scholarly journals The Economics of Rapid Multiplication of Hybrid Poplar Biomass Varieties

Forests ◽  
2019 ◽  
Vol 10 (5) ◽  
pp. 446 ◽  
Author(s):  
Brian J. Stanton ◽  
Kathy Haiby ◽  
Carlos Gantz ◽  
Jesus Espinoza ◽  
Richard A. Shuren
Keyword(s):  
Biomass Yield ◽  
Case Analysis ◽  
Base Case ◽  
Multiplication Rate ◽  
Base Case Analysis ◽  
Clonal Multiplication ◽  
Rapid Multiplication ◽  
Yield And Quality ◽  
Rapid Propagation ◽  
Serial Propagation

Background: Poplar (Populus spp.) hybridization is key to advancing biomass yields and conversion efficiency. Once superior varieties are selected, there is a lag in commercial use while they are multiplied to scale. Objective: The purpose of this study was to assess the influence of gains in biomass yield and quality on investment in rapid propagation techniques that speed the time to commercial deployment. Material and Methods: A factorial experiment of propagation method and hybrid variety was conducted to quantify the scale-up rate of in vitro and greenhouse clonal multiplication. These data were used in modeling the internal rate of return (IRR) on investment into rapid propagation as a function of genetic gains in biomass yield and quality and compared to a base case that assumed the standard method of supplying operational varieties in commercial quantities from nurseries as hardwood cuttings, capable of yields of 16.5 Mg ha−1 year−1. Results: Analysis of variance in macro-cutting yield showed that propagation method and varietal effects as well as their interaction were highly significant, with hedge propagation exceeding serial propagation in macro-cutting productivity by a factor of nearly 1.8. The Populus deltoides × P. maximowiczii and the Populus trichocarpa × P. maximowiczii varieties greatly exceeded the multiplication rate of the P. × generosa varieties due to their exceptional response to repeated hedging required to initiate multiple tracks of serial propagation. Analyses of investment into rapid propagation to introduce new material into plantation establishment followed by a 20-year rotation of six coppice harvests showed that gains in biomass yield and quality are warranted for a commitment to rapid propagation systems. The base case analysis was generally favored at yields up to 18 Mg−1 year−1 dependent on pricing. The rapid multiplication analysis proved superior to the base case analysis at the two highest yield levels (27.0 and 31.5 Mg ha−1 year−1,) at all price levels and at yields of 22.5 Mg−1 year−1, dependent on price and farm location. Conclusion: Rapid multiplication is a reliable method to move improved plant material directly into operations when valued appropriately in the marketplace.

scholarly journals Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043523
Author(s):  
Zoe McCarroll ◽  
Julia Townson ◽  
Timothy Pickles ◽  
John W Gregory ◽  
Rebecca Playle ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Case Analysis ◽  
Base Case ◽  
Base Case Analysis ◽  
Home Management ◽  
Randomised Controlled

ObjectiveThe aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of type 1 diabetes (T1D). This is based on the Delivering Early Care In Diabetes Evaluation trial (ISRCTN78114042), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months.DesignCost-effectiveness analysis alongside a randomised controlled trial.SettingEight paediatric diabetes centres in England, Wales and Northern Ireland.Participants203 clinically well children aged under 17 years, with newly diagnosed T1D and their carers.Outcome measuresThe base-case analysis adopted n National Health Service (NHS) perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER), expressed as cost per mmol/mol reduction in glycated haemoglobin (HbA1c), was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness.ResultsAt 24 months postintervention, the base-case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference −£2,217; 95% CI −£2825 to −£1,609; p<0.001). Home care dominated, with an ICER of £7434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period.ConclusionsHome management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness.Trial registration numberISRCTN78114042.

Comparison of Cost-Effectiveness of Anticoagulation with Dabigatran, Rivaroxaban and Apixaban in Patients with Non-Valvular Atrial Fibrillation Across Countries

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1164-1164 ◽  
Author(s):  
Martin Krejczy ◽  
Job Harenberg ◽  
Svetlana Marx ◽  
Konrad Obermann ◽  
Martin Wehling
Keyword(s):  
Cost Effectiveness ◽  
Markov Model ◽  
Case Analysis ◽  
Base Case ◽  
German Population ◽  
Base Case Analysis ◽  
Chads2 Score ◽  
Increased Risk ◽  
Markov Decision Model ◽  
The Cost

