of use. Unit costs and volumes of use were determined from established US government databases, all charges were adjusted using cost-to-charge ratios, and a 3% discount rate was applied to costs incurred beyond the first year. The proportions of patients consuming each resource were estimated by fitting a joint distribution to the clinical trial data, stroke outcome data from a recent Swedish study and aggregate ICD-9 specific, Massachusetts discharge data. If nothing is done, 3.2% more patients will suffer serious emboli annually and the expected annual cost of managing a patient will increase by DM 2,544 (1996 German Marks), from DM 4,366 to DM 6,910. Extensive multiway sensitivity analyses revealed that the higher price of doing nothing persists except for very extreme combinations of inputs unsupported by literature or clinical standards. The price of doing nothing is thus so high, both in health and economic terms, that cost-consciousness as well as clinical considerations mandate warfarin prophylaxis in atrial fibrillation.

ANALISIS PENGARUH BIAYA OPERASIONAL PADA PERUSAHAAN PENERBANGAN NASIONAL

2017 ◽  
Vol 1 (2) ◽  
pp. 81-107
Author(s):  
Dheny Biantara
Keyword(s):  
Value Chain ◽  
Cost Efficiency ◽  
Cost Reduction ◽  
Cost Leadership ◽  
Oil Pricing ◽  
The Cost ◽  
Operation Flexibility ◽  
Airline Maintenance

Summarized Indonesian airline executive views on the reason for the cost problem in mayor airline andon the potential areas and measures of cost reduction in airline operation. Present an introductionsurvey where 3 executives from 3 Indonesian airlines were respondent. In the executive opinion the costproblem in mayor Indonesian airline is primarily due to fuel and oil pricing and money currency. Of thevarious function in airline maintenance was seen as least cost efficiency, whereas flight operation wasseen as an area with most potential for cost reduction. Indonesian airline had made route and fleetchanges after the beginning of 2011 to reduce cost, concludes from the analisys result havingprivatization would be an important step towards more efficient airline operation. Flexibility fromIndonesian airline regulatory would be very much welcome and the value chain concept to improveIndonesian airline having competitive adventage and cost leadership differentiation.

A seven year plan for upgrading the 200.000 p.e. treatment plant of Uppsala, Sweden

1994 ◽  
Vol 29 (12) ◽  
pp. 117-127
Author(s):  
Jan Erik Lind ◽  
Ernst Olof Swedling
Keyword(s):  
Cost Efficiency ◽  
Sewage Treatment ◽  
Sewage Treatment Plant ◽  
Treatment Plant ◽  
Working Environment ◽  
Regional Environment ◽  
Nitrogen Reduction ◽  
Total Investment ◽  
Close Cooperation ◽  
The Cost

The sewage treatment plant of Uppsala was originally built in 1946 and has since then been extended and upgraded several times up to 1972 when the last major upgrading was completed. In 1987 it was decided to renew the treatment plant for at least another 20-30 years of operation and to upgrade the biological process to include nitrogen reduction. A 7 year plan covering some 18 items with a total investment cost of approximately 120 MSEK was set in action during 1987. The aim was to raise the cost efficiency by introducing modern techniques, new machinery, a better working environment and a better understanding of the processes used. The need to keep the plant in operation during reconstruction work has caused difficulties, delays and unforseen costs but a close cooperation between all parties concerned (operators, contractors, engineers and the regional environment administration) has solved most of the problems. Experiences so far include an improved effluent quality, a better cost efficiency, a healthier and more engaged operating staff. A research team has been engaged to develop and introduce a nitrogen reduction scheme in the activated sludge process. This has been a challenging and fruitful experience.

scholarly journals Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

1996 ◽  
Vol 3 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Afaf Girgis ◽  
Philip Clarke ◽  
Robert C Burton ◽  
Rob W Sanson—Fisher
Keyword(s):  
Cost Effectiveness ◽  
Screening Programme ◽  
Cost Effective ◽  
Economic Assessment ◽  
Screening Tests ◽  
Family Practitioners ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Primary Health Care Physicians ◽  
Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

Sign in / Sign up

Export Citation Format

Share Document