Aspirin with Low-Dose Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention: A Cost Per Outcome Analysis

Introduction: Secondary prevention of cardiovascular events among patients with diagnosed cardiovascular disease and high ischemic risk poses a significant challenge in clinical practice. The combinations of aspirin with low dose (LD) Ticagrelor or LD-Rivaroxaban have shown superiority in preventing major adverse cardiovascular events (MACE) than aspirin treatment alone. The comparative value for money of these two regimens remains unexplored.Methods: We analyzed each regimen's annual cost needed to treat (CNT) by multiplying the annualized number needed to treat (aNNT) by the annual cost of each drug. The aNNTs were based on outcome data from PEGASUS TIMI-54 and COMPASS trials. Scenario analyses were performed to overcome variances in terms of population risk. Costs were based on 2021 US prices. The primary outcome was defined as CNT to prevent one MACE across the two regimens. Secondary value analysis was performed for myocardial infarction (MI), stroke, and CV death as separate outcomes. Results: The aNNTs to prevent MACE with LD-Ticagrelor and with LD-Rivaroxaban were 229 [95% confidence interval (CI):141-734] and 147 (95%CI:104-252), respectively. At an annual cost of 3,618$ versus 4,308$, the corresponding CNTs were 828,478$ (95%CI:510,111$-2,655,471$) with LD-Ticagrelor and 633,270$ (95%CI:448,028$-1,085,607$) with LD-Rivaroxaban. LD-Rivaroxaban.Conclusion: Combining aspirin with LD-Rivaroxaban provides better value for money than with LD-Ticagrelor for secondary prevention of MACE.

Economic Effects of Occupational Therapy Services for Adults in Acute and Subacute Care Settings: A Systematic Review

Importance: Research supports the clinical effectiveness of hospital-based occupational therapy to improve functional outcomes, but no synthesis of economic evaluations of occupational therapy services provided in these settings has been published. Objective: To determine the economic value of occupational therapy services in acute and subacute care settings. Data Sources: MEDLINE, CINAHL, CENTRAL, EconLit, Embase, National Health Services Economic Evaluation Database, PsycINFO, ProQuest (Health and Medicine and Social Science subsets only), OTseeker, and gray literature. Study Selection and Data Collection: Eligible studies used trial-based or modeled economic analyses and included an adult population (ages ≥18 yr) and occupational therapy assessments or interventions provided in acute and subacute care. Two authors independently assessed abstracts and then full text. Articles were then appraised using the Evers Consensus on Health Economic Criteria. Findings: The authors identified 13,176 unique abstracts and assessed 190 full-text articles for eligibility. Ten studies were included in the systematic review; they varied in their primary objectives, methodology, costs, and outcomes. Studies examined the cost–benefit, cost-effectiveness, cost–utility, or cost minimization of a range of occupational therapy services. Five studies suggested that occupational therapy services offer value for money (lower cost, higher benefit); 4 suggested that they offer higher cost and benefits. One study that investigated upper limb rehabilitation did not indicate value for money. Conclusions and Relevance: The findings suggest that occupational therapy for adults poststroke and post–traumatic brain injury, acute discharge planning, and pre– and post–hip replacement is cost-effective, but further research is needed to substantiate these findings. What This Article Adds: The findings provide preliminary evidence of the economic effectiveness of occupational therapy in acute and subacute care.

