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1.
BMC Public Health ; 20(1): 1374, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907562

RESUMO

BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.


Assuntos
Análise Custo-Benefício , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Saúde Pública , Vacinação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Economia Médica , Feminino , Hospitalização/economia , Humanos , Lactente , Vírus da Influenza B/classificação , Vírus da Influenza B/imunologia , Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano , Incerteza , Vacinação/economia , Adulto Jovem
2.
Lancet Glob Health ; 8(10): e1282-e1294, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32971051

RESUMO

BACKGROUND: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. METHODS: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. FINDINGS: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. INTERPRETATION: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. FUNDING: International Development Research Centre (IDRC), Canada.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Fumar/economia , Fumar/epidemiologia , Impostos/economia , Produtos do Tabaco/economia , Humanos , América Latina/epidemiologia , Cadeias de Markov , Modelos Econômicos , Impostos/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos
3.
Value Health ; 23(9): 1163-1170, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940234

RESUMO

OBJECTIVES: The cardiovascular outcomes challenge examined the predictive accuracy of 10 diabetes models in estimating hard outcomes in 2 recent cardiovascular outcomes trials (CVOTs) and whether recalibration can be used to improve replication. METHODS: Participating groups were asked to reproduce the results of the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) and the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program. Calibration was performed and additional analyses assessed model ability to replicate absolute event rates, hazard ratios (HRs), and the generalizability of calibration across CVOTs within a drug class. RESULTS: Ten groups submitted results. Models underestimated treatment effects (ie, HRs) using uncalibrated models for both trials. Calibration to the placebo arm of EMPA-REG OUTCOME greatly improved the prediction of event rates in the placebo, but less so in the active comparator arm. Calibrating to both arms of EMPA-REG OUTCOME individually enabled replication of the observed outcomes. Using EMPA-REG OUTCOME-calibrated models to predict CANVAS Program outcomes was an improvement over uncalibrated models but failed to capture treatment effects adequately. Applying canagliflozin HRs directly provided the best fit. CONCLUSIONS: The Ninth Mount Hood Diabetes Challenge demonstrated that commonly used risk equations were generally unable to capture recent CVOT treatment effects but that calibration of the risk equations can improve predictive accuracy. Although calibration serves as a practical approach to improve predictive accuracy for CVOT outcomes, it does not extrapolate generally to other settings, time horizons, and comparators. New methods and/or new risk equations for capturing these CV benefits are needed.


Assuntos
Modelos Econômicos , Avaliação de Resultados em Cuidados de Saúde/métodos , Compostos Benzidrílicos/uso terapêutico , Calibragem , Canagliflozina/uso terapêutico , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/uso terapêutico , Humanos , Medição de Risco , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
4.
Value Health ; 23(9): 1268-1280, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940245

RESUMO

OBJECTIVES: To identify methodological considerations discussed in literature addressing economic evaluations (EEs) of gene therapies (GTs). Additionally, we assessed if these considerations are applied in published GT EEs to increase understanding and explore impact. METHODS: First a peer-reviewed literature review was performed to identify research addressing methodological considerations of GT EEs until August 2019. Identified considerations were grouped in themes using thematic content analysis. A second literature search was conducted in which we identified published evaluations. The EE quality of reporting was assessed using Consolidated Health Economic Evaluation Reporting Standards. RESULTS: The first literature search yielded 13 articles discussing methodological considerations. The second search provided 12 EEs. Considerations identified were payment models, definition of perspectives, addressing uncertainty, data extrapolation, discount rates, novel value elements, and use of indirect and surrogate endpoints. All EEs scored satisfactory to good according to Consolidated Health Economic Evaluation Reporting Standards. Regarding methodological application, we found 1 methodological element (payment models) was applied in 2 base cases. Scenarios explored alternative perspectives, survival assumptions, and extrapolation methods in 10 EEs. CONCLUSIONS: Although EE quality of reporting was considered good, their informativeness for health technology assessment and decision makers seemed limited owing to many uncertainties. We suggest accepted EE methods can broadly be applied to GTs, but few elements may need adjustment. Further research and multi-stakeholder consensus is needed to determine appropriateness and application of individual methodological considerations. For now, we recommend including scenario analyses to explore impact of methodological choices and (clinical) uncertainties. This study contributes to better understanding of perceived appropriate evaluation of GTs and informs best modeling practices.


