Resource allocation in decision support frameworks.

BACKGROUND: Cost-benefit and cost-effectiveness analysis place limits on the dimensions of value that the models can incorporate. Cost-benefit analysis requires monetization of all measures of value (including life), a task sometimes deemed either difficult to accomplish or even repugnant. Cost-effectiveness analyses include health care gains in natural units (e.g., quality-adjusted life years or QALYs) rather than purely monetizing them (e.g., in dollars) and offers an efficiency perspective based on the ratio of cost per QALYs or similar health measures. These two methods use different rules for investment. Cost-benefit analysis says to invest whenever benefits exceed costs. Cost-effectiveness analysis says to invest if the intervention has a cost per QALY that meets-or is below-a designated cutoff value. METHODS: Multi-criteria frameworks expand decision analyses by considering value tradeoffs from decision makers, and then producing a synthetic measure that summarizes the performance of investment options. This evaluation is done across all chosen dimensions of value, based on the weights provided by the decision makers, but this flexibility comes at a cost. To date, no approach is widely accepted to suggest how much to invest (how to determine a budget constraint) using multi-attribute models. Moreover, there is no agreed-upon method to measure willingness to pay for incremental multi-attribute value improvements. Our paper proposes a way forward. RESULTS: Based on existing dollar estimates of willingness to pay for QALYs, our concept creates a comparable cutoff for multi-criteria value measures. Our proposed method expands the acceptable cost per QALYs in proportion to how much of the total measure is accounted for by the QALY component. Agreed-upon values for cost per QALY are thus extrapolated to account for extra value created by non-QALY attributes of each intervention. CONCLUSION: Using our proposed methods, the cost per QALY cutoff can serve as a benchmark toward creating a resource allocation cutoff in multi-criteria frameworks.

Comparison of PFAS soil remediation alternatives at a civilian airport using cost-benefit analysis.

Contamination of soil and water systems by per- and polyfluoroalkyl substances (PFAS) due to uncontrolled use of aqueous film-forming foams (AFFFs) at firefighting training sites at civilian and military airports is a universal issue and can lead to significant human health and environmental impacts. Remediation of these sites is often complex but necessary to alleviate the PFAS burden and minimise the risks of exposure by eliminating the hotspot/source from which the PFAS spreads. This study presents a probabilistic cost-benefit analysis (CBA) for evaluating PFAS remediation alternatives, which includes monetisation of both direct costs and benefits as well as externalities. The method is applied for a case study to compare five remediation alternatives for managing PFAS contaminated soil at Stockholm Arlanda Airport in Sweden. The social profitability, or the net present value (NPV), of each remediation alternative was calculated in comparison to two reference alternatives - 'total excavation' of the site (Alt 0) or 'do nothing'. Sensitivity analyses and model scenarios were tested to account for uncertainties, including small or large PFAS spreading and simulating different values for the magnitude of annual avoided cost of inaction (i.e., aggregate benefit) from PFAS remediation. In comparison to total excavation, four of the five studied remediation alternatives resulted in a positive mean NPV. Excavation and stabilization/solidification of the hotspot on-site combined with stabilization using activated carbon for the rest of site (Alt 2) had the highest NPV for both spreading scenarios, i.e., Alt 2 was the most socially profitable alternative. Simulations of the annual avoided cost of inaction enabled estimation of the breakeven point at which a remediation alternative becomes socially profitable (NPV > 0) compared to 'do nothing'. Alt 2 had the lowest breakeven point: 7.5 and 5.75 millions of SEK/year for large and small spreading, respectively.

Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis.

Background: Using traditional health technology assessment (HTA) outcome metrics, such as quality-adjusted life-years, to assess fertility treatments raises considerable methodological challenges because the objective of fertility treatments is to create new life rather than extend, save, or improve health-related quality of life. Objective: The aim of this study was to develop a novel cost-benefit framework to assess value for money of publicly funded IVF treatment; to determine the number of cost-beneficial treatment cycles for women of different ages; and to perform an incremental cost-benefit analysis from a taxpayer perspective. Methods: We developed a Markov model to determine the net monetary benefit (NMB) of IVF treatment by female age and number of cycles performed. IVF treatment outcomes were monetized using taxpayers' willingness-to-pay values derived from a discrete choice experiment (DCE). Using the current funding environment as the comparator, we performed an incremental analysis of only funding cost-beneficial cycles. Similar outputs to cost-effectiveness analyses were generated, including net-benefit acceptability curves and cost-benefit planes. We created an interactive online app to provide a detailed and transparent presentation of the results. Results: The results suggest that at least five publicly funded IVF cycles are cost-beneficial in women aged <42 years. Cost-benefit planes suggest a strong taxpayer preference for restricting funding to cost-beneficial cycles over current funding arrangements in Australia from an economic perspective. Conclusions: The provision of fertility treatment is valued highly by taxpayers. This novel cost-benefit method overcomes several challenges of conventional cost-effectiveness methods and provides an exemplar for incorporating DCE results into HTA. The results offer new evidence to inform discussions about treatment funding arrangements.

