Economic assessment of nature-based solutions to reduce flood risk and enhance co-benefits.

Flooding is expected to increase due to climate change, urbanisation, and land use change. To address this issue, Nature-Based Solutions (NBSs) are often adopted as innovative and sustainable flood risk management methods. Besides the flood risk reduction benefits, NBSs offer co-benefits for the environment and society. However, these co-benefits are rarely considered in flood risk management due to the inherent complexities of incorporating them into economic assessments. This research addresses this gap by developing a comprehensive methodology that integrates the monetary analysis of co-benefits with flood risk reduction in economic assessments. In doing so, it aspires to provide a more holistic view of the impact of NBS in flood risk management. The assessment employs a framework based on life-cycle cost-benefit analysis, offering a systematic and transparent assessment of both costs and benefits over time supported by key indicators like net present value and benefit cost ratio. The methodology has been applied to the Tamnava basin in Serbia, where significant flooding occurred in 2014 and 2020. The methodology offers valuable insights for practitioners, researchers, and planners seeking to assess the co-benefits of NBS and integrate them into economic assessments. The results show that when considering flood risk reduction alone, all considered measures have higher costs than the benefits derived from avoiding flood damage. However, when incorporating co-benefits, several NBS have a net positive economic impact, including afforestation/reforestation and retention ponds with cost-benefit ratios of 3.5 and 5.6 respectively. This suggests that incorporating co-benefits into economic assessments can significantly increase the overall economic efficiency and viability of NBS.

Cost Benefit Analysis of Two Oral health Improvement Programmes.

INTRODUCTION: Oral health is frequently given a low priority when healthcare funds are allocated to new initiatives. One method to highlight the health and social benefits of new oral health initiatives is to use cost benefit analysis to show their value. AIM: To demonstrate how Cost Benefit Analysis (CBA) has been applied to two recent oral health initiatives to evaluate their ability to reduce costs and improve the quality of life. METHODS: CBA was applied to the Mouth Care Matters project in Kent, Surrey and Sussex, and the Senior Smiles project - improving oral health in residential homes in Australia. RESULTS: Over a five-year period, the Mouth Care Matters project would generate £2.66 in cost savings, within the healthcare system, for every £1 spent. Over a three year period the Senior Smiles project would generate a cost saving for the healthcare system of $3.14 for every $1 spent. These evaluations were instrumental to enable a national rollout for Mouth Care Matters and a public endorsement of the programme for Senior Smiles. CONCLUSIONS: Health economics can be a useful tool in aiding care organisations to assess the implications of decisions to spend limited resources in particular areas of healthcare over others.

A decade advance in eco-efficiency and cost-benefits of emissions reduction targeting fine chemical manufacturers.

Fine chemical industry, characterized of small scale, large heterogeneity, and high added value, is the most technology-intensive and dynamic sub-sector in chemical industry, but also has much high environmental factor in production. This study aims to explore green development pathways of about 60 fine chemicals manufacturers in a typical fine chemical industrial park with an annual output of 15 billion USD in China. We analyzed eco-efficiency and cost-benefits of emissions reduction of the park during 2011-2019 from multiple perspectives, by integrating decoupling index, data envelopment analysis, and linear econometric model. The key findings are: (1) the fine chemical industry has witnessed a volatile paradigm of absolute decoupling between economic growth and environmental pressure during the past decade, with a decoupling index of -2.2-12.4; (2) variation of eco-efficiency between benchmark enterprises and majority of enterprises are remarkable, at an average scope of 0.23-0.35, among which 77%-85% enterprises under-performed the average; and pharmaceutics production in particular needs a leapfrog to improve its performance substantially because 84%-95% of them were below the average; (3) pollutants emission plays a decisive role in affecting enterprises' eco-efficiency, and water pollutants work more in first half decade and air pollutants overturn in the second half; and (4) the marginal effect of control investment on water pollutants reductions has declined in 2019 by 66% (chemical oxygen demand (COD)) and 70% (ammonia nitrogen compounds (NH3-N)) compared with those of 2012; however, air pollutants reductions marginal effect is still in climb stage in 2019 by 607% (sulfur dioxide (SO2)) and 17% (nitrogen oxides (NOx)) compared with those in 2018. Fine chemical manufacturers are supposed to enforce a paradigm shift from end-of-pipe to systematic emissions control due to the decline trend of marginal cost-benefits on emissions reduction subsequently.

