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1.
Exp Parasitol ; 210: 107832, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32004854

RESUMEN

Despite food technology advancements, food safety policies and alert systems, foodborne diseases are still a relevant concern for consumers and public health authorities, with great impacts on the economy and the society. Evaluating the cost of foodborne diseases may support the design and the implementation of policy interventions. This paper proposes a simple method for cost identification of foodborne diseases, accessible to researchers and practitioners who are not specialist in economics. The method is based on the assumption that epidemiological and economic models can be integrated to understand how the burden of disease determines costs in a wider socio-economic perspective. Systems thinking and interdisciplinary approach are the pivotal conceptual tools of the method. Systems thinking allows for the understanding of the complex relationships working among the elementary units of a system (e.g. wildlife, bred animals, consumers, environment, agro-food industry) in the occurrence of a health problem such foodborne diseases. Complex systemic relationships usually cross the traditional boundaries of scientific knowledge (human medicine, veterinary science, economics) and sectoral institutional responsibilities (e.g. ministry of health, ministry of agriculture). For these reasons more scientific disciplines, institutional competences and social bodies need to work together to face complex health problems, in an interdisciplinary framework. The first step of the proposed method is the identification of the potential cost of the disease. To this aim, the authors first focus on the links between epidemiological and economic models, based on the fact that foodborne diseases, likewise other diseases, hit people's and animals' aptitude to produce utility and goods for the society (e.g. wellbeing, revenue, safe food). These utility losses are real economic costs. Then they show how simple economic models, such as the food supply chain, can help understand the way costs spread across the economic sectors and the society. It should be underlined that the authors adopt already existing and well rooted scientific tools, focusing in particular that their integration in an interdisciplinary framework can effectively contribute to increase the understanding of complex health problems in a viable way.


Asunto(s)
Costo de Enfermedad , Enfermedades Transmitidas por los Alimentos/economía , Enfermedades Transmitidas por los Alimentos/epidemiología , Modelos Biológicos , Modelos Económicos , Animales , Análisis Costo-Beneficio , Inocuidad de los Alimentos , Abastecimiento de Alimentos/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Tecnología de Alimentos/economía , Tecnología de Alimentos/tendencias , Humanos , Investigación Interdisciplinaria , Salud Única/economía , Años de Vida Ajustados por Calidad de Vida , Análisis de Sistemas
2.
J Dairy Sci ; 103(1): 451-472, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31629515

RESUMEN

The objective of this study was to perform a cost-benefit analysis (CBA) of a participatory extension model, called Ontario Focus Farms (FF), which was designed to facilitate the adoption of on-farm management practices to control Johne's disease (JD) on Ontario (ON) dairy farms. Partial budget models were developed to estimate the annual herd cost of JD on an average 78-cow Ontario dairy herd and the annual herd cost of neonatal calf diarrhea (NCD). With these estimates, a CBA was developed to assess the simulated net benefits of implementing various on-farm management scenarios (i.e., implementing 1, 2, or 3 of the following: calf feeding, maternity pen management, maternity area structure changes), where the benefits represent a reduction in the annual cost of JD and NCD. These models informed the final CBA assessing the net benefits of FF implementation over a 10-yr period. All monetary values are reported in Canadian dollars (Can$; where 1 Can$ = 0.823 US$ at the time of the study). The annual herd cost of JD was estimated to be $3,242 ($41.56/cow), and that of NCD was estimated to be $1,390 ($36/heifer calf). When farms were expected to have both JD and NCD, all scenarios, when implemented over a 10-yr period, yielded positive net benefits ranging from $439 to $2,543 per farm when changes to maternity area structure were combined with calf feeding changes. These effects were sensitive to changes in level of disease (JD and NCD) on the farm, and the costs and effects of making changes. The NPV of making any on-farm change when JD was not present on the farm was negative. Overall, FF implementation yielded positive net benefits of $426,351 or $749,808, depending on whether a veterinarian or non-veterinarian served as the facilitator. The NPV was most sensitive to changes in burden of disease, the cost of implementing changes, and the proportion of FF participants that had JD and NCD on the farm. Benefits of FF implementation are also likely to accrue to veterinarians, as a result of professional facilitator training, and the Ontario dairy industry, as a by-product of improved milk quality and safety; therefore, the true net benefits of FF implementation are likely underestimated. Overall, the FF process should be considered an economically viable program and worthy of investment as part of a JD control strategy, as it demonstrates potential to yield positive net benefits for the Ontario dairy industry.


