Comparative Evaluation of the Cost-Effectiveness of 58 Transportation Control Measures

1998 ◽  
Vol 1641 (1) ◽  
pp. 97-104 ◽  
Author(s):  
Cynthia Pansing ◽  
Eric N. Schreffler ◽  
Mark A. Sillings
Keyword(s):  
Cost Effectiveness ◽  
Control Measure ◽  
Public Investment ◽  
Demand Management ◽  
Cost Effective ◽  
Alternative Fuel ◽  
Control Measures ◽  
Standardized Method ◽  
Project Data ◽  
The Cost

Often when public agencies allocate funding for transportation programs, evaluation of a project’s performance becomes an afterthought, if a consideration at all. Relatively recently, evaluation of project performance has garnered attention as a means for both assessing how cost-effectively public funds help attain transportation and air quality objectives and guiding future public investment decisions. Nonetheless, these efforts suffer at times from a lack of coordination and would benefit from the application of a standardized method. Such a standardized method is applied to evaluate the cost-effectiveness of three categories of transportation control measure (TCM) projects: fixed-route transit, transportation demand management (TDM), and alternative fuel projects. The method provides a means for estimating and quantifying travel mode effects and converting them to net emissions benefits. Three sets of funding programs implemented in California were the subjects of evaluation efforts in which the standardized method was applied. The results of these evaluations are presented, and conclusions are suggested about project cost-effectiveness on the basis of project data and comparisons across categories of projects. On the basis of the evaluation of 58 projects, TDM projects other than telecommunications projects were cost-effective compared with alternative fuel and fixed-route transit projects. In light of the key evaluation findings, an approach and framework for future evaluations of TCM projects to ensure consistency and comparability are proposed. Some future uses of the evaluation data in the form of a centralized database are also suggested.

scholarly journals Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 707
Author(s):  
Afifah Machlaurin ◽  
Franklin Christiaan Karel Dolk ◽  
Didik Setiawan ◽  
Tjipke Sytse van der Werf ◽  
Maarten J. Postma
Keyword(s):  
Cost Effectiveness ◽  
Univariate Analysis ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Control Programme ◽  
Detection Rates ◽  
Middle Income ◽  
Bcg Vaccination ◽  
Life Years ◽  
The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

2020 ◽  
Vol 33 (4/5) ◽  
pp. 323-331
Author(s):  
Mohsen pakdaman ◽  
Raheleh akbari ◽  
Hamid reza Dehghan ◽  
Asra Asgharzadeh ◽  
Mahdieh Namayandeh
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Regular Insulin ◽  
Diabetes Control ◽  
Diabetic Patients ◽  
Insulin Analogs ◽  
Content Type ◽  
Patients With Diabetes ◽  
The Government ◽  
The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

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.

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

scholarly journals Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Cost Effective ◽  
Economic Incentives ◽  
Additional Patient ◽  
Incentive Scheme ◽  
The Cost ◽  
The Impact

Abstract Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

scholarly journals Simplified Mathematical Modelling of Uncertainty: Cost-Effectiveness of COVID-19 Vaccines in Spain

Mathematics ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 566
Author(s):  
Julio Emilio Marco-Franco ◽  
Pedro Pita-Barros ◽  
Silvia González-de-Julián ◽  
Iryna Sabat ◽  
David Vivas-Consuelo
Keyword(s):  
Cost Effectiveness ◽  
Health Planning ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Reliable Data ◽  
Simplified Model ◽  
Fatality Rate ◽  
Cost Effectiveness Ratio ◽  
Funeral Homes ◽  
The Cost

When exceptional situations, such as the COVID-19 pandemic, arise and reliable data is not available at decision-making times, estimation using mathematical models can provide a reasonable reckoning for health planning. We present a simplified model (static but with two-time references) for estimating the cost-effectiveness of the COVID-19 vaccine. A simplified model provides a quick assessment of the upper bound of cost-effectiveness, as we illustrate with data from Spain, and allows for easy comparisons between countries. It may also provide useful comparisons among different vaccines at the marketplace, from the perspective of the buyer. From the analysis of this information, key epidemiological figures, and costs of the disease for Spain have been estimated, based on mortality. The fatality rate is robust data that can alternatively be obtained from death registers, funeral homes, cemeteries, and crematoria. Our model estimates the incremental cost-effectiveness ratio (ICER) to be 5132 € (4926–5276) as of 17 February 2021, based on the following assumptions/inputs: An estimated cost of 30 euros per dose (plus transport, storing, and administration), two doses per person, efficacy of 70% and coverage of 70% of the population. Even considering the possibility of some bias, this simplified model provides confirmation that vaccination against COVID-19 is highly cost-effective.