Abstract Abstract 1164 The three new oral anticoagulants (NOAC) dabigatran 110mg bid and 150mg bid, investigated in the RE-LY trial, rivaroxaban 20mg od of the ROCKET trial, and apixaban 5mg bid of the ARISTOTLE trial showed equivalent or superior efficacy and safety compared to warfarin in these patients. We performed a cost-effectiveness analysis for these NOACs in Germany and compared the quality of life (QALY), incremental cost effectiveness ratios (ICER), and total costs across those countries form where these data are published. The base case population was a hypothetical cohort of patients 65 years or older with AF who were at increased risk for stroke (CHADS2-score >1) and had no contraindications to anticoagulation. The time horizon was based on the life expectancy of the German population. The QALYs, health insurance costs, and ICER for the NOACs compared with warfarin were calculated for each study. The sensitivity analysis was performed for different base case prices. The Markov decision model was adopted using the TreeAge Pro 2011 program. The data of the outcomes of ischemic stroke and cerebral embolism, major and intracerebral haemorrhage, myocardial infarction, and mortality were taken from the 3 studies comparing the NOAC with INR-adjusted warfarin. Prices for clinical events and for outpatient care were taken from the institute for payment regulations in German hospitals (InEK). The base-case analysis of a 65 years old person with a >2 CHADS2 score using the data from the RE-LY study resulted in 11.41 QALYs for warfarin, 11.53 QALYs for dabigatran 110mg bid, 11.66 QALYs for dabigatran 150 mg bid. ICERs per QALY were 49640€ for dabigatran 110 mg bid and 49590€ for dabigatran 150 mg bid versus warfarin. The same base-case analysis using the data from the ROCKET AF study resulted in 10.79 QALYs for warfarin versus 11.05 QALYs for rivaroxaban. ICERs per QALY were 48980€ for rivaroxaban versus warfarin. The base-case analysis using the data from the ARISTOTLE study resulted and 11.04 QALYs for warfarin versus 11.38 QALYs for apixaban. ICERs per QALY were 49720€ for apixaban versus warfarin. According the Markov Model the daily value based daily prices were 1.25€ for dabigatran 110 mg bid, 2.50€ for dabigatran 150 mg bid, 2.60€ for rivaroxaban, and 3.10€ for apixaban in Germany. The model was highly sensitive to the daily costs for the NOACs but relatively insensitive to other model inputs. Calculating the range of NOAC prices from 0.2 to 10 Euro versus the ICERs dabigatran 110 mg bid produced the highest increase of ICERs over this range of daily costs (Tukey-Kramer test, p<0.05) Comparing these data across countries using the published data shows that the willingness to pay per QALY as well as differences in treatment costs between substantially influences the daily prices of the NOACs. The data demonstrate the necessity to analyse the cost-effectiveness separately for every study due to differences in the INR-adjusted warfarin treated control group. The better the outcome during treatment with warfarin the lower is the benefit of the NOAC. The tendency of the cost-effectiveness calculated by the Markov model is comparable across countries. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cost-utility of two minimally-invasive surgical techniques for operable oropharyngeal cancer: Transoral robotic surgery versus transoral laser microsurgery

2021 ◽  
Author(s):  
Enea Parimbelli ◽  
Federico Soldati ◽  
Lorry Duchoud ◽  
Gian Luca Armas ◽  
John R. de Almeida ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Case Analysis ◽  
Cost Effective ◽  
Cost Utility ◽  
Transoral Robotic Surgery ◽  
Base Case ◽  
Base Case Analysis ◽  
Hospital Perspective ◽  
Decision Analytical Model ◽  
The Cost