Asunto(s)
Enfermedades de los Bovinos/economía , Enfermedades de los Bovinos/prevención & control , Modelos Económicos , Paratuberculosis/economía , Paratuberculosis/prevención & control , Animales , Bovinos , Análisis Costo-Beneficio , Industria Lechera/economía , Diarrea/economía , Diarrea/prevención & control , Diarrea/veterinaria , Femenino , Ontario
3.
J Dairy Sci ; 103(1): 492-506, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31733873

RESUMEN

Although estrus detection makes a relevant contribution to the reproductive performance of dairy cattle, studies on the economic evaluation of automatic estrus detection systems are rare. The objective of the present study is to provide an economic evaluation of activity meters used for estrus detection. The effect of different estrus detection rates on gross margins was modeled with SimHerd (SimHerd A/S, Viborg, Denmark). The analysis considers all costs associated with the investment in activity meters. The economic evaluation was carried out through simulation of Simmental herds with yearly milk yields of 7,000 or 9,000 kg and Holstein Friesian herds with yearly milk yields of 9,000 or 11,000 kg, each with herd sizes of 70 or 210 cows. Furthermore, we distinguished between 2 investment scenarios. In scenario 1, only cows are equipped with activity meters for estrus detection, whereas scenario 2 assumes that cows and heifers are equipped with activity meters. Because existing empirical information for some variables shows significant variability (estrus detection rates, time for estrus detection), they were modeled with distributions using the Monte Carlo method in @RISK (Palisade Corporation, Ithaca, NY), allowing us to model a probability distribution of net returns (NR) of investment in activity meters for estrus detection. The simulation results show that the average NR of investment in activity meters for estrus detection over all scenarios ranges from +€7 to +€40 per cow per year for the Simmental breed, and from +€19 to +€46 per cow per year for the Holstein Friesian breed. Generally, the NR depends on the milk production level assumed. For the Simmental breed, depending on the scenario, the simulation results show a 54 to 200% larger average NR of investment in activity meters for estrus detection with a milk yield of 9,000 kg/yr compared with 7,000 kg/yr. For the Holstein Friesian breed, the effect of the modeled milk yield on the NR is much less pronounced. Average NR of investment in activity meters are greater for larger herd sizes because of cost degression effects. An additional equipping of heifers has, on average, a positive effect on the economics of activity meters for estrus detection because of the resulting reduction in the age at first calving. Considering all scenarios, the probability of a positive NR of investment in activity meters ranges between 74 and 98% for the Simmental breed and between 85 and 99% for the Holstein Friesian breed.


Asunto(s)
Bovinos , Industria Lechera/métodos , Detección del Estro , Animales , Análisis Costo-Beneficio , Industria Lechera/economía , Dinamarca , Detección del Estro/economía , Femenino , Lactancia , Leche/economía , Modelos Económicos , Reproducción , Procesos Estocásticos
4.
Lancet ; 395(10218): 156-164, 2020 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-31852601

