Evaluating the Cost-Effectiveness of RUS Broadband Subsidies: Three Case Studies

Diagnostic tests are expensive and time-consuming to develop. Early economic evaluation using decision modeling can reduce commercial risk by providing early evidence on cost-effectiveness. The National Institute for Health Research Diagnostic Evidence Co-operatives (DECs) was established to catalyze evidence generation for diagnostic tests by collaborating with commercial developers; DEC researchers have consequently made extensive use of early modeling. The aim of this article is to summarize the experiences of the DECs using early modeling for diagnostics. We draw on 8 case studies to illustrate the methods, highlight methodological strengths and weaknesses particular to diagnostics, and provide advice. The case studies covered diagnosis, screening, and treatment stratification. Treatment effectiveness was a crucial determinant of cost-effectiveness in all cases, but robust evidence to inform this parameter was sparse. This risked limiting the usability of the results, although characterization of this uncertainty in turn highlighted the value of further evidence generation. Researchers evaluating early models must be aware of the importance of treatment effect evidence when reviewing the cost-effectiveness of diagnostics. Researchers planning to develop an early model of a test should also 1) consult widely with clinicians to ensure the model reflects real-world patient care; 2) develop comprehensive models that can be updated as the technology develops, rather than taking a “quick and dirty” approach that may risk producing misleading results; and 3) use flexible methods of reviewing evidence and evaluating model results, to fit the needs of multiple decision makers. Decision models can provide vital information for developers at an early stage, although limited evidence mean researchers should proceed with caution.

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The cost-effectiveness of teleradiology at the Women's and Children's Hospital in Adelaide

Journal of Telemedicine and Telecare ◽

10.1258/1357633001934726 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 23-25 ◽

Cited By ~ 11

Author(s):

Tina Hayward ◽

John Mitchell

Keyword(s):

Cost Effectiveness ◽

Case Studies ◽

Cost Effective ◽

Social Value ◽

Children's Hospital ◽

Special Cases ◽

Children’S Hospital ◽

Tertiary Hospitals ◽

New Form ◽

The Cost

The cost-effectiveness of teleradiology was examined in a trial conducted at the Women's and Children's Hospital (WCH) in Adelaide, from February 1998 to February 1999. The trial showed that, with the large distances between remote hospitals and metropolitan hospitals, teleradiology, relative to the transfer of remote patients, could be highly cost-effective, but that a new form of cost justification is required for teleradiology for tertiary hospitals providing second opinions in special cases. A series of compelling case studies proved the economic and social value of teleradiology at the WCH.

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Is-it worth investing in NBS aiming at mitigating water risks? Insights from the economic assessment of NAIAD case studies

10.5194/egusphere-egu2020-22537 ◽

2020 ◽

Author(s):

Philippe Le Coent ◽

Cécile Herivaux ◽

Javier Calatrava ◽

Roxane Marchal ◽

David Mouncoulon ◽

...

Keyword(s):