Dynamics of Performing Aesthetics in Architecture: A Critical Study

In architecture, Venustas (aesthetics) is always considered an important attribute along with Firmitas (firmness) and Utilitas (usefulness). Pursuing aesthetics/ beauty is one of the architect’s primary roles. However, it is critical to comprehend ‘What is aesthetics?’ and its implications for the built-unbuilt environment and human beings. In a world where everything is changing, are the definitions, concepts, and parameters of aesthetics consistent? Is it subject to change over time? If so, should architectural students and professionals be aware of it and trained in it? This study aims to critically assess and analyse the dynamic aspects of aesthetics from 3300 BCE to present and establish the ‘best fit’ definition of aesthetics in architecture. The methodology used for the study is a mixed-method approach, a comprehensive analysis of relevant literature to investigate the origin of aesthetics and aesthetics in philosophy, environmental psychology and architecture. The aspects, criteria and sub-criteria identified from the analysis. The consensus is taken from expert interviews and a questionnaire survey (n=72). Findings reveal that aesthetics in architecture is dynamic/ ever-changing. It has nine contributing aspects that make aesthetics a performing aesthetics that emphasises the enhanced worth and value for money invested. These nine aspects are spatial organisation, functional efficiency, social, psychological, environmental, maintenance, sustainability, technology, and economics.

Evaluasi Pengukuran Kinerja Pemerintah Desa Dengan Menggunakan Konsep Value For Money

This study aims to measure and analyze the financial performance of the Tembokrejo Village Office, Gumukmas District, Jember Regency in 2017 to 2020 using the value for money method. Value for money is a concept of managing public sector organizations based on three main elements, namely economy, efficiency, and effectiveness. This research design uses a qualitative descriptive that describes or factual painting of facts and actual conditions on the performance of the village government. In this study, the population and sample taken were the Village Revenue and Expenditure Budget 2017–2020. The sampling technique used the census method. Data obtained by means of observation, documentation, and literature study. The results showed that the financial performance of the Tembokrejo Village Office, Gumukmas District, Jember Regency 2017–2020 in the 2017 economic measurement was not economical, 2018 was economically balanced, 2019 was not economical, and 2020 was economical. In the 2017–2020 efficiency measurement, it is stated that the efficiency is balanced every year. In measuring the effectiveness of 2017 effective, 2018 effectively balanced, 2019 effective, and 2020 effective.

Economic evaluation of population-based type 2 diabetes mellitus screening at different healthcare settings in Vietnam

Introduction Few economic evaluations have assessed the cost-effectiveness of screening type-2 diabetes mellitus (T2DM) in different healthcare settings. This study aims to evaluate the value for money of various T2DM screening strategies in Vietnam. Methods A decision analytical model was constructed to compare costs and quality-adjusted life years (QALYs) of T2DM screening in different health care settings, including (1) screening at commune health station (CHS) and (2) screening at district health center (DHC), with no screening as the current practice. We further explored the costs and QALYs of different initial screening ages and different screening intervals. Cost and utility data were obtained by primary data collection in Vietnam. Incremental cost-effectiveness ratios were calculated from societal and payer perspectives, while uncertainty analysis was performed to explore parameter uncertainties. Results Annual T2DM screening at either CHS or DHC was cost-effective in Vietnam, from both societal and payer perspectives. Annual screening at CHS was found as the best screening strategy in terms of value for money. From a societal perspective, annual screening at CHS from initial age of 40 years was associated with 0.40 QALYs gained while saving US$ 186.21. Meanwhile, one-off screening was not cost-effective when screening for people younger than 35 years old at both CHS and DHC. Conclusions T2DM screening should be included in the Vietnamese health benefits package, and annual screening at either CHS or DHC is recommended.

ANALISIS PENGARUH AKUNTABILITAS KEUANGAN DAERAH, VALUE FOR MONEY DAN PENGAWASAN TERHADAP REALISASI PENGELOLAAN KEUANGAN DAERAH PADA PEMERINTAH KOTA BANJARBARU TAHUN 2020