RESUMEN

Observations from many countries indicate that multiple forms of malnutrition might coexist in a country, a household, and an individual. In this Series, the double burden of malnutrition (DBM) encompasses undernutrition in the form of stunting, and overweight and obesity. Health effects of the DBM include those associated with both undernutrition, such as impaired childhood development and greater susceptibility to infectious diseases, and overweight, especially in terms of increased risk of added visceral fat and increased risk of non-communicable diseases. These health effects have not been translated into economic costs for individuals and economies in the form of lost wages and productivity, as well as higher medical expenses. We summarise the existing approaches to modelling the economic effects of malnutrition and point out the weaknesses of these approaches for measuring economic losses from the DBM. Where population needs suggest that nutrition interventions take into account the DBM, economic evaluation can guide the choice of so-called double-duty interventions as an alternative to separate programming for stunting and overweight. We address the evidence gap with an economic analysis of the costs and benefits of an illustrative double-duty intervention that addresses both stunting and overweight in children aged 4 years and older by providing school meals with improved quality of diet. We assess the plausibility of our method and discuss how improved data and models can generate better estimates. Double-duty interventions could save money and be more efficient than single-duty interventions.


Asunto(s)
Costos y Análisis de Costo/métodos , Desnutrición/prevención & control , Enfermedades Transmisibles/etiología , Desarrollo Económico , Trastornos del Crecimiento/complicaciones , Trastornos del Crecimiento/economía , Trastornos del Crecimiento/prevención & control , Humanos , Desnutrición/complicaciones , Desnutrición/economía , Modelos Económicos , Estado Nutricional , Obesidad/complicaciones , Obesidad/economía , Obesidad/prevención & control , Sobrepeso/complicaciones , Sobrepeso/economía , Sobrepeso/prevención & control , Prevalencia
5.
Int J Cancer ; 146(3): 781-790, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30977121

RESUMEN

Bronchoscopy is the safest procedure for lung cancer diagnosis when an invasive evaluation is required after imaging procedures. However, its sensitivity is relatively low, especially for small and peripheral lesions. We assessed benefits and costs of introducing a bronchial gene-expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete-event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (i) location-based strategy-integrated the BGC to the bronchoscopy indication; (ii) simplified strategy-extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality-adjusted-life-years (QALYs), costs and incremental cost-effectiveness ratios. Compared to the standard practice, the location-based strategy (i) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (ii) reduced absolute rate of invasive procedures by 10% and improved quality-adjusted life expectancy, producing an incremental cost-effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location-based is cost-saving if the price of classifier declines.


Asunto(s)
Análisis Costo-Beneficio , Detección Precóz del Cáncer/normas , Neoplasias Pulmonares/diagnóstico , Anciano , Biomarcadores de Tumor/genética , Biopsia/efectos adversos , Biopsia/economía , Biopsia/normas , Bronquios/diagnóstico por imagen , Bronquios/patología , Broncoscopía/efectos adversos , Broncoscopía/economía , Broncoscopía/normas , Simulación por Computador , Ahorro de Costo , Detección Precóz del Cáncer/economía , Detección Precóz del Cáncer/métodos , Femenino , Estudios de Seguimiento , Perfilación de la Expresión Génica/economía , Perfilación de la Expresión Génica/normas , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Modelos Económicos , Años de Vida Ajustados por Calidad de Vida , Sensibilidad y Especificidad , Nivel de Atención/economía , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/economía , Tomografía Computarizada por Rayos X/normas
6.
BMC Public Health ; 19(1): 1746, 2019 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-31881876

RESUMEN

BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. METHODS: The screenings tools evaluated were chosen from Children's Healthcare Canada's National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system. RESULTS: Both screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2390. CONCLUSION: Findings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.


