Evaluating conservation dogs in the search for rare species.

Detecting rare species is important for both threatened species management and invasive species eradication programs. Conservation scent dogs provide an olfactory survey tool that has advantages over traditional visual and auditory survey techniques for some cryptic species. From the literature, we identified 5 measures important in evaluating the use of scent dogs: precision, sensitivity, effort, cost, and comparison with other techniques. We explored the scale at which performance is evaluated and examined when field testing under real working conditions is achievable. We also identified cost differences among studies. We examined 61 studies published in 1976-2018 that reported conservation dog performance, and considered the inconsistencies in the reporting of scent dog performance among these studies. The majority of studies reported some measure of performance; however, only 8 studies reported all 3 aspects necessary for performance evaluation: precision, sensitivity, and effort. Although effort was considered in 43 studies, inconsistent methods and incomplete reporting prevented meaningful evaluation of performance and comparison among studies. Differences in cost between similar studies were influenced by geographical location and how the dog and handler were sourced for the study. To develop consistent reporting for evaluation, we recommend adoption of sensitivity, precision, and effort as standard performance measures. We recommend reporting effort as the total area and total time spent searching and reporting sensitivity and precision as proportions of the sample size. Additionally, reporting of costs, survey objectives, dog training and experience, type of detection task, and human influences will provide better opportunities for comparison within and among studies.

Evaluación del Uso de Perros en la Conservación para la Búsqueda de Especies Raras Resumen La detección de las especies raras es importante tanto para el manejo de especies amenazadas como para los programas de erradicación de especies invasoras. Los perros usados para la conservación proporcionan una herramienta de censo olfativo que presenta algunas ventajas sobre las técnicas de censos visuales y auditivos usados para algunas especies crípticas. Identificamos cinco medidas importantes para la evaluación del uso de perros a partir de la literatura: precisión, sensibilidad, esfuerzo, costo y comparación con otras técnicas. Exploramos la escala a la cual se evalúa el desempeño y examinamos cuando son alcanzables las pruebas de campo bajo condiciones de trabajo reales. Examinamos 61 estudios publicados entre 1976 y 2018, los cuales reportaron sobre el desempeño de los perros para la conservación y consideramos las incongruencias en el reporte del desempeño de perros de olfato entre estos estudios. La mayoría de los estudios reportaron los tres aspectos necesarios para la evaluación del desempeño: precisión, sensibilidad y esfuerzo. Aunque 43 estudios consideraron al esfuerzo, los métodos incongruentes y el reporte incompleto impidieron una evaluación significativa del desempeño y una comparación entre los estudios. Las diferencias en el costo entre estudios similares estuvieron influenciadas por la ubicación geográfica y cómo el perro y su adiestrador fueron seleccionados para el estudio. Para desarrollar un reporte coherente para la evaluación, recomendamos la adopción de la sensibilidad la precisión y el esfuerzo como medidas estandarizadas del desempeño. Recomendamos que se reporte el esfuerzo como el área y el tiempo invertido en la búsqueda y la precisión como las proporciones del tamaño de la muestra. Además, el reporte de los costos, los objetivos de los censos, el entrenamiento y experiencia del perro, el tipo de labor de detección y la influencia humana proporcionarán mejores oportunidades para comparar dentro de un estudio o entre los estudios.

[Economic evaluation of the introduction of 4CMenB (Bexsero®) in the national vaccine schedule in Spain]. / Evaluación económica de la inclusión en el calendario vacunal de 4CMenB (Bexsero®) en España.

INTRODUCTION: Bexsero® (4CMenB), meningococcal B vaccine, was licensed in Europe in 2013. In Spain, despite MenB being the most frequent cause of invasive meningococcal disease (IMD), Bexsero® is recommended and financed for patients at increased risk of IMD but is not financed by the NHS in the routine vaccination schedule. OBJECTIVE: to evaluate the cost-utility, epidemiological impact, and total costs of the introduction of 4CMenB into the vaccination schedule to help inform vaccine policy in Spain. METHOD: We adapted a cost-utility analysis, a probabilistic decision-tree, to Spain. A cohort of new-born infants in 2015 was modelled with two dosages, using two different strategies: routine vaccination schedule with 4CMenB and non-vaccination. Costs were measured from a payer perspective and benefits were calculated in quality-adjusted life years (QALYs). A Monte Carlo analysis and 32 scenarios were performed to assess the robustness and the uncertainty of our results. RESULTS: With the 3+1 dosage, routine vaccination prevented 54% of cases and deaths and an incremental cost-utility ratio (ICUR) of 351.389 €/QALY (95% confidence interval [95%CI]: 265,193-538,428) was estimated. The 2+1 dosage prevented 50% of cases and deaths, with an ICUR of 278.556 €/QALY (95%CI: 210,285-430,122). CONCLUSIONS: Given the current incidence of invasive meningococcal disease in Spain and the information available from 4CMenB, our model shows that routine vaccination is not cost-effective at the current price. Only with a vaccine price of 1.45 € for the 3+1 schedule or 3.37 € for the 2+1 schedule could it be recommended based on efficiency criteria.

