scholarly journals Cost/effectiveness model of dabigatran in the prevention of venous thromboembolism in major orthopedic surgery: Adaptation for Italy

2010 ◽  
Vol 11 (2) ◽  
pp. 91-101 ◽  
Author(s):  
Orietta Zaniolo ◽  
Sorrel E. Wolowacz ◽  
Lorenzo Pradelli
Keyword(s):  
Cost Effectiveness ◽  
Orthopedic Surgery ◽  
Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario ◽  
Life Years ◽  
Major Orthopedic Surgery ◽  
Acquisition Costs ◽  
Alternative Scenarios ◽  
The Uk

Venous thromboembolic events (VTE) represent a dangerous complication of major orthopedic surgery, especially in total hip replacement (THR) and total knee replacement (TKR) procedures. Dabigatran etexilate (DBG), a direct and reversible thrombin inhibitor, has proven its non-inferiority with respect to enoxaparin 40mg once-daily, a low molecular weight heparin (LMWH), in the prevention of VTE in patients undergoing THR and TKR, in the RE-NOVATE and RE-MODEL trials, respectively. The objective of this analysis was to estimate cost/effectiveness and cost/utility of DBG compared to standard care for the prevention of VTE in Italy. A decision analytic, Markov-chain based model, originally developed for the UK, was adapted to the Italian context. The adaptation involved cost and demographic characteristics, clinical and utility data were not altered. Costs were taken from national observational studies, where available. Otherwise, current prices and tariffs were applied. Resource consumption was derived from practice guidelines or taken from the UK model. According to the prevalent national practice, extended prophylaxis is considered for both surgical procedures. The time horizon of the analysis was patients’ lifetimes. In order to consider different alternatives for drug dispensation and, consequently, National Health Service acquisition costs, alternative scenarios were developed. A further scenario, excluding LMWHs administration costs (“worst-case” scenario), was considered. Compared to LMWHs, DBG was associated with an expected increase of 0.019 life-years (LYs) and 0.014 quality-adjusted life-years (QALYs) per THR patient and of 0.024 LYs and 0.019 QALYs per TKR patient. DBG-related costs were lower than LMWH in both procedures, with a mean difference ranging from 89 to 116 € for THR, and 107 to 142 for TKR, depending on the LMWH product. Higher acquisition costs for DBG were completely offset and inverted by avoided administration expenses and, to a lesser extent, by savings in VTE management. The results of alternative scenarios confirm the dominance of DBG, with a net saving ranging between 119 €, when both drugs were obtained by auction, and 32 €, when the auction price was applied but DBG was dispensed through territorial pharmacies. The corresponding estimates for TKR were 148 and 54 €. In the “worst-case” scenario, DBG was no longer dominant, with a cost per LYs of 2,788 and 4,514 € and a cost per QALY gained of 3,619 and 5,926 €, for TKR and THR respectively. In conclusion, DBG dominated LMWHs, and was cost-saving and non-inferior in terms of efficacy and safety, except for in the “worst-case” scenario, in which the incremental cost/effectiveness ratio estimate was lower than commonly accepted thresholds in health economics.

scholarly journals Rotational thromboelastometry in the perioperative period of cardiac surgeries: cost-effectiveness analysis and budget impact

2020 ◽  
Vol 12 (3) ◽  
pp. 173-188
Author(s):  
André Soares Santos ◽  
◽  
Ananda Jessyla Felix Oliveira ◽  
Magda Lourenço Fernandes ◽  
José Luiz dos Santos Nogueira ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cost Effective ◽  
Perioperative Period ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario

Objective: The transfusion of blood components and blood products in cardiac surgery patients can be guided by protocols based on standard laboratory tests and/or clinical decisions (Standardof-Care, SOC) or viscoelastic haemostatic assays (VHA). The aim of this study is to evaluate the cost-effectiveness and budget impact of VHAs compared to SOC. Methods: A decision tree model was built in TreeAge Pro® 2009. Costs and benefits were taken from the medical literature. The costeffectiveness was evaluated in a base-case scenario and a worst-case scenario, considering low costs of adverse events. The budget impact was evaluated from data taken from Datasus. Cost data were measured in 2019 USD and outcomes were measured in QALYs. Results: VHAs were considered dominant in the base-case scenario and very cost-effective in the worst-case scenario (ICER = $1,083.21 USD/QALY). The budget impact analysis varied from a cost-saving result in the base-case scenario to a reasonable increase in cost in the worst-case scenario. Since the total market share of the technology is unlikely, a reasonable estimative for the base-case scenario and the worst-case scenario are about -$275 million USD and $132 million USD, respectively. Conclusion: We conclude that the VHAs are cost-effective and should be recommended for the use in the perioperative period of cardiac surgeries, especially for patients with a high risk of hemorrhage or coagulation problems.