Asunto(s)
Trastornos del Espectro Alcohólico Fetal/diagnóstico , Tamizaje Masivo/economía , Canadá , Niño , Análisis Costo-Beneficio , Humanos , Modelos Económicos
7.
BMC Health Serv Res ; 19(1): 1007, 2019 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-31883510

RESUMEN

BACKGROUND: Atrial fibrillation (AF) represents the most common sustained cardiac arrhythmia. A service evaluation was carried out at an anticoagulation clinic in Newcastle upon-Tyne to explore the efficacy of introducing self-testing of anticoagulation status for AF patients on warfarin. The analysis presented aims to assess the potential cost savings and clinical outcomes associated with introducing self-testing at a clinic in the Northeast of England, and to determine the cost-effectiveness of a redesigned treatment pathway including genetic testing and self-testing components. METHODS: Questionnaires were administered to individuals participating in the service evaluation to understand the patient costs associated with clinical monitoring (139 patients), and quality-of-life before and after the introduction of self-testing (varying numbers). Additionally, data on time in therapeutic range (TTR) were captured at multiple time points to identify any change in outcome. Finally, an economic model was developed to assess the cost-effectiveness of introducing a redesigned treatment pathway, including genetic testing and self-testing, for AF patients. RESULTS: The average cost per patient of attending the anticoagulation clinic was £16.24 per visit (including carer costs). Costs were higher amongst patients tested at the hospital clinic than those tested at the community clinic. Improvements in quality-of-life across all psychological topics, and improved TTR, were seen following the introduction of self-testing. Results of the cost-effectiveness analysis showed that the redesigned treatment pathway was less costly and more effective than current practice. CONCLUSIONS: Allowing AF patients on warfarin to self-test, rather than attend clinic to have their anticoagulation status assessed, has the potential to reduce patient costs. Additionally, self-testing may result in improved quality-of-life and TTR. Introducing genetic testing to guide patient treatment based on sensitivity to warfarin, and applying this in combination with self-testing, may also result in improved patient outcomes and reduced costs to the health service in the long-term.


Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Análisis Costo-Beneficio , Calidad de la Atención de Salud/economía , Resultado del Tratamiento , Anciano , Inglaterra , Femenino , Humanos , Modelos Económicos , Accidente Cerebrovascular/complicaciones , Encuestas y Cuestionarios , Warfarina/uso terapéutico
8.
Artículo en Inglés | MEDLINE | ID: mdl-31861055

RESUMEN

This paper describes a study of the relationship between undesired road traffic externalities and residential price values in the Spanish city of Madrid. A large database was gathered, including the price and characteristics of 21,634 flats and road traffic intensity at 3904 different points across the city. The results obtained by a hedonic model suggest that both distance from the traffic measurement point and average daily traffic are significantly related to the price of residential properties, even after controlling for structural and neighbourhood variables. Distance to traffic areas has a positive impact on dwelling prices, whilst these are negatively related to traffic intensity.


Asunto(s)
Vivienda/economía , Ruido del Transporte/economía , Ciudades , Humanos , Modelos Económicos , Características de la Residencia , España
9.
Global Health ; 15(1): 86, 2019 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-31849335

RESUMEN

BACKGROUND: Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM: This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS: We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS: Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION: Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.


Asunto(s)
Financiación de la Atención de la Salud , Modelos Económicos , Humanos
10.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 619-626, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31721598

RESUMEN

Introduction: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g. CHEERS) to assess their economic viability. This study evaluates the generalizability of four device-specific criteria, as recommended by the recent MedtechHTA project, of learning curve, incremental innovation, dynamic pricing, and organizational impact with a broader group of MDs including diagnostics and implantables. The purpose was to determine the applicability of these criteria to a broader range of MDs.Areas Covered: We determined the extent to which these criteria could be applied to each device type and attempted to identify common themes. We performed a literature search using PubMed and Google of a range of devices to understand the clinical significance, operation, and economic viability.Expert Opinion: Our findings suggest that the four characteristics are not applicable to all device types. Prior evaluation of a device's intrinsic properties (such as longevity and device location) and its FDA risk classification could help to indicate the applicability of the criteria. Documenting this process when assessing the additional four criteria on the CHEERS checklist would improve the transparency of future economic evaluations.