Assuntos
Terapia Genética/economia , Modelos Econômicos , Análise Custo-Benefício , Estudos de Avaliação como Assunto , Humanos
5.
J Ment Health Policy Econ ; 23(3): 81-91, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32853157

RESUMO

BACKGROUND: Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely incorporating financial penalties for upcoding rather than by a theoretical model that incorporates the downstream effects of upcoding on service provision requirements. AIMS OF THE STUDY: In this paper, we contribute to the literature on upcoding by developing a new theoretical model that is applicable to capitated, case-rate and shared savings payment systems. This model incorporates the downstream effects of upcoding on service provision requirements rather than just the avoidance of penalties. This difference is important especially for shared-savings models with quality benchmarks. METHODS: We test implications of our theoretical model on changes in severity determination and service use associated with changes in case-rate payments in a publicly-funded mental health care system. We model provider-assigned severity categories as a function of risk-adjusted capitated payments using conditional logit regressions and counts of service days per month using negative binomial models. RESULTS: We find that severity determination is only weakly associated with the payment rate, with relatively small upcoding effects, but that level of use shows a greater degree of association. DISCUSSION: These results are consistent with our theoretical predictions where the marginal utility of savings or profit is small, as would be expected from public sector agencies. Upcoding did seem to occur, but at very small levels and may have been mitigated after the county and providers had some experience with the new system. The association between the payment levels and the number of service days in a month, however, was significant in the first period, and potentially at a clinically important level. Limitations include data from a single county/multiple provider system and potential unmeasured confounding during the post-implementation period. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Providers in our data were not at risk for inpatient services but decreases in use of outpatient services associated with rate decreases may lead to further increases in inpatient use and therefore expenditures over time. IMPLICATIONS FOR HEALTH POLICIES: Health program directors and policy makers need to be acutely aware of the interplay between provider payments and patient care and eventual health and mental health outcomes. IMPLICATIONS FOR FURTHER RESEARCH: Further research could examine the implications of the theoretical model of upcoding in other payment systems, estimate the power of the tiered-risk systems, and examine their influence on clinical outcomes.


Assuntos
Organizações de Assistência Responsáveis , Capitação/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/economia , Motivação , Atenção Primária à Saúde/economia , Análise Custo-Benefício/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Gastos em Saúde , Humanos , Modelos Econômicos , Modelos Teóricos , Setor Público
6.
PLoS Negl Trop Dis ; 14(7): e0008410, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32735585

RESUMO

Cystic echinococcosis (CE) is a major zoonosis in Morocco despite the launch of a national control programme in 2005. As its economic consequences have not been studied yet in Morocco, this study estimated CE impact in terms of monetary losses, disability-adjusted life years (DALY), and DALY for zoonotic diseases (zDALY) in the entire country and in specific regions for the 2011 to 2014 period. The direct monetary losses were related to organ seizure from infected animal in slaughterhouses, and to healthcare expenses as well as lost wages for infected humans. Animal production losses concerned milk yield, fertility, carcass weight, and wool production. Losses due to human infection were also composed of disability and productivity losses at work. Monte Carlo simulations were used to estimate monetary losses and zDALY values. Nationwide, the estimated DALY was 0.5 years per 100,000 persons per year, and the zDALY was 55 years per 100,000 persons per year. Total yearly losses were estimated at 73 million USD (54-92 million USD). However, losses differed significantly among regions. Most of the economic losses consisted of unperceived consequences, i.e. decreased animal production and reduced productivity of asymptomatic individuals. Future studies should determine the socioeconomic and epidemiological factors underlying the differences in economic losses among regions to develop better adapted control programmes.