Game-Theoretical Model of Retroactive Hepatitis B Vaccination in China.

Hepatitis B (HepB) is one of the most common infectious diseases affecting over two billion people worldwide. About one third of all HepB cases are in China. In recent years, China made significant efforts to implement a nationwide HepB vaccination program and reduced the number of unvaccinated infants from 30 to 10%. However, many individuals still remain unprotected, particularly those born before 2003. Consequently, a catch-up retroactive vaccination is an important and potentially cost-effective way to reduce HepB prevalence. In this paper, we analyze a game theoretical model of HepB dynamics that incorporates government-provided vaccination at birth coupled with voluntary retroactive vaccinations. Given the uncertainty about the long-term efficacy of the HepB vaccinations, we study several scenarios. When the waning rate is relatively high, we show that this retroactive vaccination should be a necessary component of any HepB eradication effort. When the vaccine offers long-lasting protection, the voluntary retroactive vaccination brings the disease incidence to sufficiently low levels. Also, we find that the optimal vaccination rates are almost independent of the vaccination coverage at birth. Moreover, it is in an individual's self-interest to vaccinate (and potentially re-vaccinate) at a rate just slightly above the vaccine waning rate.

Assessing the Co-Benefits of green-blue-grey infrastructure for sustainable urban flood risk management.

Green-blue infrastructures in urban spaces offer several co-benefits besides flood risk reduction, such as water savings, energy savings due to less cooling usage, air quality improvement and carbon sequestration. Traditionally, these co-benefits were not included in decision making processes for flood risk management. In this work we present a method to include the monetary analysis of these co-benefits into a cost-benefits analysis of flood risk mitigation measures. This approach was applied to a case study, comparing costs and benefits with and without co-benefits. Different intervention strategies were considered, using green, blue and grey measures and combinations of them. The results obtained illustrate the importance of assessing co-benefits when identifying best adaptation strategies to improve urban flood risk management. Otherwise green infrastructure is likely to appear less efficient than more conventional grey infrastructure. Moreover, a mix of green, blue and grey infrastructures is likely to result in the best adaptation strategy as these three alternatives tend to complement each other. Grey infrastructure has good performance at reducing the risk of flooding, whilst green infrastructure brings in multiple additional benefits that grey infrastructure cannot offer.

An approach for optimal allocation of safety resources: using the knapsack problem to take aggregated cost-efficient preventive measures.

On the basis of the combination of the well-known knapsack problem and a widely used risk management technique in organizations (that is, the risk matrix), an approach was developed to carry out a cost-benefits analysis to efficiently take prevention investment decisions. Using the knapsack problem as a model and combining it with a well-known technique to solve this problem, bundles of prevention measures are prioritized based on their costs and benefits within a predefined prevention budget. Those bundles showing the highest efficiencies, and within a given budget, are identified from a wide variety of possible alternatives. Hence, the approach allows for an optimal allocation of safety resources, does not require any highly specialized information, and can therefore easily be applied by any organization using the risk matrix as a risk ranking tool.

Cognitive-behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT.