Asunto(s)
Equipos y Suministros/economía , Modelos Económicos , Evaluación de la Tecnología Biomédica/métodos , Lista de Verificación , Análisis Costo-Beneficio/métodos , Humanos , Evaluación de la Tecnología Biomédica/economía
11.
Med Care ; 57(11): 875-881, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31567859

RESUMEN

OBJECTIVE: Until recently, the options for summarizing Canadian patient complexity were limited to health risk predictive modeling tools developed outside of Canada. This study aims to validate a new model created by the Canadian Institute for Health Information (CIHI) for Canada's health care environment. RESEARCH DESIGN: This was a cohort study. SUBJECTS: The rolling population eligible for coverage under Ontario's Universal Provincial Health Insurance Program in the fiscal years (FYs) 2006/2007-2016/2017 (12-13 million annually) comprised the subjects. MEASURES: To evaluate model performance, we compared predicted cost risk at the individual level, on the basis of diagnosis history, with estimates of actual patient-level cost using "out-of-the-box" cost weights created by running the CIHI software "as is." We next considered whether performance could be improved by recalibrating the model weights, censoring outliers, or adding prior cost. RESULTS: We were able to closely match model performance reported by CIHI for their 2010-2012 development sample (concurrent R=48.0%; prospective R=8.9%) and show that performance improved over time (concurrent R=51.9%; prospective R=9.7% in 2014-2016). Recalibrating the model did not substantively affect prospective period performance, even with the addition of prior cost and censoring of cost outliers. However, censoring substantively improved concurrent period explanatory power (from R=53.6% to 66.7%). CONCLUSIONS: We validated the CIHI model for 2 periods, FYs 2010/2011-2012/2013 and FYs 2014/2015-2016/2017. Out-of-the-box model performance for Ontario was as good as that reported by CIHI for the development sample based on 3-province data (British Columbia, Alberta, and Ontario). We found that performance was robust to variations in model specification, data sources, and time.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Modelos Económicos , Medición de Riesgo/métodos , Estadística como Asunto/métodos , Cobertura Universal del Seguro de Salud/economía , Canadá , Estudios de Cohortes , Humanos
13.
Parasit Vectors ; 12(1): 499, 2019 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-31647019

RESUMEN

BACKGROUND: Schistosomiasis is a neglected tropical disease, targeted by the World Health Organization for reduction in morbidity by 2020. It is caused by parasitic flukes that spread through contamination of local water sources. Traditional control focuses on mass drug administration, which kills the majority of adult worms, targeted at school-aged children. However, these drugs do not confer long-term protection and there are concerns over the emergence of drug resistance. The development of a vaccine against schistosomiasis opens the potential for control methods that could generate long-lasting population-level immunity if they are cost-effective. METHODS: Using an individual-based transmission model, matched to epidemiological data, we compared the cost-effectiveness of a range of vaccination programmes against mass drug administration, across three transmission settings. Health benefit was measured by calculating the heavy-intensity infection years averted by each intervention, while vaccine costs were assessed against robust estimates for the costs of mass drug administration obtained from data. We also calculated a critical vaccination cost, a cost beyond which vaccination might not be economically favorable, by benchmarking the cost-effectiveness of potential vaccines against the cost-effectiveness of mass drug administration, and examined the effect of different vaccine protection durations. RESULTS: We found that sufficiently low-priced vaccines can be more cost-effective than traditional drugs in high prevalence settings, and can lead to a greater reduction in morbidity over shorter time-scales. MDA or vaccination programmes that target the whole community generate the most health benefits, but are generally less cost-effective than those targeting children, due to lower prevalence of schistosomiasis in adults. CONCLUSIONS: The ultimate cost-effectiveness of vaccination will be highly dependent on multiple vaccine characteristics, such as the efficacy, cost, safety and duration of protection, as well as the subset of population targeted for vaccination. However, our results indicate that if a vaccine could be developed with reasonable characteristics and for a sufficiently low cost, then vaccination programmes can be a highly cost-effective method of controlling schistosomiasis in high-transmission areas. The population-level immunity generated by vaccination will also inevitably improve the chances of interrupting transmission of the disease, which is the long-term epidemiological goal.