Assuntos
Equinococose/economia , Equinococose/epidemiologia , Zoonoses/economia , Zoonoses/epidemiologia , Criação de Animais Domésticos/economia , Animais , Parasitologia de Alimentos , Humanos , Modelos Econômicos , Método de Monte Carlo , Marrocos/epidemiologia , Fatores Socioeconômicos
7.
PLoS One ; 15(8): e0236730, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756584

RESUMO

The global energy system changes towards renewables-dominated and liberalized markets. This requires making novel trade-offs between the profitable development of hydropower and its environmental effects on the natural flow regime. Here, we used a pristine river as a model for how these future changes will affect the natural flow regime and identify future changes on previously overlooked levels. We found that damming and discharging based on market prices leads to first- and second-level deviation from natural flows. Beyond these effects, we identified a third level of distance from natural flow. This third level is created by the transition towards a renewables-dominated energy system. The volatile energy input from renewables incentivizes hydropower plant operators to discharge based on more flexible trading behavior. We conclude that novel economic models be combined with tailored implementations of environmental flows. This will allow to find novel solutions for the trade-off between market liberalization and sustainable hydropower development.


Assuntos
Meio Ambiente , Hidrologia , Internacionalidade , Energia Renovável/economia , Modelos Econômicos
8.
PLoS One ; 15(8): e0232385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790729

RESUMO

Classical value-based decision theories state that economic choices are solely based on the value of available options. Experimental evidence suggests, however, that individuals' choices are biased towards default options, prompted by the framing of decisions. Although the effects of default options created by exogenous framing-such as how choice options are displayed-are well-documented, little is known about the potential effects and properties of endogenous framing, that is, originating from an individual's internal state. In this study, we investigated the existence and properties of endogenous default options in a task involving choices between risky lotteries. By manipulating and examining the effects of three experimental features-time pressure, time spent on task and relative choice proportion towards a specific option-, we reveal and dissociate two features of endogenous default options which bias individuals' choices: a natural tendency to prefer certain types of options (natural default), and the tendency to implicitly learn a default option from past choices (learned default). Additional analyses suggest that while the natural default may bias the standard choice process towards an option category, the learned default effects may be attributable to a second independent choice process. Overall, these investigations provide a first experimental evidence of how individuals build and apply diverse endogenous default options in economic decision-making and how this biases their choices.


Assuntos
Comportamento de Escolha , Teoria da Decisão , Modelos Econômicos , Adolescente , Adulto , Viés , Tomada de Decisões , Feminino , Humanos , Masculino , Modelos Psicológicos , Assunção de Riscos , Adulto Jovem
9.
PLoS One ; 15(8): e0235953, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841253

RESUMO

The most crucial challenge in the functioning of the wireless networks is the efficient utilization of radio resources. A significant element of resource handling is power regulation. With increasing requirement of wireless data transmission services, it is essential to devise energy harvesting techniques for mobile devices. In this research, a new methodology has been proposed for distributed power regulation in cognitive radio, networks of CR are grounded on non-cooperation game phenomenon and pricing technique. QoS (Quality of service) of the user of CR is anticipated as a beneficial activity through pricing as well as dissemination of energy generating as an unbeneficial game wherein the consumers increase their overall efficacy. The price is defined as an actual function of transmission power to upraise the pricing of the most distant consumers. The proposed mathematical model shows that the proposed game model has a Nash equilibrium and is also unique. Furthermore, in order to make the proposed algorithm valid for green communication within the wireless network, the best response technique was proposed. Finally, simulation results showed that the proposed energy harvesting technique, grounded on a unique function of the utilization, reduces the consumption of transmission power and greatly improves the convergence speed; which are suitable for the vision of the 5G networks.


Assuntos
Custos e Análise de Custo/métodos , Teoria do Jogo , Modelos Econômicos , Ondas de Rádio , Tecnologia sem Fio/economia , Algoritmos , Simulação por Computador
10.
PLoS One ; 15(8): e0236979, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760110

RESUMO

The aim of this study is to identify the dynamic explicit and implicit information factors which displayed on the webpage of platforms that influence backers' investment decision-making behavior. We analyze the connections among these factors by collecting the longitudinal dataset from reward-based crowdfunding platform. Based on ELM model, we establish Fixed Estimation Panel Data Model respectively according to explicit and implicit factors and take Funding Status (crowdfunding results) as the moderating variable to observe the goal gradient effect. Results indicate that most variables in the central route affect backers' investment behavior positively, while most variables in the periphery route have a negative impact on backers' investment behavior. The Funding Status has a significant negative moderating effect on the explicit variables, and has no significant moderating effect on the implicit information variables of the project. In addition, we upgrade the econometric method used by previous scholars, which could improve the accuracy of the FE model. Furthermore, we find strong support for the herding effect in reward-based crowdfunding and the intensity tends to decrease before the funding goal draws near.