AbstractImportanceTransoral robotic surgery (TORS) and transoral laser micro-surgery (TLM) are two different but competing minimally invasive techniques to surgically remove operable oropharyngeal squamous cell cancers (OPSCC). As of now, no comparative analysis as to the cost-utility of these techniques exists.ObjectiveRecent population-level data suggest for TORS and TLM equivalent tumor control, but different total costs, need for adjuvant chemoradiation, and learning curves. Therefore, the objective of this study was to compare TORS and TLM from the cost-utility (C/U) point of view using a decision-analytical model from a Swiss hospital perspective.DesignOur decision-analytical model combines decision trees and a Markov model to compare TORS and TLM strategies. Model parameters were quantified using available literature, original cost data from two Swiss university tertiary referral centers, and utilities elicited directly from a Swiss population sample using standard gamble. C/U and sensitivity analyses were used to generate results and gauge model robustness.SettingSwiss hospital perspectiveInterventionCost-utility analysisMain outcome measureComparative cost-utility data from TLM and TORSResultsIn the base case analysis TLM dominates TORS. This advantage remains robust, even if the costs for TORS would reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment (pTorsAlone>0.407), whereby in an interval between 55%-62% (pTorsAlone 0.38-0.45) cost effectiveness of TORS is sensitive to the prescription of adjuvant CRT. Also, exceeding 29% of TLM patients requiring a re-operation for inadequate margins renders TORS more cost-effective.ConclusionTLM is more cost-effective than TORS. However, this advantage is sensitive to various parameters i.e. the number of re-operations and adjuvant treatment.Key pointsQuestionCompare cost-utility of TORS versus TLMFindingsIn the base case analysis TLM dominates TORS, even if the costs for TORS would reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment, whereby in an interval between 55%-62% cost effectiveness of TORS is sensitive to the prescription of adjuvant CRT. Exceeding 29% of TLM patients requiring a re-operation for inadequate margins renders TORS more cost-effective.MeaningTLM is more cost-effective than TORS. However, this advantage is sensitive to the number of re-operations and adjuvant treatment

Economic Evaluation of the Good Life Club Intervention for Diabetes Self-Management

2006 ◽  
Vol 12 (1) ◽  
pp. 91 ◽  
Author(s):  
Duncan Mortimer ◽  
Jill Kelly
Keyword(s):  
Incremental Cost ◽  
Usual Care ◽  
Type Ii Diabetes ◽  
Good Life ◽  
Case Analysis ◽  
Self Management ◽  
Base Case ◽  
The Good Life ◽  
Type Ii ◽  
Base Case Analysis

This paper reports results from an economic evaluation of the Good Life Club (GLC), a self-management intervention for type II diabetes. Based on intention to treat data at 18-month follow-up, 39% of GLC clients were well-managed compared to just 30% at baseline. This gives a risk difference of 0.09 (95%CI: 0.01, 0.16) and a relative risk of being well-managed equal to 1.28 (95%CI: 1.04, 1.58) for the GLC intervention as compared to usual care. Based on detailed description of the GLC intervention, client-level data as to service utilisation and published unit costs, the incremental cost per client of the GLC intervention as compared to usual care was calculated at $1,457 in the base case analysis. Combining estimates of incremental cost and treatment effect implies an incremental cost-effectiveness ratio of just over $16,000 per additional responder (client with well-managed type II diabetes) in the base-case analysis. Additional cost savings are, however, expected to accrue in future years because well-managed diabetes is less likely than usual care to result in diabetes-related complications.

scholarly journals Cost-Effectiveness Evaluation for the US of Fondaparinux Compared to Argatroban in the Management of Suspected HIT

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4727-4727
Author(s):  
Ahmed Aljabri ◽  
Mahdi Gharaibeh ◽  
Yvonne Huckleberry ◽  
Hussam Kutbi ◽  
Yuval Raz ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Wholesale Price ◽  
Secondary Analysis ◽  
Case Analysis ◽  
Base Case ◽  
Base Case Analysis ◽  
Off Label ◽  
Primary Base

Abstract Introduction. The relative efficacy and safety of fondaparinux and argatroban in the management of suspected heparin-induced thrombocytopenia (HIT) have been documented. We conducted a cost-effectiveness analysis of both agents in terms of cost and adverse events averted. Methods. We developed a two-armed decision tree model to simulate a cohort of patients with suspected or confirmed HIT managed with argatroban or fondaparinux, using published efficacy data and probabilities of developing HIT-related VTE or major bleeding. The primary base case analysis considered our institutional cost while the secondary analysis used the Average Wholesale Price. Probabilistic sensitivity analysis (PSA) was performed to confirm findings and one-way sensitivity analysis to evaluate additional scenarios. Results. In the primary base case analysis, fondaparinux dominated argatroban treatment as it was less expensive in managing suspected HIT ($154 vs. $2,064) and more effective in terms of adverse events averted (0.998878 vs. 0.995739). This was confirmed in PSA in terms of both cost ($154 vs. $1,999) and adverse events averted (0.9988711 vs. 0.9957212). Sensitivity analysis showed that the total costs of argatroban would never be less than fondaparinux based on our assumptions. In the secondary analysis, fondaparinux was less expensive ($362 vs. $3722) and more effective in terms of adverse event averted (0.998878 vs. 0.995739). The PSA confirmed these findings both in terms of cost ($343 vs. $3477) adverse events averted. (0.9988711 vs. 0.9957212). Conclusions. The cost savings from a once-daily SC fondaparinux injection with limited laboratory monitoring are more advantageous than IV argatroban infusion that requires continuous titration. Disclosures Off Label Use: Fondaparinux is used as "off-label" for the management of patients with suspected or confirmed HIT.