Asunto(s)
Administración Masiva de Medicamentos/economía , Enfermedades Desatendidas/prevención & control , Esquistosomiasis/prevención & control , Vacunación/economía , Adolescente , Animales , Benchmarking , Niño , Preescolar , Estudios de Cohortes , Análisis Costo-Beneficio , Reservorios de Enfermedades/parasitología , Humanos , Lactante , Administración Masiva de Medicamentos/normas , Modelos Animales , Modelos Económicos , Enfermedades Desatendidas/tratamiento farmacológico , Enfermedades Desatendidas/economía , Esquistosomiasis/tratamiento farmacológico , Esquistosomiasis/economía , Esquistosomiasis/transmisión , Procesos Estocásticos , Factores de Tiempo , Vacunación/normas , Vacunas/administración & dosificación , Vacunas/economía
14.
Inquiry ; 56: 46958019884190, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31640449

RESUMEN

This article provides an economic model on the optimal penalty of health care workplace violence based on health care workplace classification and cost structure, aiming to deter potential offenders. By developing an EIP (externality, identifiability, and preventability) analytical method, we distinguish the characteristics of different workplaces and find that the health care workplace is the combination of externality, low identifiability, and low preventability. Besides the private cost to victims for ordinary workplace violence, the cost structure of health care workplace violence includes social costs like externality-related public safety cost, defensive medicine cost, and specific factors cost. When the optimal penalty corresponding to different levels of health care workplace violence increases, the threshold level of punishable violence decreases after incorporating the social costs into analysis. Our model shows that public safety costs are positively correlated with the importance of health care workplace in the service network, and a higher public safety cost should be matched with a greater optimal penalty.


Asunto(s)
Personal de Salud , Modelos Económicos , Salud Laboral , Violencia Laboral/estadística & datos numéricos , Crimen , Hospitales , Humanos , Internacionalidad
15.
Artículo en Inglés | MEDLINE | ID: mdl-31569603

RESUMEN

We used a two-part model for the estimation of the price elasticity of participation and consumption of cigarettes by the duration of the smoking habit and a continuous-time split-population model for the estimation of prevalence and duration of smoking onset and smoking addiction, allowing for covariates in the participation component of the model. Results: We computed the total price elasticity of consumption of cigarettes by quartiles of addiction and found that for the people located in the lowest quartile of addiction the total price elasticity is around -0.51; while for those located in the highest quartile of addiction this figure is only -0.19. Then, a 10% increase in cigarette prices, via taxes, reduces the consumption of those in the early stages of the addiction by 5% and for those with a longer history of addiction by only 1.9%. Estimating the continuous-time split-population model we found that, at the mean starting age of 15 years, an increase of 10% in real cigarette prices is expected to delay smoking onset by almost two and a half years. On the other hand, the same policy is less effective to reduce the duration of the habit because there is no meaningful relationship between the duration of the smoking habit and the real price of cigarettes.The policy of raising cigarette excise taxes, to increment prices, seems to be more effective to delay smoking onset. On the other hand, the same policy is less effective to reduce the duration of the habit. A policy recommendation that emerges from this evidence is that for people with a developed addiction a combination of increasing taxes and other public health policies, like cessation therapies, could prove more effective.


