Determining the financial costs and benefits of conservation actions: a framework to support decision making

The need for conservation action to be cost-effective is widely accepted and this has prompted an increased interest and effort to assess effectiveness. Assessing financial costs of conservation is equally important, yet its measurement and assessment are repeatedly identified as lacking. The healthcare sector however, has made substantial progress in identifying and including costs in decision-making. Here, we consider what conservation can learn from this experience. We present a three-step framework for identifying and recording the relevant financial costs and benefits of conservation interventions where the user 1) describes the costing context, 2) determines which types of cost and benefit to include and 3) obtains values for these costs and benefits alongside metadata necessary for others to interpret the data. This framework is designed to help estimate economic costs, but can also be used flexibly to record direct costs of interventions (i.e. accounting costs), calculate financial benefits, and calculate cost effectiveness. Although recording cost data can be deceptively complex, this framework facilitates the improved recording of financial costs and benefits, and shows how this could enhance the assessment of cost-effectiveness across a broad range of conservation contexts.

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Principles of Cost-Effective Resource Allocation in Health Care organizations

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300008953 ◽

1990 ◽

Vol 6 (1) ◽

pp. 93-103 ◽

Cited By ~ 132

Author(s):

Milton C. Weinstein

Keyword(s):

Health Care ◽

Decision Making ◽

Cost Effectiveness ◽

Health Care Organizations ◽

Cost Effective ◽

Limited Resources ◽

Effectiveness Analysis ◽

The Cost ◽

Common Understanding ◽

Analytical Errors

Cost-effectiveness analysis (CEA) is a method of economic evaluation that can be used to assess the efficiency with which health care technologies use limited resources to produce health outputs. However, inconsistencies in the way that such ratios are constructed often lead to misleading conclusions when CEAs are compared. Some of these inconsistencies, such as failure to discount or to calculate incremental ratios correctly, reflect analytical errors that, if corrected, would resolve the inconsistencies. Others reflect fundamental differences in the viewpoint of the analysis. The perspectives of different decision-making entities can properly lead to different items in the numerator and denominator of the cost-effectiveness (C/E) ratio. Producers and consumers of CEA need to be more conscious of the perspectives of analysis, so that C/E comparisons from a given perspective are based upon a common understanding of the elements that are properly included.

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Cost Effectiveness of Molecular Profiling for Adjuvant Decision Making in Patients With Node-Negative Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2013.54.9931 ◽

2014 ◽

Vol 32 (31) ◽

pp. 3513-3519 ◽

Cited By ~ 17

Author(s):

Julia Bonastre ◽

Sophie Marguet ◽

Beranger Lueza ◽

Stefan Michiels ◽

Suzette Delaloge ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cost Effectiveness ◽

Adjuvant Chemotherapy ◽

Cost Effective ◽

Gene Signature ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Life Years ◽

Er Positive

Purpose To conduct an economic evaluation of the 70-gene signature used to guide adjuvant chemotherapy decision making both in patients with node-negative breast cancer (NNBC) and in the subgroup of estrogen receptor (ER) –positive patients. Patients and Methods We used a mixed approach combining patient-level data from a multicenter validation study of the 70-gene signature (untreated patients) and secondary sources for chemotherapy efficacy, unit costs, and utility values. Three strategies on which to base the decision to administer adjuvant chemotherapy were compared: the 70-gene signature, Adjuvant! Online, and chemotherapy in all patients. In the base-case analysis, costs from the French National Insurance Scheme, life-years (LYs), and quality-adjusted life-years (QALYs) were computed for the three strategies over a 10-year period. Cost-effectiveness acceptability curves using the net monetary benefit were computed, combining bootstrap and probabilistic sensitivity analyses. Results The mean differences in LYs and QALYs were similar between the three strategies. The 70-gene signature strategy was associated with a higher cost, with a mean difference of €2,037 (range, €1,472 to €2,515) compared with Adjuvant! Online and of €657 (95% CI, −€642 to €3,130) compared with systematic chemotherapy. For a €50,000 per QALY willingness-to-pay threshold, the probability of being the most cost-effective strategy was 92% (76% in ER-positive patients) for the Adjuvant! Online strategy, 6% (4% in ER-positive patients) for the systematic chemotherapy strategy, and 2% (20% in ER-positive patients) for the 70-gene strategy. Conclusion Optimizing adjuvant chemotherapy decision making based on the 70-gene signature is unlikely to be cost effective in patients with NNBC.

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A Non-inferiority Framework for Cost-Effectiveness Analysis

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319000576 ◽

2019 ◽

Vol 35 (4) ◽

pp. 291-297

Author(s):

Xuanqian Xie ◽

Lindsey Falk ◽

James M. Brophy ◽

Hong Anh Tu ◽

Jennifer Guo ◽

...

Keyword(s):

Decision Making ◽

Cost Effectiveness ◽

Active Control ◽

Repetitive Transcranial Magnetic Stimulation ◽

Cost Effective ◽

Placebo Control ◽

Decision Framework ◽

Life Years ◽

Intervention Cost ◽

New Framework

AbstractBackgroundTraditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression.MethodsWe modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP).ResultsrTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively.ConclusionsThis new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.