Assuntos
Crowdsourcing/economia , Investimentos em Saúde , Comunicação Persuasiva , Recompensa , Bases de Dados Factuais , Tomada de Decisões , Humanos , Internet , Funções Verossimilhança , Modelos Econômicos , Modelos Psicológicos
11.
Value Health ; 23(7): 953-968, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762998

RESUMO

OBJECTIVES: We performed a systematic review of health state utility values (HSUVs) obtained using the EQ-5D questionnaire for patients with hematologic malignancies. METHODS: The following databases were searched up to September 2018: MEDLINE, EMBASE, The Cochrane Library, and the EQ-5D publications database on the EuroQol website. Additional references were extracted from reviewed articles. Only studies presenting EQ-Index results were incorporated. In view of the heterogeneity across the included publications, we limited ourselves to a narrative synthesis of original HSUVs found. RESULTS: Fifty-nine studies (described in 63 articles) met the inclusion criteria. Data from 21 635 respondents provided 796 HSUV estimates for hematologic malignancy patients. EQ-Index scores ranged from -0.025 to 0.980. The most represented area was multiple myeloma (4 studies, 11 112 patients, and 249 HSUVs). In clinical areas such as chronic myeloid leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, and mantle cell lymphoma, we described over 50 health utilities in each. In contrast, we identified only 13 HSUVs (based on 4 studies and the data of 166 patients) for Hodgkin lymphoma. Areas without EQ-5D-based health utilities comprised: polycythemia vera, primary myelofibrosis, essential thrombocythemia, mastocytosis, myeloid sarcoma, chronic myelomonocytic, eosinophilic leukemia, and neutrophilic leukemia. CONCLUSIONS: There is a wide range of HSUVs available for hematologic cancer patients with different indications. The review provides a catalog of utility values for use in cost-effectiveness models for hematologic malignancies.


Assuntos
Nível de Saúde , Neoplasias Hematológicas/psicologia , Qualidade de Vida , Análise Custo-Benefício , Neoplasias Hematológicas/economia , Neoplasias Hematológicas/patologia , Humanos , Modelos Econômicos , Inquéritos e Questionários
12.
PLoS One ; 15(8): e0237172, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817623

RESUMO

This paper contributes to better understand the dynamic interactions between effective exchange rate (EER) and oil price for an oil-importing country like the U.S. by considering a Time-Varying Parameter VAR model with the use of monthly data from 1974:01 to 2019:07. Our findings show a depreciation after an oil price shock in the short-run for any period of time, although the pattern of long-run responses of U.S. EER is diverse across time periods, with an appreciation being observed before the mid-2000s and after the mid-2010s, and a depreciation between both periods. This diversity of response should lead policy makers to react differently in order to counteract such shocks. Furthermore, the reaction of oil price to an appreciation of U.S. EER is negative and different over time, which may generate different adverse effects on investment. The knowledge of such effects may help financial investors to diversify their investments in order to optimize the risk-return profile of their portfolios.


Assuntos
Comércio , Modelos Econômicos , Petróleo/economia , Teorema de Bayes , Humanos , Investimentos em Saúde/economia , Cadeias de Markov , Distribuição Normal , Estados Unidos
13.
PLoS One ; 15(8): e0238030, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857783

RESUMO

While most studies have viewed strategic flexibility as a capability to cope with the environmental turbulence and promote the product innovation, few of them investigate the mediating mechanism in the relationship between the strategic flexibility and product innovation. According to the resource-based view, we regard the bricolage as a concrete activity of recombining the different resources in the product development process and explore the underlying mechanism. Our results reveal that strategic flexibility has a positive and significant effect on bricolage. The effect of strategic flexibility on product innovation is partially mediated by bricolage. Furthermore, environmental turbulence moderates the relationship between strategic flexibility and bricolage positively. We contribute to the strategic flexibility research by exploring the effect of strategic flexibility on the bricolage and product innovation form a mediating perspective and offering a more nuanced and in-depth understanding of the impact of strategic flexibility. This research also provides new evidence on the effect of strategic flexibility on product innovation in transition economies such as China, where strategic flexibility is essential for firms to adapt to an uncertain environment.