Asunto(s)
Comercio , Política de Salud/economía , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/psicología , Fumar/economía , Fumar/psicología , Productos de Tabaco/economía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Modelos Psicológicos , Prevalencia , Estudios Retrospectivos , Fumar/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Impuestos , Adulto Joven
16.
Artículo en Inglés | MEDLINE | ID: mdl-31557848

RESUMEN

The purpose of this paper is to develop an applied fuzzy model of information technology to obtain quantitative estimates of environmental start-up projects in air transport. The developed model will become a useful tool for venture funds, business angels, or crowdfunding platforms for the development of innovative air transport businesses. Obtaining a quantitative estimate of the environmental start-up projects will increase the sustainability of the decision making on the security of financing of such projects by investors. This article develops a fuzzy evaluation model of project start-ups in air transport as an application of our neuro-fuzzy model in a specific air transport environment. The applied model provides output ranking of start-up project teams in air transport based on a four-layer neuro-fuzzy network. The presented model declares the possibilities of the application to solve these economic problems and offers the space for subsequent research focused on its usability in several areas of start-up development, in sectors and processes differentiated. The benefits are also visible for several types of policies, with an emphasis on decision-making processes in regulatory mechanisms to support the state funding in Slovakia, the EU etc.


Asunto(s)
Aviación/economía , Ambiente , Lógica Difusa , Modelos Económicos , Toma de Decisiones , Inversiones en Salud
17.
Artículo en Inglés | MEDLINE | ID: mdl-31546849

RESUMEN

The development of rural infrastructure plays an essential role in improving rural livelihoods and enhancing sustainable and environmentally friendly agricultural production. However, little is known about whether rural infrastructure enables the promotion of resource-conserving agriculture and reduces production costs. Understanding the relationship between rural infrastructure and production costs can provide significant information for policy-makers in their efforts to promote resource-saving agriculture that is beneficial to environmental performance. This study contributes to the literature by analyzing the heterogeneous effects of irrigation infrastructure and standard and substandard roads on agricultural production costs, using an unconditional quantile regression model and provincial data from China for the period 1995-2017. The empirical results show that the effects of rural infrastructure on production costs are mixed. In particular, irrigation infrastructure affects production costs positively in the lower quantiles, but it negatively affects production costs in the higher quantiles. In the higher 80th and 90th quantiles, standard and substandard roads affect production costs both negatively and significantly. Our findings suggest that improving rural infrastructure enables the promotion of resource-conserving agriculture and enhances environmental performance, especially for those paying high production costs.


Asunto(s)
Riego Agrícola , Conservación de los Recursos Naturales , Producción de Cultivos/economía , Modelos Económicos , Transportes , Agricultura , China , Humanos , Población Rural
18.
BMJ ; 366: l4786, 2019 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-31484641

RESUMEN

OBJECTIVE: To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks. DESIGN: Modelling study. SETTING: General adult population of the United Kingdom. PARTICIPANTS: 36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity. MAIN OUTCOME MEASURES: The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI. RESULTS: For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103 kcal (95% confidence interval -13.1×103 to -4.2×103 kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight. CONCLUSIONS: Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.


Asunto(s)
Comercio , Obesidad/epidemiología , Bocadillos , Azúcares/efectos adversos , Impuestos , Adolescente , Adulto , Índice de Masa Corporal , Ingestión de Energía , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Modelos Biológicos , Modelos Económicos , Obesidad/etiología , Obesidad/prevención & control , Prevalencia , Reino Unido/epidemiología , Adulto Joven
19.
J Manag Care Spec Pharm ; 25(10): 1089-1095, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556816

