The Impact of Narrow and Tiered Networks on Costs, Access, Quality, and Patient Steering: A Systematic Review

Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.

Overview of Environmental Problems Caused by Logistics Transportation

Logistic transportation works is considered the main pollutant for the environment, with over 25 per cent CO2 emissions in the EU. This situation has raised concerns for the EU and governments to find solutions and impose regulations to diminish the environmental impact. The purpose of this paper is to investigate two questions regarding environmental issues connected to transportation; “What are the recent trends for establishing sustainable logistics for different transportation methods?” “Which alternatives can be incentivized to decrease the environmental impact of transportation activities?” These projects among the most noteworthy environmental benefits, which are also the case studies of this research are The Viking Concept, The WestMed Bridge, Scandinavian Shuttle and Baxter Inland Sea Transport. The result highlighted in this research is that shifting transportation modes has been successfully implemented, with considerable positive outcomes in terms of environment impact, cost and lead times in several European Union funded projects.

Impact of assumptions on future costs, disutility and mortality in cost-effectiveness analysis; a model exploration

Introduction In cost-effectiveness analyses, the future costs, disutility and mortality from alternative causes of morbidity are often not completely taken into account. We explored the impact of different assumed values for each of these factors on the cost-effectiveness of screening for colorectal cancer (CRC) and esophageal adenocarcinoma (EAC). Methods Twenty different CRC screening strategies and two EAC screening strategies were evaluated using microsimulation. Average health-related expenses, disutility and mortality by age for the U.S. general population were estimated using surveys and lifetables. First, we evaluated strategies under default assumptions, with average mortality, and no accounting for health-related costs and disutility. Then, we varied costs, disutility and mortality between 100% and 150% of the estimated population averages, with 125% as the best estimate. Primary outcome was the incremental cost per quality-adjusted life-year (QALY) gained among efficient strategies. Results The set of efficient strategies was robust to assumptions on future costs, disutility and mortality from other causes of morbidity. However, the incremental cost per QALY gained increased with higher assumed values. For example, for CRC, the ratio for the recommended strategy increased from $15,600 with default assumptions, to $32,600 with average assumption levels, $61,100 with 25% increased levels, and $111,100 with 50% increased levels. Similarly, for EAC, the incremental costs per QALY gained for the recommended EAC screening strategy increased from $106,300 with default assumptions to $198,300 with 50% increased assumptions. In sensitivity analyses without discounting or including only above-average expenses, the impact of assumptions was relatively smaller, but best estimates of the cost per QALY gained remained substantially higher than default estimates. Conclusions Assumptions on future costs, utility and mortality from other causes of morbidity substantially impact cost-effectiveness outcomes of cancer screening. More empiric evidence and consensus are needed to guide assumptions in future analyses.

Systematic Review of Life Cycle Assessment and Life Cycle Cost Analysis for Pavement and a Case Study

Development of the pavement network systems, which is inevitable due to the rapid economic growth, has increasingly become a topic of significant concern because of the severe environmental impacts of road expansion. For achieving the sustainable development goals (SDGs), the policies and actions towards the pavements’ life cycle assessment (LCA) and life cycle cost analysis (LCCA) must be carefully assessed. Consequently, the purpose of this review is to present an overview of LCA and LCCA used in pavement engineering and management. Through the quality control of PRISMA, fifty-five most relevant documents were extracted for a thorough investigation. The state of the art review reveals that a limited number of the papers considered environmental impacts of the pavements. Consequently, to assess the environmental impact cost, a conceptual framework was developed to better consider the LCA and LCCA on various aspects of the pavement projects including the sustainability aspects. Besides, a case study was given to validate the literature review towards proposing a novel framework for the incorporation of environmental impact cost.

The validation status of blood biomarkers of amyloid and phospho-tau assessed with the 5-phase development framework for AD biomarkers

Purpose The development of blood biomarkers that reflect Alzheimer’s disease (AD) pathophysiology (phosphorylated tau and amyloid-β) has offered potential as scalable tests for dementia differential diagnosis and early detection. In 2019, the Geneva AD Biomarker Roadmap Initiative included blood biomarkers in the systematic validation of AD biomarkers. Methods A panel of experts convened in November 2019 at a two-day workshop in Geneva. The level of maturity (fully achieved, partly achieved, preliminary evidence, not achieved, unsuccessful) of blood biomarkers was assessed based on the Biomarker Roadmap methodology and discussed fully during the workshop which also evaluated cerebrospinal fluid (CSF) and positron emission tomography (PET) biomarkers. Results Plasma p-tau has shown analytical validity (phase 2 primary aim 1) and first evidence of clinical validity (phase 3 primary aim 1), whereas the maturity level for Aβ remains to be partially achieved. Full and partial achievement has been assigned to p-tau and Aβ, respectively, in their associations to ante-mortem measures (phase 2 secondary aim 2). However, only preliminary evidence exists for the influence of covariates, assay comparison and cut-off criteria. Conclusions Despite the relative infancy of blood biomarkers, in comparison to CSF biomarkers, much has already been achieved for phases 1 through 3 – with p-tau having greater success in detecting AD and predicting disease progression. However, sufficient data about the effect of covariates on the biomarker measurement is lacking. No phase 4 (real-world performance) or phase 5 (assessment of impact/cost) aim has been tested, thus not achieved.