Assuntos
Modelos Econômicos , China , Meio Ambiente , Invenções
14.
PLoS One ; 15(8): e0237870, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857817

RESUMO

The increasing heterogeneity of populations affects cooperation in common-pool resources in a time where the depletion of natural resources is a growing problem. This study investigates the effects of economic and sociocultural heterogeneity on trust and cooperation in common-pool resources using a laboratory experiment. The experiment comprises two Investment Games and a Common-Pool Resource Game, with a sample of 344 subjects from the United Kingdom and the Netherlands. By measuring the effects of economic and sociocultural heterogeneity separately as well as combined, this study disentangles the effects of specific heterogeneity types on cooperation in common-pool resources; something that has not been done before. Higher levels of trusting behaviour are found to have a positive effect on cooperation on the micro- and macro-level over time. While theory suggests negative effects of both forms of heterogeneity on cooperation through decreased levels of trust, the results show a surprising positive effect of economic heterogeneity on cooperation, but a negative effect if economic and sociocultural heterogeneity are combined. This study concludes that economic inequality can promote cooperation in CPRs, unless this inequality is lined up with sociocultural differences.


Assuntos
Comportamento Cooperativo , Teoria do Jogo , Confiança , Viés , Humanos , Modelos Econômicos , Análise Multinível , Análise de Regressão , Fatores de Tempo
15.
S Afr Med J ; 110(5): 369-373, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657719

RESUMO

BACKGROUND: There is little information on the financial return of investment when funding the tertiary education of healthcare professionals (HCPs) in South Africa (SA). OBJECTIVES: To assess the cost-benefit of the Umthombo Youth Development Foundation (UYDF) scholarship scheme, which has supported the training of HCPs from rural areas in KwaZulu-Natal Province, SA, for the past 19 years, and to establish whether it is a worthwhile investment. METHODS: This was an economic analysis to estimate the costs and economic value of UYDF's investment in the training of HCPs, using a deterministic model developed in Excel 2010 (Microsoft, USA) to analyse the UYDF's historical, numerical and economic data. Costs were measured in monetary terms, and a rate of return on investment was calculated over the working life of HCPs who had been supported by the UYDF. RESULTS: With a >90% pass rate, the total cost of training the 254 graduates supported by the UYDF from 2009 to 2015 was estimated to be ZAR186 million. Graduates are expected to generate an estimated ZAR15 billion in lifetime earnings, which is equal to ZAR4 billion at 2015 prices, and represents an internal rate of return of 63%. Income tax paid on future earnings will be ~ZAR4 billion, assuming a 20 - 30% tax rate. CONCLUSIONS: The analysis has shown that the cost of HCPs' education, where the annual pass rate is >90%, and >98% of graduates are employed, is an excellent investment. Consideration should be given to finding ways of improving the pass rate at institutions of higher learning and ensuring that graduates obtain meaningful employment if such returns on investment are to be seen on a national level.


Assuntos
Educação Profissionalizante/economia , Bolsas de Estudo/economia , Pessoal de Saúde/educação , Análise Custo-Benefício , Fundações , Humanos , Modelos Econômicos , África do Sul
16.
PLoS One ; 15(7): e0234996, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649663

RESUMO

BACKGROUND: Numerous economic models have assessed the cost-effectiveness of antipsychotic medications in schizophrenia. It is important to understand what key impacts of antipsychotic medications were considered in the existing models and limitations of existing models in order to inform the development of future models. OBJECTIVES: This systematic review aims to identify which clinical benefits, clinical harms, costs and cost savings of antipsychotic medication have been considered by existing models, to assess quality of existing models and to suggest good practice recommendations for future economic models of antipsychotic medications. METHODS: An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, The NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Key impacts of antipsychotic medications considered by exiting models were descriptively summarised. RESULTS: Sixty models were included. Existing models varied greatly in key impacts of antipsychotic medication included in the model, especially in clinical outcomes used for assessing reduction in psychotic symptoms and types of adverse events considered in the model. Quality of existing models was generally low due to failure to capture the health and cost impact of adverse events of antipsychotic medications and input data not obtained from best available source. Good practices for modelling antipsychotic medications are suggested. DISCUSSIONS: This review highlights inconsistency in key impacts considered by different models, and limitations of the existing models. Recommendations on future research are provided.