BACKGROUND: Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. OBJECTIVES: To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive-behavioural therapy for adults with dissociative seizures. DESIGN: This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. SETTING: This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive-behavioural therapy services. PARTICIPANTS: Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. INTERVENTIONS: Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive-behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. MAIN OUTCOME MEASURES: The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. RESULTS: In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive-behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1-35 dissociative seizures); cognitive-behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0-20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive-behavioural therapy at a p-value < 0.05, including the following at a p-value ≤ 0.001: the longest dissociative seizure-free period in months 7-12 inclusive post randomisation (incidence rate ratio 1.64, 95% confidence interval 1.22 to 2.20; p = 0.001); better psychosocial functioning (Work and Social Adjustment Scale, standardised treatment effect -0.39, 95% confidence interval -0.61 to -0.18; p < 0.001); greater self-rated and clinician-rated clinical improvement (self-rated: standardised treatment effect 0.39, 95% confidence interval 0.16 to 0.62; p = 0.001; clinician rated: standardised treatment effect 0.37, 95% confidence interval 0.17 to 0.57; p < 0.001); and satisfaction with treatment (standardised treatment effect 0.50, 95% confidence interval 0.27 to 0.73; p < 0.001). Rates of adverse events were similar across arms. Cognitive-behavioural therapy plus standardised medical care produced 0.0152 more quality-adjusted life-years (95% confidence interval -0.0106 to 0.0392 quality-adjusted life-years) than standardised medical care alone. The incremental cost-effectiveness ratio (cost per quality-adjusted life-year) for cognitive-behavioural therapy plus standardised medical care versus standardised medical care alone based on the EuroQol-5 Dimensions, five-level version, and imputed data was £120,658. In sensitivity analyses, incremental cost-effectiveness ratios ranged between £85,724 and £206,067. Qualitative and quantitative process evaluations highlighted useful study components, the importance of clinical experience in treating patients with dissociative seizures and potential benefits of our multidisciplinary care pathway. LIMITATIONS: Unlike outcome assessors, participants and clinicians were not blinded to the interventions. CONCLUSIONS: There was no significant additional benefit of dissociative seizure-specific cognitive-behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive-behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive-behavioural therapy. FUTURE WORK: Examination of moderators and mediators of outcome. TRIAL REGISTRATION: Current Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 43. See the NIHR Journals Library website for further project information.

Dissociative seizures resemble epileptic seizures or faints, but can be distinguished from them by trained doctors. Dissociation is the medical word for a 'trance-like' or 'switching off' state. People with dissociative seizures commonly have other psychological or physical problems. Quality of life may be low. The condition accounts for about one in every six patients seen in hospitals because of seizures. We wanted to find out if people with dissociative seizures receiving standardised treatment would also benefit from a talking therapy, called cognitive­behavioural therapy, made specific to this disorder. We did a randomised controlled trial to find out if people with dissociative seizures given standardised treatment and cognitive­behavioural therapy (talking therapy) would do better than those given standardised treatment alone. Standardised treatment of dissociative seizures began with careful diagnosis from a neurologist and then further assessment and treatment from a psychiatrist. In total, 368 people with dissociative seizures participated, with half receiving standardised treatment alone and half having talking therapy plus standardised treatment. We measured seizures and psychological and physical health in both trial groups. We also investigated whether or not cognitive­behavioural therapy was good value for money. After 12 months, patients in both trial groups seemed to have fewer monthly seizures, but there was no advantage in the talking therapy group. Patients in the talking therapy group had more consecutive days without seizures, reporting less impact from them in everyday situations. Patients in the talking therapy group, and their doctors, considered improvements to be better, and patients in this group reported greater satisfaction with treatment. However, the talking therapy was expensive and not as cost-effective as hoped. Interviews with patients and study clinicians showed that they valued aspects of both treatments and of the care provided by the multidisciplinary teams. Overall, cognitive­behavioural therapy designed for dissociative seizures plus standardised treatment was not better at reducing the total numbers of seizures reported, but did produce several positive benefits for participants compared with standardised treatment alone.

Cd contamination status and cost-benefits analysis in agriculture soils of Yangtze River basin.

Soil is a fundamental carrier to support for human living and development and has been polluted seriously by heavy metals. This fact highlights the urgency to realize soil heavy metal pollution prevention through soil heavy metals contamination status assessment and root cause analysis. The previous research tends to focus status assessment and source identification without consideration of economic aspect. This study realized the systematic analysis from status assessment, sources identification and economic-environmental cost-benefits analysis in the Yangtze River basin. Through the spatial difference comparison among the provinces of upper, middle and lower in the Yangtze River basin, it revealed that anthropogenic influence is the main reason caused the current Cd contamination in Yangtze River basin. An interesting finding is that the human caused Cd concentration contribution amount is nearly the same between upstream and downstream which is all about 0.1 mg/kg, while they have quite different economic scale. It indicated that due to the difference of the scale and structure of local economy, and the level of cleaner production and pollution treatment, some regions could own high economic-benefits and low environmental cost, which it is opposite in other regions. The geographic location and natural resources is the root cause to form the environmental cost-economic benefits difference among regions. The convenient traffic promoted downstream to develop large amount and high quality of economy. The natural mineral resources promoted midstream to develop resources based economy. The poor condition of traffic and natural resources has restricted the development of Qinghai province, and made it has the highest Cd pollution intensity. The results would provide effective economic management measures for better soil quality and sustainable development goals achievement.

Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST / Cost-effectiveness of fondaparinux in patients with acute coronary syndrome without ST-segment Elevation

FUNDAMENTO: O uso combinado de agentes antitrombínicos, antiplaquetários e estratégias invasivas na síndrome coronariana aguda sem supradesnivelamento do ST (SCAsSST) reduz eventos cardiovasculares. O fondaparinux demonstrou equivalência à enoxaparina na redução de eventos cardiovasculares, porém com menor índice de sangramento nos pacientes que usaram fondaparinux. OBJETIVO: Avaliar o custo-efetividade de fondaparinux versus enoxaparina em pacientes com SCAsSST no Brasil a partir da perspectiva econômica do Sistema Único de Saúde (SUS). MÉTODOS: Um modelo de decisão analítico foi construído para calcular os custos e consequências resultantes dos tratamentos comparados. Os parâmetros do modelo foram obtidos do estudo OASIS-5 (N = 20.078 pacientes com SCAsSST randomizados para fondaparinux ou enoxaparina). O desfecho avaliado foi um composto de eventos cardiovasculares (isto é, morte, infarto agudo do miocárdio, isquemia refratária e sangramentos graves) nos dias 9, 30 e 180 pós-SCAsSST. Foram avaliados todos os custos diretos de tratamento e eventos relacionados à SCAsSST. O ano da análise foi 2010 e os custos foram descritos em reais (R$). RESULTADOS: No dia 9, o custo de tratamento por paciente foi R$ 2.768 para fondaparinux e R$ 2.852 para enoxaparina. Aproximadamente 80% do custo total foram associados a tratamentos invasivos. Os custos com medicamentos representaram 10% do custo total. As taxas combinadas de eventos cardiovasculares e de sangramentos maiores foram 7,3% e 9,0% para fondaparinux e enoxaparina, respectivamente. Análises de sensibilidade confirmaram os resultados iniciais do modelo. CONCLUSÃO: O fondaparinux para tratamento de pacientes com SCAsSST é superior à enoxaparina em termos de prevenção de novos eventos cardiovasculares com menor custo. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: The combined use of antithrombotic agents, antiplatelet agents and invasive strategies in acute coronary syndrome without ST-segment elevation (ACSWSTE) reduces cardiovascular events. Fondaparinux has demonstrated equivalence to enoxaparin in reducing cardiovascular events, but with a lower rate of bleeding in patients using fondaparinux. OBJECTIVE: Evaluate the cost-effectiveness of fondaparinux versus enoxaparin in patients with ACSWSTE in Brazil from the economic perspective of the Brazilian Unified Health System (SUS). METHODS: A decision analytic model was constructed to calculate the costs and consequences of the compared treatments. The model parameters were obtained from the OASIS-5 study (N = 20,078 patients with ACSWSTE randomized to fondaparinux or enoxaparin). The target outcome consisted of cardiovascular events (i.e., death, myocardial infarction, refractory ischemia and major bleeding) on days 9, 30 and 180 after ACSWSTE. We evaluated all direct costs of treatment and ACSWSTE-related events. The year of the analysis was 2010 and the costs were described in reais (R$). RESULTS: On day 9, the cost of treatment per patient was R$ 2,768 for fondaparinux and R$ 2,852 for enoxaparin. Approximately 80% of total costs were associated with invasive treatments. The drug costs accounted for 10% of the total cost. The combined rates of cardiovascular events and major bleeding were 7.3% and 9.0% for fondaparinux and enoxaparin, respectively. Sensitivity analyses confirmed the initial results of the model. CONCLUSION: The use of fondaparinux for the treatment of patients with ACSWSTE is superior to that of enoxaparin in terms of prevention of further cardiovascular events at lower cost. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).