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The financial benefits of improved street lighting, based on crime reduction

Lighting Research and Technology ◽

10.1177/136578280103300102 ◽

2001 ◽

Vol 33 (1) ◽

pp. 3-10 ◽

Cited By ~ 41

Author(s):

Kate A Painter ◽

David P Farrington

Keyword(s):

Cost Effective ◽

Control Area ◽

Crime Reduction ◽

Research Projects ◽

Street Lighting ◽

Financial Costs ◽

Experimental Area ◽

Financial Benefits ◽

One Year

Two research projects were carried out to investigate the effects of improved street lighting on crime in Dudley and Stoke-on-Trent. In Dudley, crimes decreased by 41% in the experimental area, compared with a 15% decrease in a control area. In Stoke, crimes decreased by 43% in the experimental area and by 45% in two adjacent areas, compared with a decrease of only 2% in two control areas. In the two projects, the financial savings (from reduced crimes) exceeded the financial costs by between 2.4 and 10 times after one year. It is concluded that improved street lighting can be extremely cost-effective.

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Daily Almond Consumption in Cardiovascular Disease Prevention via LDL-C Change in the U.S. Population: a Cost-Effectiveness Analysis

10.21203/rs.2.11042/v2 ◽

2019 ◽

Author(s):

Jifan Wang(New Corresponding Author) ◽

Michelle A. Lee Bravatti ◽

Elizabeth J. Johnson ◽

Gowri Raman(Former Corresponding Author)

Keyword(s):

Cardiovascular Disease ◽

Cost Effectiveness ◽

Willingness To Pay ◽

Cost Effective ◽

Dietary Factors ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Cvd Prevention ◽

The Cost ◽

The U.S

Abstract Objectives Heart disease is the leading cause of death in the United States. The U.S. Food and Drug Administration approved the health claim that 1.5 ounces (42.5 grams) of nut intake may reduce the risk of cardiovascular disease (CVD). Previous studies have focused on the cost-effectiveness of other foods or dietary factors on primary CVD prevention, yet not in almond consumption. This study aimed to examine the cost-effectiveness of almond consumption in CVD primary prevention. Perspective & Setting This study assessed the cost-effectiveness of consuming 42.5 grams of almond from the U.S. healthcare sector perspective. Methods A decision model was developed for 42.5 grams of almond per day versus no almond consumption and CVD in the U.S. population. Parameters in the model were derived from the literature, which included the probabilities of increasing LDL-C, developing acute myocardial infarction (MI) and stroke, treating MI, dying from the disease and surgery, as well as the costs of the disease and procedures in the U.S. population, and the quality-adjusted life years (QALY). The cost of almonds was based on the current price in the U.S. market. Sensitivity analyses were conducted for different levels of willingness-to-pay, the probabilistic sensitivity analysis, ten-year risk prevention, different costs of procedures and almond prices, and patients with or without CVD. Results The almond strategy had $363 lower cost and 0.02 higher QALY gain compared to the non-almond strategy in the base-case model. The annual net monetary benefit (NMB) of almond consumption was $1,421 higher per person than no almond consumption, when the willingness to pay threshold was set at $50,000 for annual health care expenditure. Almond was more cost-effective than non-almond in CVD prevention in all the sensitivity analyses. Conclusion Consuming 42.5 grams of almonds per day is a cost-effective approach to prevent CVD in the short term and potentially in the long term.

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Cost-Effectiveness Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Venous Thromboembolism in China

Frontiers in Pharmacology ◽

10.3389/fphar.2021.716224 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ke-Xin Sun ◽

Bin Cui ◽

Shan-Shan Cao ◽

Qi-Xiang Huang ◽

Ru-Yi Xia ◽

...

Keyword(s):

Decision Making ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Markov Model ◽