Health Outcomes and Costs of Rituximab in Combination with Cyclophosphamide, Vincristine and Prednisolone in the Treatment of Patients with Advanced Follicular Lymphoma in Portugal.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2481-2481
Author(s):  
Paula Braga ◽  
Susana Carvalho ◽  
Marília Gomes ◽  
Lurdes Guerra ◽  
Paulo Lúcio ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Life Expectancy ◽  
Probabilistic Sensitivity Analysis ◽  
Time Horizon ◽  
Case Analysis ◽  
Base Case ◽  
Base Case Analysis ◽  
Non Hodgkin Lymphoma ◽  
Life Years ◽  
Quality Adjusted Life

Abstract Abstract 2481 Poster Board II-458 Objective: With the pressure on healthcare budgets, it has become increasingly important for healthcare decision makers to consider the value for money of the treatments they reimburse. The objective of this analysis was to evaluate the long term outcomes and costs of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP) versus CVP alone, in previously untreated patients with indolent Non-Hodgkin Lymphoma (NHL) from the Portuguese National Health System (NHS) perspective. Methods: Cost-effectiveness (Life Years Gained - LYG) and cost-utility analysis (Quality Adjusted Life years – QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (“progression free survival”, “progression” and “death”) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial (Marcus 2007) was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis. Results: The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and quality-adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. Conclusions: This study demonstrates that the combination R-CVP in previously untreated non-Hodgkin lymphoma patients improves life expectancy and is a cost-effective alternative to CVP in Portugal. Disclosures: Braga: Roche Farmacêutica Química, Lda: Employment. Pereira:Roche Farmacêutica Química, Lda.: Employment.

scholarly journals Decision analysis for small, asymptomatic intracranial arteriovenous malformations

2001 ◽  
Vol 11 (5) ◽  
pp. 1-8 ◽  
Author(s):  
James McInerney ◽  
David A. Gould ◽  
John D. Birkmeyer ◽  
Robert E. Harbaugh
Keyword(s):  
Sensitivity Analysis ◽  
Decision Analysis ◽  
Arteriovenous Malformations ◽  
Case Analysis ◽  
Morbidity And Mortality ◽  
Base Case ◽  
Base Case Analysis ◽  
Intracranial Arteriovenous Malformations ◽  
Neurological Morbidity ◽  
Input Variables

Object Asymptomatic intracranial arteriovenous malformations (AVMs) represent a clinically challenging problem because of the complex decision making that must be undertaken prior to beginning any type of treatment. In addition, the relative infrequency of these lesions means that there is relatively little experience reported in the literature. The authors use a decision-analysis technique to model the considerations that go into determining the treatment of these lesions in an effort to quantify the various risks and overall benefits conferred by the following three treatment strategies: observation/natural history, microsurgery, and stereotactic radiosurgery. Methods The authors conducted a thorough literature search to elucidate the risks and outcomes associated with each treatment option. These values were used to build and run a comprehensive Markov model to determine a base-case analysis. All of the input variables were also subjected to sensitivity analysis to identify the most influential input variables and the crossover points in which favored strategies changed. The base-case analysis suggested that microsurgery was the favored treatment option because this hypothetical cohort accumulated 21.53 quality-adjusted life years (QALYs) over the course of the model compared with the 16.97 QALYs and 16.40 QALYs for stereotctic radiosurgery and observation, respectively. Sensitivity analysis demonstrated that overall major neurological morbidity and mortality were the most influential input variables both perioperatively and during the radiosurgical “latent” period (that is, up to 2 years posttreatment). The maximum acceptable perioperative combined major neurological morbidity and mortality rate was 6.8%. The latent period combined major neurological morbidity and mortality would need to be 0.7% to make radiosurgery favorable in this analysis. Conclusions Results of this decision analysis model suggest that microsurgery in the hands of experienced cerebrovascular surgeons, who can expect a less than 6.8% combined rate of major neurological morbidity and mortality, offers patients a greater overall quality of life over time.