Hospitalization costs due to severe acute respiratory infection (SARI) in three Central American countries / Costos de hospitalización de infección respiratoria aguda grave (IRAG) en tres países de América Central

Objective: To estimate the direct medical costs of severe acute respiratory infection (SARI) in children and adults from three Central American countries with a bottom-up costing approach. Methods: The costs of inpatients treatment were estimated through the retrospective bottom-up costing in a randomized sample of clinical records from SARI patients treated in teaching tertiary hospitals during 2009 - 2011 period. Activities incurred per patient were registered and a setting-specific cost per activity was acquired. Average cost per patient in the group of children and elderly adults was estimated for each country. In Nicaragua, only the pediatric population was included. Costs were expressed in local currency (2011), American dollars, and international dollars (2005) for country comparison. Results: The care cost per case in children in Guatemala was the cheaper (I$971.95) compared to Nicaragua (I$1,431.96) and Honduras (I$1,761.29). In adults, the treatment cost for Guatemala was the more expensive: I$4,065.00 vs. I$2,707.91 in Honduras. Conclusion: Bottom-up costing of SARI cases allowed the mean estimates per treated case that could have external validity for the target population diagnosed in hospitals with similar epidemiological profiles and level of complexity for the study countries. This information is very relevant for the decision-making.

Objetivo: Estimar los costos directos de la atención de infección respiratoria aguda (IRAG) en niños y adultos en tres países de América Central. Métodos: Los costos de pacientes hospitalizados fueron estimados a través de análisis retrospectivo en una muestra aleatoria de registros de historias clínicas de casos de IRAG tratado en hospitales universitarios durante el periodo 2009-2011. Las actividades incurridas por paciente fueron registradas y un costo especifico para cada sitio fue estimado. El costo por cada niño y adulto mayor fue estimado para cada país. En Nicaragua sólo se incluyó población pediátrica. Los costos fueron expresados en moneda local (2011), dolar americano y dolar internacional (2005). Resultados: El costo por caso en niños en Guatemala fue el más barato (I$971.95) comparado al de Nicaragua (I$1,431.96) y Honduras (I$1,761.29). En adultos, el costo de tratamiento para Guatemala fue el más costoso: I$4,065.00 vs. I$2,707.91 en Honduras. Conclusión: Los costos de tratar casos IRAG estimados a partir de costos promedios pro caso pueden tener validez externa para hospitales con perfiles epidemiologicos similares y nivel de complejidad de atención para los países del estudio. Esta información es muy relevante para la toma de decisiones.

The need for spatially explicit quantification of benefits in invasive-species management.

Worldwide, invasive species are a leading driver of environmental change across terrestrial, marine, and freshwater environments and cost billions of dollars annually in ecological damages and economic losses. Resources limit invasive-species control, and planning processes are needed to identify cost-effective solutions. Thus, studies are increasingly considering spatially variable natural and socioeconomic assets (e.g., species persistence, recreational fishing) when planning the allocation of actions for invasive-species management. There is a need to improve understanding of how such assets are considered in invasive-species management. We reviewed over 1600 studies focused on management of invasive species, including flora and fauna. Eighty-four of these studies were included in our final analysis because they focused on the prioritization of actions for invasive species management. Forty-five percent (n = 38) of these studies were based on spatial optimization methods, and 35% (n = 13) accounted for spatially variable assets. Across all 84 optimization studies considered, 27% (n = 23) explicitly accounted for spatially variable assets. Based on our findings, we further explored the potential costs and benefits to invasive species management when spatially variable assets are explicitly considered or not. To include spatially variable assets in decision-making processes that guide invasive-species management there is a need to quantify environmental responses to invasive species and to enhance understanding of potential impacts of invasive species on different natural or socioeconomic assets. We suggest these gaps could be filled by systematic reviews, quantifying invasive species impacts on native species at different periods, and broadening sources and enhancing sharing of knowledge.

