Comparing Health Gains, Costs and Cost-Effectiveness of 100s of Interventions in Australia and New Zealand: An Online Interactive League Table

Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness (ACE) research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programmes, or using similar methodology, with: health gains quantified as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3–5% discount rates. Results We identified 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable disease; overweight and obesity; physical inactivity; salt; tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining >10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving. Conclusions League tables of comparably conducted evaluations illustrate the large health gain (and cost) variations per capita between interventions, in addition to cost-effectiveness. Further work can test the utility of this league table with policy makers and researchers.

Estimation of final standings in football competitions with a premature ending: the case of COVID-19

We study an alternative approach to determine the final league table in football competitions with a premature ending. For several countries, a premature ending of the 2019/2020 football season has occurred due to the COVID-19 pandemic. We propose a model-based method as a possible alternative to the use of the incomplete standings to determine the final table. This method measures the performance of the teams in the matches of the season that have been played and predicts the remaining non-played matches through a paired-comparison model. The main advantage of the method compared to the incomplete standings is that it takes account of the bias in the performance measure due to the schedule of the matches in a season. Therefore, the resulting ranking of the teams based on our proposed method can be regarded as more fair in this respect. A forecasting study based on historical data of seven of the main European competitions is used to validate the method. The empirical results suggest that the model-based approach produces more accurate predictions of the true final standings than those based on the incomplete standings.

The relationship between team ability and home advantage in the English football league system

The existence of home advantage (HA) has been found in a variety of team sports including football. There is a paucity of research on the relationship between team ability and HA in domestic football leagues and the findings of previous studies are inconclusive. Using longitudinal data from the top four football divisions in England, this study investigates the influence of team ability on the HA of teams. The data collected for this study spans 24 seasons from 1995/96 to 2018/19 and includes 48,864 matches from the English Premier League (n = 9120), the Championship (n = 13,248), League One (n = 13,248) and League Two (n = 13,248). Team ability was interpreted in two ways: (1) the division in which teams play and (2) their league table position within each division. For both the divisional and positional analysis, HA was calculated as the ratio of home points to total points achieved by teams in each season under review. Evidence of a statistically significant HA was found in all four divisions and for teams of all abilities within each division. Small but statistically significant differences in HA were observed between divisions and between high, moderate and low ability teams within divisions.

Adding an international lens to the university striving model: How both global and national indicators influence the Chinese higher education hierarchy

Institutions that are most attuned to university rankings are known as “strivers.” These striving universities chase prestige by altering policies to match league table indicators, while also benchmarking against elite universities within the domestic hierarchy. However, this model has mostly been ascribed to studies in the United States and it has not been considered in non-Western contexts. Through interviews with 48 academics and administrators from Chinese universities, the research explores striving behaviors in China and expands the US-centric model to include global competition with international rankings. The findings show that striving universities in China have placed considerable emphasis on international rankings, but distinctions from the central government have still dominated competition within the domestic hierarchy. Pressures from the various rankings must be balanced between the local and global. These new considerations offer a global outlook on the domestic university striving model.

Decision Rules in Cost-Utility Analysis of Health Technologies

This review identified 4 distinct decision rules used in the cost-utility analysis of health technologies: threshold incremental cost-effectiveness ratio (ICER), league table, decision making (DM) plane, and linear programming. The threshold ICER is currently the most widely-used approach. However, it comes with certain disadvantages: unrealistic assumptions (perfect divisibility and constant return to scale), arbitrarily-set threshold, and ignorance of opportunity cost. League table involves comparison of several health technologies simultaneously. The issue related to comparability between evaluation of each health technology limits its application. DM plane ensures improvement in health and sufficient resources mostly by disinvestment of currently funded programs. Its major disadvantages are difficulties in identification and disinvestment of such programs. Linear programming is, in theory, the best approach. Ideally, it requires sufficient data from all currently-funded or potential health technologies in conducting the analysis. Hence, the approach is somewhat impractical. Ongoing development in the field of data science and increasing availability of big data might enable its application in the near future. Given the mentioned shortcomings, pragmatic applications of league table and DM plane use them to evaluate competitive treatment programs for single health conditions. Using linear programming in prioritizing health programs was proven possible at the district level.

QALY league table of Iran: a practical method for better resource allocation

Background The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. Methods A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. Results In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. Conclusions However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.

Levelling the playing field: The effect of including widening participation in university league tables

Nationally and internationally, universities are ranked in university league tables (ULTs). Sustained academic criticism of the rationale and methodology of compiling ULTs has not stopped these rankings exerting considerable pressure on the decisions of university managers. The compilation of ULTs is an inherently political act, with the choice and weighting of metrics resulting in particular characteristics of individual institutions being rewarded or penalised. One aspect that is currently not considered by league tables is the diversity of the student intake, and the extent to which an institution has been successful in widening participation (WP) in higher education (HE). The need to take action is reflected in target 4.3 of the fourth United Nations Sustainable Development Goal (SDG 4), which aims to “ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university” by 2030. This article explores how current ULT metrics for universities in the United Kingdom (UK) relate to WP. Using publicly available data, the authors found that over 75% of UK league table metrics are negatively related to WP. This has the effect of making institutions with a diverse student body significantly more likely to be lower down in the league tables. The worst relationship with WP is for entry standards. Universities which recruit high-performing students are actively rewarded in the league tables; this fails to recognise that students with high entry grades are more likely to come from privileged backgrounds. The authors developed a ULT which includes a WP score as an explicit league table metric and found that their WP-adjusted table removed the negative relationship between WP and league table rank, resulting in a somewhat fairer comparison between universities. They conclude that ULT compilers have an ethical duty to improve their definition of a “good” university, which in the current HE environment of the UK must include WP. The authors believe this should be an urgent priority for the sector, so that universities with a commitment to widening participation can be recognised and rewarded.

Portugal: The PISA Effects on Education

From the bottom of the league table for PISA 2000 Portugal has raised to the OCDE average being the only OECD member that showed, up to PISA 2018, consistent growth in reading, mathematics, and science. This chapter gives a brief description of the Portuguese Education system and how PISA outcomes have shaped Portuguese education policies. It identifies the policies that probably explain the improvement in PISA and pinpoints weakness of the Portuguese education system through the lenses of PISA.