Budget Impact Analysis of Comprehensive Genomic Profiling in Patients With Advanced Non-Small-Cell Lung Cancer.

PURPOSE: This study assessed the economic impact of increased use of comprehensive genomic profiling (CGP) versus conventional testing strategies among patients with advanced non-small-cell lung cancer (aNSCLC) from a US commercial health plan perspective. METHODS: A decision analytic model was developed to estimate the incremental benefits and costs across testing methodologies (CGP v non-CGP), as well as across sample types (tissue-based and liquid-based), for patients with newly diagnosed aNSCLC. Model outcomes included total direct costs, testing costs, and per member per month budget impact. Secondary model outcomes included the number of patients needed to test with CGP to add 1 life-year, and the number of patients needed to test with CGP to treat one individual with a biomarker-matched therapy. RESULTS: In a hypothetical 2,000,000-member health plan, 790 members were estimated to have incident aNSCLC; 609 underwent molecular diagnostic testing with 122 (20%) tested with CGP (109 tissue-based and 13 liquid) in the base-case. An increase in CGP from 20% to 30% (an additional 61 patients tested with CGP) was associated with 3.11 additional life-years gained and a $0.01 in US dollars per member per month budget impact. Approximately 19.6 patients would need to be tested with CGP versus non-CGP to add one life-year and 5.9 patients would need to be tested with CGP to treat at least one patient with a biomarker-matched therapy. CONCLUSION: An increase in CGP from 20% to 30% among patients with aNSCLC undergoing molecular diagnostic testing was associated with modest budget impact, most of which was attributable to prolonged survival associated with increased use of more effective treatments.

Characterisation and energy assessment of fats, oils and greases (FOG) waste at catchment level.

Several of the waste materials that have a negative impact on the sewer system are produced by fats, oils and greases (FOG) discharged from commercial and domestic kitchens. These materials accumulate at different points in the sewer catchment, from kitchens to pumping stations, sewers and sewage treatment works (STWs), and comprise oily wastewater, floating agglomerates and hard deposits. Despite their detrimental effects, these waste materials have a high calorific content and are an ideal feedstock for energy recovery processes. So far, the overall volume of each type of waste and their physical-chemical properties in relation to their collection point are unknown. However, from a management point of view, knowledge on each feedstock quality and volumes is necessary to develop an economic viable solution for their collection and for energy recovery purposes. In this study, FOG wastes collected from households, food service establishments (FSEs), sewage pumping stations, sewers and STWs, were compared to sewage sludge in terms of organic contents and energy potentials. As expected, FOG recovered at source (households and FSEs) were 'cleaner' and had a higher energy content. Once mixed with wastewater the materials changed in composition and lost some of their energy per unit mass. Our results showed that around 94,730 tonnes.year-1 of these materials could be recovered from the Thames Water Utilities' catchment, one of the most populated in the UK. These materials could produce up to 222 GWh.year-1 as biogas, close to double of what is produced with sewage sludge digestion and around 19% of the company energy needs. Finally, even with over six million households in the catchment, the results showed that most of the FOG waste was produced by FSEs (over 48,000 premises) with an estimated average of 79,810 tonnes.year-1 compared to 14,920 tonnes.year-1 from private households. This is an important outcome as recovery from FSEs will be cheaper and easier if the company decides to implement a collection system for energy recovery.

Early Usability Assessment of a Conversational Agent for HPV Vaccination.

With the emerging use of speech technology in consumer goods, we experimented with the application of conversational agents for the communication of health information relating to HPV vaccine. Research have stated that one-to-one contact between providers and patients have a variety of positive influences on patients' perception towards vaccines, even leading to uptake, compared to paper-based methods. We implemented a Wizard of Oz experiment that counsels adults with children (n=18) on the HPV vaccine, using an iPad tablet and dialogue script developed by public health collaborators, and for early testing of a prospective conversational agent in this area. Our early results show that non-vaccine hesitant parents believed that agent was easy to use and had capabilities needed, despite the desire for additional features. Our future work will involve developing a dialogue engine to provide automated dialogue interaction and future improvements and experimentation for the speech interface.

The Texas Children's Hospital immunization forecaster: conceptualization to implementation.

OBJECTIVES: Immunization forecasting systems evaluate patient vaccination histories and recommend the dates and vaccines that should be administered. We described the conceptualization, development, implementation, and distribution of a novel immunization forecaster, the Texas Children's Hospital (TCH) Forecaster. METHODS: In 2007, TCH convened an internal expert team that included a pediatrician, immunization nurse, software engineer, and immunization subject matter experts to develop the TCH Forecaster. Our team developed the design of the model, wrote the software, populated the Excel tables, integrated the software, and tested the Forecaster. We created a table of rules that contained each vaccine's recommendations, minimum ages and intervals, and contraindications, which served as the basis for the TCH Forecaster. RESULTS: We created 15 vaccine tables that incorporated 79 unique dose states and 84 vaccine types to operationalize the entire United States recommended immunization schedule. The TCH Forecaster was implemented throughout the TCH system, the Indian Health Service, and the Virginia Department of Health. The TCH Forecast Tester is currently being used nationally. CONCLUSIONS: Immunization forecasting systems might positively affect adherence to vaccine recommendations. Efforts to support health care provider utilization of immunization forecasting systems and to evaluate their impact on patient care are needed.