scholarly journals Control and Cost-benefit Analysis of Fast Spreading Diseases: The case of Ebola

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Romarie Rosado Morales ◽  
Lauren Charles-Smith ◽  
Brent Daniel
Keyword(s):  
Infectious Disease ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Professionals ◽  
Disease Incidence ◽  
Cost Benefit ◽  
Control Methods ◽  
Special Equipment ◽  
Policy Makers ◽  
The Cost

IntroductionMitigating the spread of infectious disease is of great importancefor policy makers. Taking the recent outbreak of Ebola as an example,it was difficult for policy makers to identify the best course of actionbased on the cost-effectiveness of what was available.In effort to address the needs of policy makers to mitigate the spreadof infectious disease before an outbreak becomes uncontrollable, wehave devised a cost-benefit disease control model to simulate theeffect of various control methods on disease incidence and the costassociated with each of the scenarios. Here, we present a case studyof Ebola used to quantify the cost effectiveness of vaccination andisolation methods to minimize the spread of the disease. We evaluatethe impact of changing strategy levels on the incidence of the diseaseand address the benefits of choosing one strategy over the other withregards to cost of vaccine and isolation.MethodsDisease.We use a general SEIRJ model for disease transmission.Here, S-Susceptible, E- Exposed (latent), IA– Infected (asymptomatic),IM– Infected (mild symptoms), IS– Infected (severe symptoms),JM– Isolated (mild symptoms at home), JS– Isolated (severesymptoms in hospital), and R- Recovered individuals. In this model,we consider the dynamics of the system and the effect of the relativetransmissibility of isolated individuals (L) compared to other infectedindividuals1.Cost.Ebola vaccination and treatment are very expensive andnot widely available. Some preliminary data shows that it will take$73 million (M) to produce 27 M vaccines2plus the cost for vaccinedelivery and health care professionals (not included here). On theother hand, the treatment for Ebola in the U.S. would cost $25,000dollars a day per person3to ensure proper isolation and adequate care(treatment, health care professionals, facilities and special equipment).Although not included in this research, the proper isolation of Ebolapatients would also lead to a loss in hospital revenue of $148,000per day due to reduced patient capacity3. Here, we use $27,000 perindividual hospitalized per day and $2.70 per person vaccinated.Model.To evaluate the cost-effectiveness of control methods ondisease transmission, we assessed the affect of different levels ofvaccination coverage on the resulting number of infected individuals.Then, we calculated the overall estimated cost of vaccination andresulting hospitalization for each scenario to identify the lowest cost-benefit ratio.ResultsUsing a base population of 10 M individuals, we ran scenarios fordifferent levels of vaccination (μ= 0.01, 0.05, 0.1) while varying therelative transmissibility of isolated individuals (L = 0.5, 0.6, 0.65).For each combination, we calculated the incidence, vaccination andhospitalization cost per individual per day (Fig 1). We note that anincrease in the relative transmissibility of isolated individuals leads toa higher number of infected people and, therefore, a reduced numberof candidates for vaccination and an overall increase in cost. Since thecost of vaccination is 1 ten-thousandth of the cost of hospitalization,our results clearly show the cost-benefit of vaccinating over hospitaltreatment. In every scenario studied, we observed a measurablereduction in disease incidence when vaccinating a higher fraction ofthe population compared to isolating individuals post infection.ConclusionsGiven these preliminary results, we plan to extend the frameworkof our model to a dynamic control system where we consider the costof vaccination and isolation embedded in the system of differentialequations. This approach will allow us see the best availablecontrol implementation while minimizing the cost of treatment andvaccination.KeywordsControl; Epidemiological Modeling; Transmission Dynamics; Cost;EBOLAReferences1. Chowell D, Castillo-Chavez C, Krishna S, Qiu X, Anderson KS. 2015.Modeling the effect of early detection of Ebola.The Lancet InfectiousDiseases, 15(2), 148-149.2. http://www.forbes.com/sites/danmunro/2014/10/23/head-of-gsk-ebola-vaccine-research-can-we-even-consider-doing-a-trial/#3cbd929665db3. http://www.usatoday.com/story/news/nation/2014/11/25/ebola-costs-add-up/19346913/

scholarly journals Factors Affecting the Cost Effectiveness of Antibiotics

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Steven Simoens
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Antibiotic Treatment ◽  
Bacterial Infections ◽  
Guideline Implementation ◽  
Economic Evaluations ◽  
Policy Makers ◽  
Factors Affecting ◽  
The Cost ◽  
Care Costs

In an era of spiraling health care costs and limited resources, policy makers and health care payers are concerned about the cost effectiveness of antibiotics. The aim of this study is to draw on published economic evaluations with a view to identify and illustrate the factors affecting the cost effectiveness of antibiotic treatment of bacterial infections. The findings indicate that the cost effectiveness of antibiotics is influenced by factors relating to the characteristics and the use of antibiotics (i.e., diagnosis, comparative costs and comparative effectiveness, resistance, patient compliance with treatment, and treatment failure) and by external factors (i.e., funding source, clinical pharmacy interventions, and guideline implementation interventions). Physicians need to take into account these factors when prescribing an antibiotic and assess whether a specific antibiotic treatment adds sufficient value to justify its costs.