RESUMEN

Decision tree and Markov models have been the most commonly used modeling methods in health economic evaluations. Both methods are known for their limitations. Discrete-event simulation (DES), an event-driven model in continuous time at the patient level, is a relatively new method in health economic evaluations that addresses some limitations of the common modeling techniques. Specifically, with the advent of personalized medicine, conventional methods for value assessment that are based on population-level measures might not be appropriate. The best treatment would depend on patient characteristics and clinical profiles. Value assessment of health interventions can vary substantially and may lead to different health decision making due to patient heterogeneity. As such, modeling at the patient level is an appropriate approach for value assessment of health interventions. The DES model has several advantages, such as flexibility, ability to reflect patient heterogeneity, increased precision, and better characterization of modeling uncertainty, that may be preferred to decision tree and Markov models. In addition, with increasing health care spending and drug prices, it is important to quantify value of available treatment options for women with postmenopausal osteoporosis (PMO). The purpose of this Viewpoints article was to describe and demonstrate an application of a DES model to evaluate the cost-effectiveness of the current treatment guidelines for women with PMO. In particular, the DES model indicated that the optimal treatment at the common willingness-to-pay thresholds between $100,000 per quality-adjusted life-year (QALY) and $150,000 per QALY was denosumab. Analysis of patient heterogeneity in terms of low, medium, high, and very high risk of fractures resulted in a similar conclusion. DISCLOSURES: Funding for this study was received through the PhRMA Foundation Value Assessment Challenge Award. The author has no conflicts of interest to declare.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Análisis Costo-Beneficio , Fracturas Óseas/prevención & control , Modelos Económicos , Osteoporosis Posmenopáusica/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Árboles de Decisión , Costos de los Medicamentos , Femenino , Fracturas Óseas/economía , Fracturas Óseas/epidemiología , Humanos , Cadenas de Markov , Osteoporosis Posmenopáusica/economía , Osteoporosis Posmenopáusica/genética , Guías de Práctica Clínica como Asunto , Medicina de Precisión/economía , Medicina de Precisión/normas , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo
20.
J Manag Care Spec Pharm ; 25(10): 1133-1139, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556818

RESUMEN

BACKGROUND: Disease-free survival (DFS) in early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer is significantly greater with the addition of neratinib after adjuvant trastuzumab versus no additional therapy. However, it remains uncertain whether these survival gains represent good value for the money, given the substantial cost of neratinib. OBJECTIVE: To evaluate clinical and economic implications of adding neratinib after adjuvant trastuzumab based on results from the phase III ExteNET trial. METHODS: A 3-state Markov model was developed to estimate the cost-effectiveness of neratinib for women with early-stage (I-III) HER2-positive breast cancer. Five-year recurrence rates were derived from the ExteNET trial. Mortality and recurrence rates after 5 years were derived from the HERceptin Adjuvant (HERA) trial. Outcomes included life-years, quality-adjusted life-years (QALYs), and direct medical expenditures. The analysis was performed from a payer perspective over a lifetime horizon. One-way sensitivity and probabilistic analyses were conducted to evaluate uncertainty. RESULTS: Total cost of neratinib following adjuvant trastuzumab was $317,619 versus $152,812 for adjuvant trastuzumab alone. A gain of 0.4 QALYs (15.7 vs. 15.3) and 0.1 years of projected life expectancy (18.3 vs. 18.2) favored neratinib after trastuzumab versus trastuzumab alone. The neratinib cost per QALY gained was $416,106. At standard willingness-to-pay thresholds of $50,000, $100,000, and $200,000 per QALY gained, neratinib has a probability of 2.8%, 16.7%, and 33.9% of cost-effectiveness, respectively. The cost per QALY gained in a scenario analysis only including patients with hormone-receptor positive disease was $275,311. CONCLUSIONS: Based on 5-year data from ExteNET, neratinib following adjuvant trastuzumab is not projected to be cost-effective, even among those patients shown to derive the greatest clinical benefit. Future analyses should reassess the cost-effectiveness associated with neratinib treatment as trial data mature. DISCLOSURES: No outside funding supported this study. Roth reports consulting fees from Genentech. Steuten reports grants from AstraZeneca, EMD Serono, and Genomic Health, along with personal fees from Agendia, unrelated to this study. The other authors have no conflicts of interest in connection with this study.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Análisis Costo-Beneficio , Quinolinas/uso terapéutico , Trastuzumab/uso terapéutico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Supervivencia sin Enfermedad , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Modelos Económicos , Estadificación de Neoplasias , Años de Vida Ajustados por Calidad de Vida , Quinolinas/economía , Receptor ErbB-2/metabolismo , Trastuzumab/economía
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