Clinical Decision Making ◽

Cost Effective ◽

Clinical Decision ◽

Base Case ◽

Effectiveness Analysis ◽

The Cost

Background: The drug therapy of venous thromboembolism (VTE) presents a significant economic burden to the health-care system in low- and middle-income countries. To understand which anticoagulation therapy is most cost-effective for clinical decision-making , the cost-effectiveness of apixaban (API) versus rivaroxaban (RIV), dabigatran (DAB), and low molecular weight heparin (LMWH), followed by vitamin K antagonist (VKA), in the treatment of VTE in China was assessed.Methods: To access the quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), a long-term cost-effectiveness analysis was constructed using a Markov model with 5 health states. The Markov model was developed using patient data collected from the Xijing Hospital from January 1, 2016 to January 1, 2021. The time horizon was set at 30 years, and a 6-month cycle length was used in the model. Costs and ICERs were reported in 2020 U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the uncertainties. A Chinese health-care system perspective was used.Results: In the base case, the data of 231 VTE patients were calculated in the base case analysis retrospectively. The RIV group resulted in a mean VTE attributable to 95% effective treatment. API, DAB, and VKA have a negative ICER (−187017.543, −284,674.922, and −9,283.339, respectively) and were absolutely dominated. The Markov model results confirmed this observation. The ICER of the API and RIV was negative (−216176.977), which belongs to the absolute inferiority scheme, and the ICER value of the DAB and VKA versus RIV was positive (110,577.872 and 836,846.343). Since the ICER of DAB and VKA exceeds the threshold, RIV therapy was likely to be the best choice for the treatment of VTE within the acceptable threshold range. The results of the sensitivity analysis revealed that the model output varied mostly with the cost in the DAB on-treatment therapy. In a probabilistic sensitivity analysis of 1,000 patients for 30 years, RIV has 100% probability of being cost-effective compared with other regimens when the WTP is $10973 per QALY. When WTP exceeded $148,000, DAB was more cost-effective than RIV.Conclusions: Compared with LMWH + VKA and API, the results proved that RIV may be the most cost-effective treatment for VTE patients in China. Our findings could be helpful for physicians in clinical decision-making to select the appropriate treatment option for VTE.

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Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II

10.2337/figshare.13622906.v1 ◽

2021 ◽

Author(s):

Shihchen Kuo ◽

Wen Ye ◽

Mary de Groot ◽

Chandan Saha ◽

Jay H. Shubrook ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Cost Saving ◽

Behavioral Therapy ◽

Intervention Strategy ◽

Cost Effective ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Community Based

Objective: We estimated the cost-effectiveness of the Program ACTIVE II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to UC and each other. Research Design and Methods: Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the healthcare sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained. Results: From the healthcare sector perspective, the EXER intervention strategy saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared to UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention strategy saved $126 (cost-saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses. Conclusions: All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the CBT or EXER interventions.

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Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine

Medical Decision Making ◽

10.1177/0272989x20954391 ◽

2020 ◽

Vol 40 (7) ◽

pp. 924-938

Author(s):

Stuart J. Wright ◽

Mike Paulden ◽

Katherine Payne

Keyword(s):

Cost Effectiveness ◽

Precision Medicine ◽

Implementation Strategies ◽

Recurrence Score ◽

Cost Effective ◽

Decision Analytic Model ◽

Costs And Benefits ◽

Marginal Costs ◽

The Impact

Purpose. A range of barriers may constrain the effective implementation of strategies to deliver precision medicine. If the marginal costs and consequences of precision medicine vary at different levels of implementation, then such variation will have an impact on relative cost-effectiveness. This study aimed to illustrate the importance and quantify the impact of varying marginal costs and benefits on the value of implementation for a case study in precision medicine. Methods. An existing method to calculate the value of implementation was adapted to allow marginal costs and consequences of introducing precision medicine into practice to vary across differing levels of implementation. This illustrative analysis used a case study based on a published decision-analytic model-based cost-effectiveness analysis of a 70-gene recurrence score (MammaPrint) for breast cancer. The impact of allowing for varying costs and benefits for the value of the precision medicine and of implementation strategies was illustrated graphically and numerically in both static and dynamic forms. Results. The increasing returns to scale exhibited by introducing this specific example of precision medicine mean that a minimum level of implementation (51%) is required for using the 70-gene recurrence score to be cost-effective at a defined threshold of €20,000 per quality-adjusted life year. The observed variation in net monetary benefit implies that the value of implementation strategies was dependent on the initial and ending levels of implementation in addition to the magnitude of the increase in patients receiving the 70-gene recurrence score. In dynamic models, incremental losses caused by low implementation accrue over time unless implementation is improved. Conclusions. Poor implementation of approaches to deliver precision medicine, identified to be cost-effective using decision-analytic model-based cost-effectiveness analysis, can have a significant economic impact on health systems. Developing and evaluating the economic impact of strategies to improve the implementation of precision medicine will potentially realize the more cost-effective use of health care budgets.

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Economic and epidemiological evaluation of interventions to reduce the burden of hepatitis C in Yunnan province, China

PLoS ONE ◽

10.1371/journal.pone.0245288 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245288

Author(s):

Alastair Heffernan ◽

Yanling Ma ◽

Shevanthi Nayagam ◽

Polin Chan ◽

Zhongdan Chen ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Yunnan Province ◽

Treatment Options ◽

Scale Up ◽

Cost Effective ◽

Credible Interval ◽

Hiv Care ◽

Healthcare Sector ◽

Hcv Treatment

Background The paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China. Methods and findings We simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17–1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream of future benefits, is not adopted. The study had two key limitations: costing data were not always specific to Yunnan province but were taken from China-level studies; and modelled interventions may require more operational research to ensure they can be effectively and efficiently rolled-out to the entire province. Conclusions Introducing DAAs is cost effective, the optimal package of screening measures is focussed on higher risk groups, and there are likely to be positive returns from investing in such HCV interventions. Our analysis shows that targeted investment in HCV interventions will have net benefits to society; these benefits will only increase as DAA costs fall.

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