Cost Effectiveness and Cost Benefit of Vaccination Against Pneumococcal Pneumonia. Implications for Clinical Practice

1982 ◽  
Vol 3 (4) ◽  
pp. 299-302 ◽  
Author(s):  
Jane Sisk Willems
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Cost Effectiveness ◽  
Pneumococcal Pneumonia ◽  
Cost Benefit Analysis ◽  
Pneumococcal Vaccination ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Cost Of Treatment ◽  
The Cost

AbstractThe economic techniques of cost-effectiveness and cost-benefit analysis have provided useful insights into the potential advantages of vaccination against pneumococcal pneumonia. They suggest that the cost of vaccinating persons 65 years and older and perhaps younger persons with high risk conditions would be reasonable when compared with the cost of treatment for pneumococcal pneumonia. These findings, together with other considerations, may guide physicians and health care policymakers in deciding which individuals might be expected to benefit from pneumococcal vaccination.

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.

Principles of Cost-Effective Resource Allocation in Health Care organizations

1990 ◽  
Vol 6 (1) ◽  
pp. 93-103 ◽  
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.

Home Visitation Investment

PEDIATRICS ◽  
1992 ◽  
Vol 89 (1) ◽  
pp. 169-169
Author(s):  
NORMAN J. SISSMAN
Keyword(s):  
Health Care ◽  
Home Visits ◽  
Cost Benefit ◽  
Home Visitation ◽  
Benefit Ratio ◽  
Health Care Resources ◽  
Detailed Consideration ◽  
Cost Benefit Ratio ◽  
Women And Children ◽  
The Cost

To the Editor.— Two recent reviews in Pediatrics1,2 provide much interesting information on the effect of home visits on the health of women and children. However, I was disappointed not to find in either article more than token reference to the cost of the programs reviewed. In this day of increasingly scarce health care resources, we no longer have the luxury of evaluating programs such as these without detailed consideration of their cost-benefit ratio.

Generic Prescribing, Generic Substitution, and Therapeutic Substitution

PEDIATRICS ◽  
1987 ◽  
Vol 79 (5) ◽  
pp. 835-835
Author(s):  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Generic Substitution ◽  
Drug Product ◽  
Therapeutic Substitution ◽  
General Acceptance ◽  
Conflicting Evidence ◽  
Therapeutic Category ◽  
Generic Prescribing ◽  
The Cost

Pressures generated by a constellation of professional consumer, legislative, and health care provider vider groups in this era of increasing health care costs have led to enactment of generic substitution laws in 50 states. The general acceptance of this concept, despite conflicting evidence that it has reduced the cost of prescription items to the consumer, has led to the concept of therapeutic substitution. Considerable confusion exists among health care professionals regarding the precise meaning of these concepts. Generic prescribing is the prescribing of a drug by a physician using the generic name. This leaves the choice of brand to the dispensing pharmacist. Generic substitution is a pharmacist-initiated act by which a different brand or an unbranded drug product is dispensed instead of a drug brand that was prescribed by the physician. This means substituting the same chemical entity in the same dosage form for one marketed by a different company. Therapeutic substitution is a pharmacist-initiated act by which a pharmaceutical or therapeutic alternate for the physician-prescribed drug is dispensed without consulting the physician. This denotes replacement of the prescribed drug with a chemically different drug within the same therapeutic category, eg, hydrochlorothiazide for furosemide; ranitidine for cimetidine; chloramphenicol for erythromycin. In 1976, the AAP Committee on Drugs published a commentary in Pediatrics (1976;57:275-277) on generic prescribing and concluded that "the lack of data on bioavailability and bioequivalence in children precludes blanket support of generic prescribing for infants and children." The Committee recently reviewed this issue and concluded that the situation has changed little during the past decade.