Cost-effectiveness analysis of magnetic resonance-guided focused ultrasound ablation for palliation of refractory painful bone metastases

2020 ◽  
pp. 1-7
Author(s):  
Matthew D. Bucknor ◽  
Frandics P. Chan ◽  
Jessica Y. Matuoka ◽  
Patti K. Curl ◽  
James G. Kahn
Keyword(s):  
Cost Effectiveness ◽  
Bone Metastases ◽  
Time Horizon ◽  
Focused Ultrasound ◽  
Case Analysis ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Base Case Analysis ◽  
Painful Bone Metastases

Abstract Objective The aim of this study was to determine if magnetic resonance-guided focused ultrasound (MRgFUS) is cost-effective compared with medication, for refractory pain from bone metastases in the United States. Methods We constructed a Markov state transition model using TreeAge Pro software (TreeAge Software, Inc., Williamstown, MA, USA) to model costs, outcomes, and the cost-effectiveness of a treatment strategy using MRgFUS for palliative treatment of painful bone metastases compared with a Medication Only strategy (Figure 1). Model transition state probabilities, costs (in 2018 US$), and effectiveness data (quality-adjusted life-years [QALYs]) were derived from available literature, local expert opinion, and reimbursement patterns at two U.S. tertiary academic medical centers actively performing MRgFUS. Costs and QALYs, discounted at three percent per year, were accumulated each month over a 24-month time horizon. One-way and probabilistic sensitivity analyses were performed. Results In the base-case analysis, the MRgFUS treatment strategy costs an additional $11,863 over the 2-year time horizon to accumulate additional 0.22 QALYs, equal to a $54,160/QALY ICER, thus making MRgFUS the preferred strategy. One-way sensitivity analyses demonstrate that for the base-case analysis, the crossover point at which Medication Only would instead become the preferred strategy is $23,341 per treatment. Probabilistic sensitivity analyses demonstrate that 67 percent of model iterations supported the conclusion of the base case. Conclusions Our model demonstrates that MRgFUS is cost-effective compared with Medication Only for palliation of painful bone metastases for patients with medically refractory metastatic bone pain across a range of sensitivity analyses.

scholarly journals The Value and Sustainability of Ocrelizumab in Relapsing Multiple Sclerosis: A Cost-Effectiveness and Budget Impact Analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Paolo Angelo Cortesi ◽  
Damiano Paolicelli ◽  
Marco Capobianco ◽  
Paolo Cozzolino ◽  
Lorenzo Giovanni Mantovani
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Economic Impact ◽  
Impact Analysis ◽  
Budget Impact ◽  
Case Analysis ◽  
Base Case ◽  
Base Case Analysis ◽  
Effectiveness Analysis ◽  
The Cost

INTRODUCTION: The availability of ocrelizumab for the relapsing forms of multiple sclerosis (MS) in the Italian markets raised some questions about its economic impact and value compared to the alternative treatment options available.AIM: To assess the cost-effectiveness and budget impact of ocrelizumab compared to the most used second line disease modifying therapies (DMTs) in Italy.METHODS: The study was divided in two phases: Phase 1 – based on the development of a decision analytical Markov model to assess the cost-effectiveness of ocrelizumab compared to natalizumab and fingolimod, and Phase 2 – based on the development of a budget impact model to assess the economic impact of ocrelizumab in Italy. Both models used the National Health System perspective; a lifetime horizon was applied in the cost-effectiveness analysis and a 3-year time horizon in the budget impact. The cost-effectiveness analysis results were reported as incremental cost-effectiveness ratio (ICER) expressed as € per Quality Adjusted Life Year (QALY) gained, the budget impact analysis results were reported as difference in the overall budget (€) between a scenario with and without ocrelizumab.RESULTS: The two analyses reported ocrelizumab as a cost-effective option compared to natalizumab and fingolimod with a positive impact on the overall NHS budget. In the base-case analysis, the ICER was € 2,023 for ocrelizumab compared to fingolimod; while ocrelizumab resulted cost-saving compared to natalizumab. The sensitivity analysis confirmed the base-case analysis results. Further, the use of ocrelizumab was associated to a budget decrease of € 21 million (-2.6%) in a 3-year time horizon.CONCLUSION: The results of our cost-effectiveness and budget impact models reported ocrelizumab as an effective and efficient treatment in patients with relapsing forms of MS who failed a first line DMTs from the Italian NHS perspective.

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