Reducing Probabilistic Weather Forecasts to the Worst Case Scenario: Anchoring Effects

2008 ◽  
Author(s):  
Sonia Savelli ◽  
Susan Joslyn ◽  
Limor Nadav-Greenberg ◽  
Queena Chen
Keyword(s):  
Case Scenario ◽  
Worst Case ◽  
Weather Forecasts ◽  
Worst Case Scenario ◽  
Anchoring Effects

scholarly journals A Comparison of Match Demands Using Ball-in-Play versus Whole Match Data in Professional Soccer Players of the English Championship

Sports ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 76
Author(s):  
Dylan Mernagh ◽  
Anthony Weldon ◽  
Josh Wass ◽  
John Phillips ◽  
Nimai Parmar ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Soccer Players ◽  
Training Methods ◽  
Case Scenario ◽  
Worst Case ◽  
Repeated Measures Design ◽  
Worst Case Scenario ◽  
Professional Soccer ◽  
Peak Match ◽  
Playing Time

This is the first study to report the whole match, ball-in-play (BiP), ball-out-of-play (BoP), and Max BiP (worst case scenario phases of play) demands of professional soccer players competing in the English Championship. Effective playing time per soccer game is typically <60 min. When the ball is out of play, players spend time repositioning themselves, which is likely less physically demanding. Consequently, reporting whole match demands may under-report the physical requirements of soccer players. Twenty professional soccer players, categorized by position (defenders, midfielders, and forwards), participated in this study. A repeated measures design was used to collect Global Positioning System (GPS) data over eight professional soccer matches in the English Championship. Data were divided into whole match and BiP data, and BiP data were further sub-divided into different time points (30–60 s, 60–90 s, and >90 s), providing peak match demands. Whole match demands recorded were compared to BiP and Max BiP, with BiP data excluding all match stoppages, providing a more precise analysis of match demands. Whole match metrics were significantly lower than BiP metrics (p < 0.05), and Max BiP for 30–60 s was significantly higher than periods between 60–90 s and >90 s. No significant differences were found between positions. BiP analysis allows for a more accurate representation of the game and physical demands imposed on professional soccer players. Through having a clearer understanding of maximum game demands in professional soccer, practitioners can design more specific training methods to better prepare players for worst case scenario passages of play.

Legal adaptability in Elbonia

2006 ◽  
Vol 2 (4) ◽  
pp. 393-408 ◽  
Author(s):  
Mathias M. Siems
Keyword(s):  
Empirical Data ◽  
Baltic States ◽  
Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario ◽  
The Law

Law has to be able to respond to new or changing circumstances. This ‘legal adaptability’ may be more important than details in the ‘law as such’. However, its meaning and its significance have not yet been analysed in detail. Thus, legal adaptability will be examined in this article. It looks at the worst case scenario by discussing a fictional country (Elbonia) where legal adaptability is poor, and identifies the main adaptability criteria. By using empirical data from the three Baltic States (Lithuania, Latvia, Estonia), it also provides an example of how to ascertain the degree of legal adaptability of particular countries.

Discussion of the Worst Case Scenario of FLD0

2000 ◽  
Author(s):  
Naji Arwashan
Keyword(s):  
Simple Formula ◽  
Forming Limit Diagram ◽  
Forming Limit ◽  
Vertical Position ◽  
Engineering Practice ◽  
Case Scenario ◽  
Worst Case ◽  
Grid Analysis ◽  
Worst Case Scenario ◽  
Minimum Value

Abstract The Forming Limit Diagram is used in circle grid analysis to check the safety of a formed panel. The shape of the Forming Limit Diagram for steel is always the same, it is only the vertical position of the diagram that varies depending on the value of FLD0. For steel, FLD0 is widely accepted to be dependent on the thickness and n value which are both inherently indeterministic, and can exhibit variations, small or large, depending on the manufacturing process. To account for this variability in determining the safety of a formed panel, the engineering practice in many companies is to use a minimum value for FLD0 called Worst Case Scenario, because it is calculated using minimum values for both t and n. This paper presents a different and better approach to calculate the minimum value of FLD0. The approach is based on probabilistic concepts, and allows the calculation of a minimum value for FLD0 that is related to a certain probability of occurrence. The derivation technique used in the paper is borrowed from Reliability Analysis and tailored to solve our problem. The derivation leads to a simple formula that can be easily used. The minimum value of FLD0 calculated according to the paper is more accurate than the Worst Case Scenario, and provides better cost saving since it is always greater than the Worst Case Scenario value.

Genetic Family Histories: An Aid to Social Work Assessment

1993 ◽  
Vol 74 (4) ◽  
pp. 195-206 ◽  
Author(s):  
Barbara Bernhardt ◽  
Julia B. Rauch
Keyword(s):  
Social Work ◽  
Genetic Services ◽  
Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario ◽  
Family Histories ◽  
Work Assessment ◽  
Focus Depth ◽  
Service Training ◽  
Agency Design

The focus, depth, and use of genetic family histories vary depending on the agency purpose and the client's presenting problem. Failure to obtain genetic family histories can result in inaccurate assessment and incomplete or misdirected services. In the worst-case scenario, failure to obtain such information and to advise clients of available genetic services are potential grounds for malpractice and wrongful-adoption suits. The authors discuss approaches to obtaining and recording genetic family histories and present criteria for referral to genetic services. The authors recommend that agency administrators consider consulting with a genetic professional to determine the appropriate focus of genetic family histories within the agency, design a protocol, and arrange in-service training in use of the protocol.

scholarly journals Scalable modEls of Community rehAbilitation for Individuals Recovering From COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol—“SeaCole Cohort Evaluation”

2021 ◽  
Vol 9 ◽  
Author(s):  
Benjamin Kelly ◽  
Aidan Innes ◽  
Marc Holl ◽  
Laura Mould ◽  
Susan Powell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Outcome Measures ◽  
Well Being ◽  
Rehabilitation Programme ◽  
Secondary Outcome ◽  
Rehabilitation Service ◽  
Community Rehabilitation ◽  
Life Years ◽  
The Uk

Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community.Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment.Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19.Trial Registration: Current Trials ISRCTN ISRCTN14707226Web: http://www.isrctn.com/ISRCTN14707226

Sign in / Sign up

Export Citation Format

Share Document