The general public's attitude towards accepting payment for kidney donation.

Introduction: Kidney transplantation has become the most cost-effective treatment for patients with end-stage kidney disease (ESKD) and offers them the highest quality of life. Yet, kidney donation is often inaccessible due to cultural and traditional beliefs about organ donation. The goal of our study is to assess the value of kidney donation using the Willingness to Accept (WTA) technique. We also aim to understand the factors influencing an individual's willingness to donate an organ. Methods: A self-administered survey was completed by 985 participants from the general public. The quantitative method and survey design that were chosen used descriptive, correlational, nonparametric, and multivariate statistical tests. Results: Most of the respondents, 895 (90.9%) are not willing to donate a kidney while alive. Four hundred and five (41.1%) of the respondents are not willing to donate a kidney after their death, while the rest are willing to donate their kidney after their death without financial compensation. The same attitude applies to the donation of a kidney from their relatives. Significant predictors from the results of the logistic regression model in predicting the lowest (minimal) amount that will encourage donation of one kidney after death were: Marital status; Nationality; Adi card holder; Knowing people who need a kidney donation; confidence in the medical staff; and consideration of the family's opinions regarding organ donation. Discussion: Using cost benefit analysis (CBA), with the aim of evaluating the willingness of individuals to accept payment for innovative medical procedures, such as kidney donation, allows an assessment of the perceived value of the medical procedure and enables policymakers to decide whether to allocate funds or offer subsidies for kidney donation, given the limited healthcare resources available. During our research, we found that most participants did not support the commercialization of organs. Our recommendation for policymakers and health professionals is to continue providing adequate funding for kidney donations and to implement educational programs aimed at improving attitudes towards organ donation.

Differential Willingness to Pay for Kidney Transplantation From Living and Deceased Donors: Empirical Study Among End-Stage Kidney Disease (ESKD) Patients.

Kidney transplantation has developed to the stage where it is currently the most cost-effective treatment for patients suffering from end-stage kidney disease (ESKD) and, when available, offers them the highest quality of life. Yet, kidney transplantation is challenged by cultural and traditional beliefs; thus, this study sought to evaluate the willingness to pay for a kidney transplant in a culturally sensitive population. A self-administered survey was completed by 734 end-stage kidney disease (ESKD) patients. A quantitative method and survey design were chosen and employed descriptive, correlational, nonparametric, and multivariate statistical tests. Participants were willing to pay a mean amount of $40 751.36 for a living donor kidney transplant, whereas the mean is considerably lower, $18 350.51, for a deceased donor kidney. Significant predictors of the willingness to pay (WTP) for a kidney transplant from a living donor and a deceased donor were found, among them: religiosity and ethnicity. The participants' willingness to pay for a kidney transplant could attest to significant benefits in enhancing patient well-being. The willingness to pay differentially for a donation from a deceased or a living donor stems from the higher chances of success with a living-donor organ as well as from moral and religious motives. In Israel kidney transplantation is not tradable in the free market and is fully funded by the state. The average cost of kidney transplantation in Israel is $61 714.50. Since the cost exceeds the utility and since the economic literature suggests that the funding of healthcare interventions should be provided up to the point where the costs of that funding equal the benefits that society derives from it, crucial revisions in public health policy should be made. Education may have a significant impact on the approach to kidney donation and organ donation in general.

A Cost-Benefit Analysis of Automated Physiological Data Acquisition Systems Using Data-Driven Modeling.

Precision medicine and the continuous analysis of "Big data" promises to improve patient outcomes dramatically in the near future. Very recently, healthcare facilities have started to explore automatic collection of patient-specific physiological data with the aim of reducing nursing workload and decreasing manual data entry errors. In addition to those purposes, continuous physiological data can be used for the early detection and prevention of common, and possibly fatal, diseases. For instance, poor patient outcomes from sepsis, a leading cause of mortality in healthcare facilities and a major driver of hospital costs in the USA, can be mitigated when detected early using screening tools that monitor the changing dynamics of physiological data. However, the potential cost of collecting continuous physiological data remains a barrier to the widespread adoption of automated high-frequency data collection systems. In this paper, we perform cost-benefit analysis (CBA) of machine learning applied to various types of acquisition systems (with different collection intervals) to determine if the benefits of such systems will outweigh their implementation costs. Although such systems can be used in the detection of various complications, in order to showcase the immediate benefits, we focus on the early detection of sepsis, one of the major challenges of hospital systems. We present a general approach to conduct such analysis for a wide range of hospitals and highlight its applicability using a case study for a small hospital with 150 beds and 3000 annual patients where the acquisition system would collect data at 1-min intervals. Lastly, we discuss how the analysis may help guide incentives/policies with regard to adopting automated data acquisition systems.

Risk-based cost-benefit analysis for evaluating microbial risk mitigation in a drinking water system.

Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant. The fourth alternative, A4, represented installing a UV-disinfection unit in the drinking water treatment plant. Quantitative microbial risk assessment was used to estimate the positive health effects in terms of quality adjusted life years (QALYs), resulting from the four mitigation alternatives. The health benefits were monetised using a unit cost per QALY. For each mitigation alternative, the net present value of health and environmental benefits and investment, maintenance and running costs was calculated. The results showed that only A4 can reduce the risk (probability of infection) below the World Health Organization guidelines of 10-4 infections per person per year (looking at the 95th percentile). Furthermore, all alternatives resulted in a negative net present value. However, the net present value would be positive (looking at the 50th percentile using a 1% discount rate) if non-monetised benefits (e.g. increased property value divided evenly over the studied time horizon and reduced microbial risks posed to animals), estimated at 800-1200 SEK (€100-150) per connected on-site wastewater treatment system per year, were included. This risk-based decision model creates a robust and transparent decision support tool. It is flexible enough to be tailored and applied to local settings of drinking water systems. The model provides a clear and holistic structure for decisions related to microbial risk mitigation. To improve the decision model, we suggest to further develop the valuation and monetisation of health effects and to refine the propagation of uncertainties and variabilities between the included methods.

A Cost-Benefit Analysis of the Official Development Assistance Project on Maternal and Child Health in Kwango, DR Congo.

A project on maternal and child health (MCH) was conducted by the Korea International Cooperation Agency to reduce maternal and child mortality rates in Kwango, Democratic Republic of Congo (DRC). The objective of this study was to evaluate the costs and benefits of the MCH project, which was under Official Development Assistance for a period of 3 years from 2014 to 2016. The study conducted a cost-benefit analysis (CBA) using a benefit-cost ratio (BCR). The costs were the total costs incurred in implementing the MCH project. The benefits of the MCH project were estimated as the monetary values of the reduction in maternal mortality rates and the mortality rates of infants and children aged under 5 years. The adjusted costs that converted the time value for 2016 were estimated as USD 1,969,532 as part of the CBA. The benefits of reduced maternal mortality and the mortality of infants and children aged under 5 years were estimated as USD 681,416, USD 4,332,376, and USD 1,710,184, respectively, in monetary terms. The total benefits were estimated as USD 6,723,976 and the BCR was calculated at 3.41. In addition, the benefits were estimated by the different economic assumptions through a sensitivity analysis. The MCH project was economically satisfied under the most conservative assumptions.

What, who and when? Incorporating a discrete choice experiment into an economic evaluation.

BACKGROUND: Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants. METHODS: Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared. RESULTS: At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit. CONCLUSION: When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all-trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias.

A cost-benefit analysis of landfill mining and material recycling in China.

Landfill mining is an environmentally-friendly technology that combines the concepts of material recycling and sustainable waste management, and it has received a great deal of worldwide attention because of its significant environmental and economic potential in material recycling, energy recovery, land reclamation and pollution prevention. This work applied a cost-benefit analysis model for assessing the economic feasibility, which is important for promoting landfill mining. The model includes eight indicators of costs and nine indicators of benefits. Four landfill mining scenarios were designed and analyzed based on field data. The economic feasibility of landfill mining was then evaluated by the indicator of net present value (NPV). According to our case study of a typical old landfill mining project in China (Yingchun landfill), rental of excavation and hauling equipment, waste processing and material transportation were the top three costs of landfill mining, accounting for 88.2% of the total cost, and the average cost per unit of stored waste was 12.7USDton(-1). The top three benefits of landfill mining were electricity generation by incineration, land reclamation and recycling soil-like materials. The NPV analysis of the four different scenarios indicated that the Yingchun landfill mining project could obtain a net positive benefit varying from 1.92 million USD to 16.63 million USD. However, the NPV was sensitive to the mode of land reuse, the availability of energy recovery facilities and the possibility of obtaining financial support by avoiding post-closure care.

Quantifying the costs and benefits of occupational health and safety interventions at a Bangladesh shipbuilding company.

BACKGROUND: This study is the first cost-benefit analysis (CBA) of occupational health and safety (OHS) in a low-income country. It focuses on one of the largest shipbuilding companies in Bangladesh, where globally recognised Occupational Health and Safety Advisory Services (OHSAS) 18001 certification was achieved in 2012. OBJECTIVES: The study examines the relative costs of implementing OHS measures against qualitative and quantifiable benefits of implementation in order to determine whether OHSAS measures are economically advantageous. METHODS: Quantifying past costs and benefits and discounting future ones, this study looks at the returns of OHS measures at Western Marine Shipbuilding Company Ltd. RESULTS: Costs included investments in workplace and environmental safety, a new clinic that also serves the community, and personal protective equipment (PPE) and training. The results are impressive: previously high injury statistics dropped to close to zero. CONCLUSIONS: OHS measures decrease injuries, increase efficiency, and bring income security to workers' families. Certification has proven a competitive edge for the shipyard, resulting in access to greater markets. Intangible benefits such as trust, motivation and security are deemed crucial in the CBA, and this study finds the high investments made are difficult to offset with quantifiable benefits alone.

Cost-Benefit Analysis of Back School Program for Occupational Low Back pain Patients / 예방의학회지

Although occupational low back pain accounts for 20~40% of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and functional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. we estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson(1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of 30~45%, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.