Environmental cost of using poor decision metrics to prioritize environmental projects.

Conservation decision makers commonly use project-scoring metrics that are inconsistent with theory on optimal ranking of projects. As a result, there may often be a loss of environmental benefits. We estimated the magnitudes of these losses for various metrics that deviate from theory in ways that are common in practice. These metrics included cases where relevant variables were omitted from the benefits metric, project costs were omitted, and benefits were calculated using a faulty functional form. We estimated distributions of parameters from 129 environmental projects from Australia, New Zealand, and Italy for which detailed analyses had been completed previously. The cost of using poor prioritization metrics (in terms of lost environmental values) was often high--up to 80% in the scenarios we examined. The cost in percentage terms was greater when the budget was smaller. The most costly errors were omitting information about environmental values (up to 31% loss of environmental values), omitting project costs (up to 35% loss), omitting the effectiveness of management actions (up to 9% loss), and using a weighted-additive decision metric for variables that should be multiplied (up to 23% loss). The latter 3 are errors that occur commonly in real-world decision metrics, in combination often reducing potential benefits from conservation investments by 30-50%. Uncertainty about parameter values also reduced the benefits from investments in conservation projects but often not by as much as faulty prioritization metrics.

ErbB2+ metastatic breast cancer treatment after progression on trastuzumab: a cost-effectiveness analysis for a developing country / Tratamientos para cáncer de seno metastásico ErbB2+ en progresión Post-Trastuzumab: Análisis de costo-efectividad para un país en vía de desarrollo

Objective Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst women worldwide, including developing countries. The cost of treatment in the latter is even more of an issue than in higher income countries. ErbB2 overexpression is a marker of poor prognosis and the goal for targeted therapy. This study was aimed at evaluating the cost-effectiveness in Colombia of ErbB2+ MBC treatment after progression on trastuzumab. Methods A decision analytic model was constructed for evaluating such treatment in a hypothetical cohort of ErbB2+MBC patients who progressed after a first scheme involving trastuzumab. The alternatives compared were lapatinib+capecitabine (L+C), and trastuzumab+a chemotherapy agent (capecitabine, vinorelbine or a taxane). Markov models were used for calculating progression-free time and the associated costs. Effectiveness estimators for such therapy were identified from primary studies; all direct medical costs based on national fees-guidelines were included. Sensitivity was analyzed and acceptability curves estimated. A 3 % discount rate and third-payer perspective were used within a 5-year horizon. Results L+C dominated its comparators. Its cost-effectiveness ratio was COP $49,725,045 per progression-free year. The factors most influencing the results were the alternatives' hazard ratios and the cost of trastuzumab. Conclusion Lapatinib was cost-effective compared to its alternatives for treating MBC after progression on trastuzumab using a Colombian decision analytic model.

Objetivo El cáncer de seno (CS) y cáncer de seno metastásico (CSM) son importantes causas de muerte entre las mujeres a nivel mundial y en países en vía de desarrollo. En estos últimos los costos de los tratamientos son aún más preocupantes que en países de alto ingreso. La sobreexpresión de ErbB2 es marcador de pobre pronóstico y objetivo de terapias dirigidas. Se evaluó la costo-efectividad de los tratamientos de CSM ErbB2+ en progresión post-trastuzumab en Colombia. Métodos Se desarrolló un modelo analístico de decisiones para evaluar los tratamientos en una cohorte hipotética de CSM ErbB2+ que progresaron después de un primer esquema con trastuzumab. Las alternativas comparadas fueron: lapatinib+capecitabina (L+C), y trastuzumab más un agente quimioterápico (capecitabina, vinorelbinao un taxano). Se usaron modelos de Markov para calcular el tiempo libre de progresión y los costos asociados. Estimaciones de efectividad fueron identificadas de estudios primarios. Se incluyeron todos los costos médicos directos basados en los manuales tarifarios nacionales. Se realizaron análisis de sensibilidad y curvas de aceptabilidad. Se descontaron costos y resultados a una tasa anual de 3 %, la perspectiva de análisis fue del tercer pagador y el horizonte de 5 años. Resultados L+C domina a sus comparadores con un razón de costo-efectividad de COP $49 725 045 por año libre de progresión. Los factores que más influencian los resultados son los hazard ratios de las alternativas y el costo de trastuzumab. Conclusión Lapatinib es costo-efectivo comparado con sus alternativas para el tratamiento del CSM después de la progresión con trastuzumab en el escenario colombiano.