Risk Management ◽

Cost Effectiveness ◽

Case Studies ◽

Economic Efficiency ◽

Cost Benefit Analysis ◽

Cost Benefit ◽

Economic Assessment ◽

Physical Models ◽

Valuation Methods ◽

The Cost

<p>The economic advantage of NBS solutions aiming at mitigating water-risk is widely put forward as an argument for their development. There is nevertheless limited scientific evidence to support this argument. This paper therefore elaborates a methodological framework for the economic assessment of NBS and presents its application to three NAIAD case studies (the Lez catchment, France; Rotterdam, the Netherlands and Brague catchment, France). Robust methods are particularly applied for the estimation of the benefits associated with NBS. Physical models coupled with damage estimation models are developed to estimate the avoided damages generated by NBS. A diversity of ecosystem service valuation methods are also applied to evaluate the monetary value of NBS co-benefits: contingent valuation (Brague), choice experiment (Lez) and direct valuation methods (Rotterdam). We estimate the cost of implementation and maintenance mainly through the transfer of values coming from studies in similar contexts. Proxies are used to estimate the opportunity costs associated with the development of NBS. Finally, these estimations are compiled in a cost-benefit indicator allowing the estimation of the economic efficiency of NBS strategies. The study confirms that the cost of implementation and maintenance of NBS strategies is lower than the cost of grey solutions for the same level of water risk management, emphasizing the better cost-effectiveness of these solutions. Benefits in terms of avoided damages are however not sufficient to cover investment and maintenance costs. The cost&#8211;effectiveness of NBS strategies, which are combinations of individual NBS measures, may be improved by combining cost effective individual NBS measures. There is indeed a very large heterogeneity of cost-effectiveness of individual NBS measures (cost/m<sup>3</sup> of water retention). Results also reveal that co-benefits represent the largest share of the value generated by NBS strategies. It is therefore of utmost importance that co-benefits are integrated in the economic valuation of NBS for them to be judged economically efficient. This conclusion must be taken into account in the elaboration of NBS funding strategies.There is finally no clear-cut conclusion on the overall economic efficiency of NBS throughout the case studies. Lez reveal a positive cost-benefit analysis, while Rotterdam and Brague cases do not. Results are therefore case-specific and confirm the importance to carry out thorough economic valuations of a diversity of strategies at each sites, including NBS, grey and hybrid solutions, in order to identify the most adequate strategy for water risk management and to address territorial challenges.</p>

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Increasing the information provided by probabilistic sensitivity analysis: The relative density plot

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-020-00251-7 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Joost W. Geenen ◽

Rick A. Vreman ◽

Cornelis Boersma ◽

Olaf H. Klungel ◽

Anke M. Hövels ◽

...

Keyword(s):

Cost Effectiveness ◽

Relative Density ◽

Case Studies ◽

Real World ◽

Visual Information ◽

Sensitivity Analyses ◽

Cumulative Probability ◽

Contour Plot ◽

Density Plot ◽

The Cost

Abstract Background Results of probabilistic sensitivity analyses (PSA) are frequently visualized as a scatterplot, which is limited through overdrawing and a lack of insight in relative density. To overcome these limitations, we have developed the Relative Density plot (PSA-ReD). Methods The PSA-ReD combines a density plot and a contour plot to visualize and quantify PSA results. Relative density, depicted using a color gradient, is transformed to a cumulative probability. Contours are then plotted over regions with a specific cumulative probability. We use two real-world case studies to demonstrate the value of the PSA-ReD plot. Results The PSA-ReD method demonstrates proof-of-concept and feasibility. In the real-world case-studies, PSA-ReD provided additional visual information that could not be understood from the traditional scatterplot. High density areas were identified by color-coding and the contour plot allowed for quantification of PSA iterations within areas of the cost-effectiveness plane, diminishing overdrawing and putting infrequent iterations in perspective. Critically, the PSA-ReD plot informs modellers about non-linearities within their model. Conclusions The PSA-ReD plot is easy to implement, presents more of the information enclosed in PSA data, and prevents inappropriate interpretation of PSA results. It gives modelers additional insight in model functioning and the distribution of uncertainty around the cost-effectiveness estimate.

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Increasing the cost-effectiveness of telemedicine by embracing e-health

Journal of Telemedicine and Telecare ◽

10.1258/1357633001934500 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 16-19 ◽

Cited By ~ 37

Author(s):

John Mitchell

Keyword(s):

Cost Effectiveness ◽

Case Studies ◽

Health Sector ◽

National Study ◽

Sources Of Information ◽

Multiple Functions ◽

Original Report ◽

The Cost ◽

Consequent Increase ◽

Convergence Of Technologies

In 1999 a national study of telemedicine in Australia led to the promotion of the concept of ‘e-health’, the health sector's equivalent of ‘e-commerce’. A new study explored the view that, with the convergence of technologies and the consequent increase in ability to perform multiple functions with those technologies, it is unwise to promote telemedicine in isolation from other uses of technologies in health-care. The major sources of information for the study were the presentations and discussions at five national workshops held to discuss the findings of the original report on telemedicine. Nineteen case studies were identified. The case studies showed that with the convergence of technologies telehealth is becoming part of e-health. The cost-effectiveness of both telehealth and telemedicine improves considerably when they are part of an integrated use of telecommunications and information technology in the health sector.

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