Avarice, Inefficiency, and Inequality: An International Health Care Tale

1977 ◽  
Vol 7 (2) ◽  
pp. 179-190
Author(s):  
Alan Maynard
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Care Delivery ◽  
Medical Profession ◽  
International Health ◽  
West Germany ◽  
Health Care Outcomes ◽  
Care Outcomes ◽  
Health Care Delivery Systems ◽  
The Cost

The paper is concerned with impact of a medical profession, physicians, on the delivery of health care. The basic economic motivation of self-interest and avarice has led this profession to produce health care outcomes which are inequitable and inefficient. In the first section of the paper the regional geographical distribution of physicians in four disparate health systems—England, Ireland, France, and West Germany-is analyzed and found to be highly unequal. The next section is concerned with the efficacy of therapies and the cost-effectiveness of health care delivery systems in a variety of countries. The final section discusses how health care can be more equitably and more efficiently delivered. It is argued that both markets and bureaucracies are likely to be inadequate unless carefully monitored. In particular, there is a great need to investigate the cost-effectiveness of therapies and then persuade physicians, via pecuniary and nonpecuniary incentives, to behave in a manner which leads to more equitable and efficient health care outcomes.

Sustainable Distribution Design: Contrasting Disposable, Recyclable, and Reusable Strategies for Packaging Materials Using a Total Cost Analysis With an Illustration of Milk Distribution

2010 ◽  
Author(s):  
Sri Satya Kanaka Nagendra Jayanty ◽  
William J. Sawaya ◽  
Michael D. Johnson
Keyword(s):  
Cost Benefit ◽  
Packaging Materials ◽  
Policy Makers ◽  
Specific Product ◽  
Cost Structures ◽  
Trade Offs ◽  
Technological Advances ◽  
The Cost ◽  
Total Cost Analysis ◽  
Plastic Containers

Engineers, policy makers, and managers have shown increasing interest in increasing the sustainability of products over their complete lifecycles and also from the ‘cradle to grave’ or from production to the disposal of each specific product. However, a significant amount of material is disposed of in landfills rather than being reused in some form. A sizeable proportion of the products being dumped in landfills consist of packaging materials for consumable products. Technological advances in plastics, packaging, cleaning, logistics, and new environmental awareness and understanding may have altered the cost structures surrounding the lifecycle use and disposal costs of many materials and products resulting in different cost-benefit trade-offs. An explicit and well-informed economic analysis of reusing certain containers might change current practices and results in significantly less waste disposal in landfills and in less consumption of resources for manufacturing packaging materials. This work presents a method for calculating the costs associated with a complete process of implementing a system to reuse plastic containers for food products. Specifically, the different relative costs of using a container and then either disposing of it in a landfill, recycling the material, or reconditioning the container for reuse and then reusing it are compared explicitly. Specific numbers and values are calculated for the case of plastic milk bottles to demonstrate the complicated interactions and the feasibility of such a strategy.

scholarly journals Views of health care professionals and policy-makers on the use of surveillance data to combat antimicrobial resistance

2020 ◽  
Author(s):  
Mustafa Al-Haboubi ◽  
Andrew Trathen ◽  
Nick Black ◽  
Elizabeth Eastmure ◽  
Nicholas Mays
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Health Care Professionals ◽  
Secondary Care ◽  
Local Level ◽  
Surveillance Data ◽  
Data Availability ◽  
Electronic Prescribing ◽  
Data Systems ◽  
Policy Makers

Abstract Background Providing healthcare professionals with health surveillance data aims to support professional and organisational behaviour change. The UK Five Year Antimicrobial Resistance (AMR) Strategy 2013 to 2018 identified better access to and use of surveillance data as a key component. Our aim was to determine the extent to which data on antimicrobial use and resistance met the perceived needs of health care professionals and policy-makers at national, regional and local levels, and how provision could be improved. Methods We conducted 41 semi-structured interviews with national policy makers in the four Devolved Administrations and 71 interviews with health care professionals in six locations across the United Kingdom selected to achieve maximum variation in terms of population and health system characteristics. Transcripts were analysed thematically using a mix of a priori reasoning guided by the main topics in the interview guide together with themes emerging inductively from the data. Views were considered at three levels - primary care, secondary care and national - and in terms of availability of data, current uses, benefits, gaps and potential improvements. Results Respondents described a range of uses for prescribing and resistance data. The principal gaps identified were prescribing in private practice, internet prescribing and secondary care (where some hospitals did not have electronic prescribing systems). Some respondents under-estimated the range of data available. There was a perception that the responsibility for collecting and analysing data often rests with a few individuals who may lack sufficient time and appropriate skills. Conclusions There is a need to raise awareness of data availability and the potential value of these data, and to ensure that data systems are more accessible. Any skills gap at local level in how to process and use data needs to be addressed. This requires an identification of the best methods to improve support and education relating to AMR data systems.

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