Benefits of investing in ecosystem restoration.

Measures aimed at conservation or restoration of ecosystems are often seen as net-cost projects by governments and businesses because they are based on incomplete and often faulty cost-benefit analyses. After screening over 200 studies, we examined the costs (94 studies) and benefits (225 studies) of ecosystem restoration projects that had sufficient reliable data in 9 different biomes ranging from coral reefs to tropical forests. Costs included capital investment and maintenance of the restoration project, and benefits were based on the monetary value of the total bundle of ecosystem services provided by the restored ecosystem. Assuming restoration is always imperfect and benefits attain only 75% of the maximum value of the reference systems over 20 years, we calculated the net present value at the social discount rates of 2% and 8%. We also conducted 2 threshold cum sensitivity analyses. Benefit-cost ratios ranged from about 0.05:1 (coral reefs and coastal systems, worst-case scenario) to as much as 35:1 (grasslands, best-case scenario). Our results provide only partial estimates of benefits at one point in time and reflect the lower limit of the welfare benefits of ecosystem restoration because both scarcity of and demand for ecosystem services is increasing and new benefits of natural ecosystems and biological diversity are being discovered. Nonetheless, when accounting for even the incomplete range of known benefits through the use of static estimates that fail to capture rising values, the majority of the restoration projects we analyzed provided net benefits and should be considered not only as profitable but also as high-yielding investments. Beneficios de Invertir en la Restauración de Ecosistemas.

Evaluación de la efectividad, seguridad y costos del tratamiento antimicrobiano intravenoso ambulatorio (TAIA) vs hospitalizado en infección urinaria en pediatría / Evaluation of the effectiveness, safety and costs of outpatient intravenous antimicrobial treatment (OPAT) vs hospitalized in urinary infection in Pediatrics

Background: Childrens hospitalization for intravenous antibiotic treatment has been replaced in developed countries and in some Chilean centers to outpatient intravenous therapy (OPAT). Aim: To compare the effectiveness, safety and cost of OPAT versus inpatient care. Patients andMethods: Prospective cohort study in children (2 months-5 years) with febrile urinary tract infection (UTI) attended at two public Chilean hospitals: outpatient cohort and inpatient cohort. Between November of 2009-2010, 111 children were enrolled in OPAT and between January 2010-June 2011, 81 children were hospitalized. Demographic data, costs and parental care, response to treatment, adverse events and complications were registered. Results: There was no difference in the effectiveness of both treatments (100% in OPAT and 98.6% in inpatient cohort, p: 0.41). Adherence to OPAT was 100%. Prevalence of adverse events was higher in inpatient cohort (76.3% versus 16.2%, p < 0.01). The average direct cost was four times higher in inpatients, mainly due to bed-day cost. Indirect cost was similar in both groups. There were more days of absence from work and care centers in inpatients (p: 0.017, p: 0.045 respectively). Conclusion: OPAT for febrile UTI was equally effective, safer and significantly less expensive than inpatient care. OPAT represents a recommended intervention for pediatric services of Chilean public hospitals.

Introducción: La hospitalización de niños para tratamiento antimicrobiano intravenoso, ha sido reemplazada en países desarrollados y en algunos centros chilenos por el tratamiento antimicrobiano intravenoso ambulatorio (TAIA). Objetivo: Comparar efectividad, seguridad y costos de TAIA versus hospitalizado. Pacientes y Métodos: Se efectuó un estudio de cohorte prospectiva en niños (2 meses-5 años) con infección urinaria (ITU) febril atendidos en dos hospitales públicos chilenos: una cohorte ambulatoria y otra hospitalizada. Entre noviembre 2009 y 2010, se enrolaron 111 niños en TAIA y entre enero 2010-junio 2011, 81 niños hospitalizados. Se registraron datos demográficos, gastos de atención y de los padres, respuesta al tratamiento, eventos adversos y complicaciones. Resultados: No hubo diferencia en la efectividad de ambos tratamientos (100% en TAIA y 98,6% en hospitalizado; p: 0,41). La adherencia a TAIA fue 100%. La prevalencia de eventos adversos fue mayor en los hospitalizados (76,3 versus16,2%, p < 0,01). El costo directo promedio fue cuatro veces superior en hospitalizados, principalmente por costo día-cama. El costo indirecto fue similar. Hubo más días de ausentismo laboral y a centros de cuidado en hospitalizados (p: 0,017, p: 0,045, respectivamente). Conclusión: El tratamiento de ITU febril con TAIA en niños fue igualmente efectivo, más seguro y significativamente menos costoso que el hospitalizado y representa una intervención recomendable para los servicios pediátricos de hospitales públicos chilenos.