scholarly journals Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomised, open-label, phase III trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038867 ◽  
Author(s):  
Wenxiu Xin ◽  
Haiying Ding ◽  
Qilu Fang ◽  
Xiaowei Zheng ◽  
Yinghui Tong ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Squamous Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Platinum Resistant ◽  
The Cost

BackgroundPembrolizumab was recently demonstrated to have survival benefit in patients with recurrent or metastatic head and neck squamous cell carcinoma (r/mHNSCC). However, the cost-effectiveness of pembrolizumab versus chemotherapy in China remains uncertain.ObjectiveThis analysis aimed to describe the cost-effectiveness of pembrolizumab versus standard-of-care (SOC) therapy in r/mHNSCC in China.DesignA Markov model consisting of three health states (stable, progressive and dead) was developed to compare the cost and effectiveness of pembrolizumab with SOC in platinum-resistant r/mHNSCC. Model inputs for transition probabilities and toxicity were collected from the KEYNOTE-040 trial, while health utilities were estimated from a literature review. Cost data were acquired for the payer’s perspective in China. Costs and outcomes were discounted at an annual rate of 3.0%. Sensitivity analyses were conducted to test the uncertainties surrounding model parameters.Outcome measuresThe primary outcome was incremental cost-effectiveness ratios (ICERs), which were calculated as the cost per quality-adjusted life years (QALYs).ResultsThe total mean cost of pembrolizumab and SOC was US$45 861 and US$41 950, respectively. As for effectiveness, pembrolizumab yielded 0.31 QALYs compared with 0.25 QALYs for SOC therapy. The ICER for pembrolizumab versus SOC was US$65 186/QALY, which was higher than the willingness-to-pay threshold (WTP) of US$28 130/QALY in China. The univariate sensitivity analysis indicated that utility values for progressive state, probability from stable to progressive in the SOC group, as well as cost of pembrolizumab were the three most influential variables on ICER. The probabilistic sensitivity analysis demonstrated that standard therapy was more likely to be cost-effective compared with pembrolizumab at a WTP value of US$28 130/QALY. Results were robust across both univariate analysis and probabilistic sensitivity analysis.ConclusionsPembrolizumab is not likely to be a cost-effective strategy compared with SOC therapy in patients with platinum-resistant r/mHNSCC in China.Trial registration numberNCT02252042; Post-results.

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 503. The Misappropriation of COVID-19 Related TV Ad Expenditures

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S317-S317
Author(s):  
Kartavya J Vyas
Keyword(s):  
Cost Effectiveness ◽  
Performance Metrics ◽  
Control Measures ◽  
Mortality Data ◽  
Preventive Interventions ◽  
Social Distancing ◽  
Epidemic Curve ◽  
Incidence And Mortality ◽  
The Cost ◽  
The U.S

Abstract Background With nearly three-fourths of the U.S. population isolated in their homes between early March and the end of May, almost all of whom regularly watch television (TV), it was no surprise that companies began to purchase airtime on major television networks to advertise (ad) their brands and showcase their empathy with the populace. But how would the coronavirus disease 2019 (COVID-19) epidemic curve have changed had these same dollars been allocated to proven preventive interventions? Methods Performance and activity metrics on all COVID-19 related TV ads that have aired in the U.S. between February 26th and June 7th, 2020, were provided by iSpot.tv, Inc., including expenditures. COVID-19 incidence and mortality data were collected from the Centers for Disease Control and Prevention (CDC). Descriptive statistics were performed to calculate total TV ad expenditures and other performance metrics across industry categories. Leveraging a previously published stochastic agent-based model that was used to assess the cost-effectiveness of non-pharmaceutical interventions to control COVID-19, the number of cases that would have been prevented had these same dollars been used for preventive interventions was calculated using cost-effectiveness ratios (CERs), the cost divided by cases prevented. Results A total of 1,513 companies purchased TV airtime during the study period, totaling approximately 1.1 million airings, 215.5 billion impressions, and $2.7 billion in expenditures; most of the expenditures were spent by the restaurant (15.9%), electronics and communications (15.4%), and vehicle (13.7%) industries. The CERs for PPE and social distancing measures were $13,856 and $29,552, respectively; therefore, had all of these TV ad dollars instead been allocated to PPE or social distancing measures, approximately 194,908 and 91,386 cases of COVID-19 may have been prevented by the end of the study period, respectively. Figure 2. COVID-19 cases prevented had TV ad expenditures been reallocated for interventions. Conclusion Americans were inundated with COVID-19 related TV ads during the early months of the pandemic and companies are now showing some signs to relent. In times of disaster, however, it is paramount that the private sector go beyond showcasing their empathy and truly become socially responsible by allocating their funds to proven prevention and control measures. Disclosures All Authors: No reported disclosures

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