Abstrak: Tujuan penelitian adalah 1) untuk mengetahui dan menganalisa pengaruh secara parsial variabel akuntabilitas keuangan daerah terhadap realisasi pengelolaan keuangan daerah di Pemerintah Kota Banjarbaru. 2) untuk mengetahui dan menganalisa pengaruh secara parsial variabel value for Money terhadap realisasi pengelolaan keuangan daerah di Pemerintah Kota Banjarbaru. 3) untuk mengetahui dan menganalisa pengaruh secara parsial variabel pengawasan terhadap realisasi pengelolaan keuangan daerah di Pemerintah Kota Banjarbaru. 4) untuk mengetahui dan menganalisa pengaruh secara simultan variabel akuntabilitas keuangan daerah, value for money, dan pengawasan terhadap realisasi pengelolaan keuangan daerah di Pemerintah Kota Banjarbaru. Penelitian ini merupakan penelitian kuantitatif dengan menggunakan data yang diperoleh dari kuesioner dan diukur dengan menggunakan skala likert. Teknik pengambilan sampel dalam penelitian ini menggunakan purposive sampling. Sampel yang digunakan dalam penelitian ini adalah pegawai Satuan Kerja Perangkat Daerah (SKPD) Kota Banjarbaru yang berkaitan dengan bidang keuangan sebanyak 62 pegawai. Teknik analisis data yang digunakan yaitu uji regresi linier berganda. Data dianalisis dengan menggunakan software SPSS versi 22. Hasil dari penelitian ini menunjukan bahwa: (1) terdapat pengaruh yang positif dan signifikan antara akuntabilitas keuangan daerah terhadap realisasi pengelolaan keuangan daerah, (2) tidak terdapat pengaruh yang positif dan signifikan antara value for money terhadap realisasi pengelolaan keuangan daerah, (3) terdapat pengaruh yang positif dan signifikan antara pengawasan terhadap realisasi pengelolaan keuangan daerah, (4) terdapat pengaruh yang signifikan antara akuntabilitas keuangan daerah, value for money, dan pengawasan terhadap realisasi pengelolaan keuangan daerah. Kata kunci: akuntabilitas keuangan daerah, value for money, pengawasan

Pengaruh Akuntabilitas Keuangan Daerah, Value For Money, Kejujuran, Transparansi, Dan Pengawasan Terhadap Pengelolaan Keuangan Daerah (Studi Kajian Pada Pemerintah Kabupaten Labuhanbatu Pusat)

This study aims to examine the influence of local financial accountability, value for money, honesty, transparency and supervision of local financial management. The sample of this research is all SKPD (Local Work Unit Unit) as user of budget related to regional finance management at Regency Government of Labuhanbatu amounting 36 SKPD and 36 Committing Officer of Commitment so amounted 72 person. Sampling method is census method, and data used is primary data. Data were collected by distributing the queryer directly submitted to the respondent. Data analysis techniques use path analysis with the help of SmartPLS 3 program. The results of this study show that value for money, honesty, transparency and oversight have positive and significant correlation to Regional Financial Management, while Regional Financial Accountability has negative and significant correlation to Regional Financial Management.

Rapid Public-Private Partnership Deployment in Kazakhstan: Enablers and Implications

Public-private partnerships (PPPs) are a relatively new phenomenon in Kazakh-stan – their development began in 2005 in the transport and energy sectors. Initially sluggish growth transformed into rapid PPP deployment from 2016 to 2019 when hundreds of PPPs were launched in many industries (infrastructure, hospitals, schools), which was in sharp contrast to just a handful of PPPs formed prior to 2016. Rapid PPP deployment raised deep concerns whether the government’s supporting schemes and PPP launch procedures are appropriate and whether they may backfire for the government in the form of increasing debt. This paper aims to investigate the enablers and implications of accelerated PPP formation. The study is based on semi-structured in-depth interviews with a range of actors in the field, including PPP operators (railroad, energy company, kindergarten), regional and local governments, national and regional PPP centres, lawyers and private investors, which afforded an opportunity to mitigate bias in opinions. The study has identified three principal enablers: simplified procedures for a PPP launch, pressure exerted on regional governments, and extensive government financial support to PPPs. By making use of agency theory, property rights theory and the value-for-money concept, the paper offers a conceptualisation of rapid PPP growth in Kazakhstan in recent years and argues that growth was disproportionally fast and unintended. Policy implications include a need to re-establish the value-for-money approach to PPP formation, a significant increase in government liabilities to PPPs, and a misconception regarding the role of PPP collaborative governance.