Aplicación del costo-eficiencia en un área de salud

Se realiza un estudio descriptivo de corte transversal de costo-eficiencia en el policlínico "Turcios Lima" en Ciudad de La Habana, que correlaciona los gastos y resultados de salud alcanzados en el período de un año. Se analiza el presupuesto y los costos unitarios, obtenidos de la aplicación del sistema aprobado para ese fin por el Ministerio de Salud Pública. Se muestra el comportamiento de un grupo de indicadores de salud seleccionados, que reflejan el grado de eficacia. Se establece una relación entre ambos aspectos, concluyendo que existen reservas de eficiencia económica sin explotar, basándonos para ello en los resultados siguientes: el salario representa el 75 % de los gastos, los altos costos por consulta del Plan Familia son de $ 3,65, en Interconsultas de $ 11,09, en Atención Médica Especializada de $ 10,59 y en Psicología de $ 10,50. Los consultorios en centros de trabajo y educacionales son caros, al igual que los medios diagnósticos. Se recomienda la evaluación sistemática en las reuniones del GBT de los resultados de costos.

A cross-sectional descriptive study of cost-efficiency was conducted at "Turcios Lima" Polyclinic in Havana City to correlate the health expenditures and the results attained during a year. The budget as well as the unitary costs resulting from the application of the system approved by the Ministry of Public Health are analyzed. The behavior of a group of selected health indicators reflecting the degree of efficiency is shown. A relationship between both aspects is established and it is concluded that there are reserves of economic efficiency that have not been exploted yet based on the following results: the salary accounts for 75% of the expenditures, the high costs by consultation of the Family Physician Plan are $3,65; in Interconsultations, $11,09; in Specialized Medical Attention, $10,59; and in Psychology, $10,50. The physcian?s offices in working and educational centers are expensive, as a well as the diagnostic tools. It is recommended the systematic evaluation of the results of the costs in the meetings of the Working Basic Group.

Análisis costo beneficio del Programa de Detección Oportuna del Cáncer Cervicouterino / Cost benefit analysis of the Cervical Cancer Screening Program

Objetivo. Determinar el costo beneficio de la reorganización del Programa de Detección Oportuna del Cáncer Cervicouterino (PDOC) mediante intervenciones de garantía de calidad. Material y métodos. Se siguieron tres estapas: a) identificación y cuantificación de costos; b) identificación y cuantificación de beneficios, y c) evaluación económica del costo beneficio. Resultados. El costo unitario de operación por citología -obtención, fijación, el traslado al centro de lectura, su tinción e interpretación y la notificación de resultados- se estimó en USD$ 11.6. En conjunto, las intervenciones en calidad al PDOC elevarían el costo de cada citología en 32.7 por ciento. Sin embargo, la nueva organización generaría una razón beneficio/costo de 2 y un beneficio neto de 88 millones de dólares para los próximos cinco años. Conclusiones. La operación del programa propuesto resulta socialmente deseable, siempre y cuando las modificaciones se lleven a cabo, particularmente la capacitación, la notificación personalizada de los casos positivos, el incremento de cobertura, la introducción de mecanismos de control de calidad, el monitoreo contínuo y el tratamiento en mujeres con anormalidades detectadas

La eficacia en funcion de los costos y la reforma del sector salud / Cost-effectiveness and the health sector reform

La eficacia en función del costo de una intervención de salud es una estimación de la relación entre lo que cuesta proveer una intervención, y el mejoramiento en salud que se produce como consecuencia. La salud puede mejorar porque se reduce la incidencia de la enfermedad o lesión, porque se evita o demora la muerte, o porque se reduce el intervalo o la severidad de una incapacidad. El cálculo de este beneficio combina factores objetivos, como son la edad de incidencia y si resulta o no en muerte, con factores subjetivos, como son la evaluación del grado de incapacidad no-mortal, la ponderación del valor de la vida sana según la edad, y la tasa de descuento que se aplica al futuro. Se explica cómo se construye el estimado y cómo se debería interpretarlo. Luego, se examina el grado en que el concepto es consistente con normas éticas y de equidad, concluyéndose que no están en conflicto. Finalmente, se discute la incorporación de la eficacia en función de los costos como elemento de una reforma de salud, y las posibles medidas para implementarla.

The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.