Assuntos
Antipsicóticos/economia , Modelos Econômicos , Esquizofrenia/tratamento farmacológico , Antipsicóticos/uso terapêutico , Análise Custo-Benefício , Economia Médica/normas , Humanos
17.
PLoS One ; 15(7): e0235040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628684

RESUMO

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.


Assuntos
Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/economia , Melhoria de Qualidade/economia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Alabama/epidemiologia , Orçamentos/estatística & dados numéricos , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/economia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia
18.
PLoS One ; 15(7): e0233761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702026

RESUMO

In decision-making situations individuals rarely have complete information available to select the best option and often show decisional randomness, i.e. given the same amount of knowledge individuals choose different options at different times. Dysfunctional processes resulting in altered decisional randomness can be considered a target process for psychiatric disorders, yet these processes remain poorly understood. Advances in computational modeling of decision-making offer a potential explanation for decisional randomness by positing that decisions are implemented in the brain through accumulation of noisy evidence, causing a generally less preferred option to be chosen at times by chance. One such model, the linear ballistic accumulator (LBA), assumes that individuals accumulate information for each option independently over time and that the first option to reach a threshold will be selected. To investigate the mechanisms of decisional randomness, we applied the LBA to a decision-making task in which risk and expected value (EV) were explicitly signaled prior to making a choice, and estimated separate drift rates for each of the four task stimuli (representing high and low EV and high and low risk). We then used the fitted LBA parameters to predict subject response rates on held-out trials for each of the 6 possible stimulus pairs. We found that choices predicted by LBA were correlated with actual choices across subjects for all stimulus pairs. Taken together, these findings suggest that sequential sampling models can account for decisional randomness on an explicit probabilistic task, which may have implications for understanding decision-making in healthy individuals and in psychiatric populations.


Assuntos
Biologia Computacional/métodos , Tomada de Decisões/fisiologia , Modelos Neurológicos , Modelos Psicológicos , Probabilidade , Assunção de Riscos , Processos Estocásticos , Adolescente , Distribuição de Qui-Quadrado , Comportamento de Escolha , Retroalimentação Psicológica , Feminino , Jogo de Azar , Jogos Experimentais , Humanos , Masculino , Modelos Econômicos , Satisfação Pessoal , Valores Sociais , Estatísticas não Paramétricas , Adulto Jovem
19.
Infect Dis Poverty ; 9(1): 78, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600426

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global public threat. Given the pandemic of COVID-19, the economic impact of COVID-19 is essential to add value to the policy-making process. We retrospectively conducted a cost and affordability analysis to determine the medical costs of COVID-19 patients in China, and also assess the factors affecting their costs. METHODS: This analysis was retrospectively conducted in Shandong Provincial Chest Hospital between 24 January and 16 March 2020. The total direct medical expenditures were analyzed by cost factors. We also assessed affordability by comparing the simulated out-of-pocket expenditure of COVID-19 cases relative to the per capita disposable income. Differences between groups were tested by student t test and Mann-Whitney test when appropriate. A multiple logistic regression model was built to determine the risk factors associated with high cost. RESULTS: A total of 70 COVID-19 patients were included in the analysis. The overall mean cost was USD 6827 per treated episode. The highest mean cost was observed in drug acquisition, accounting for 45.1% of the overall cost. Total mean cost was significantly higher in patients with pre-existing diseases compared to those without pre-existing diseases. Pre-existing diseases and the advanced disease severity were strongly associated with higher cost. Around USD 0.49 billion were expected for clinical manage of COVID-19 in China. Among rural households, the proportions of health insurance coverage should be increased to 70% for severe cases, and 80% for critically ill cases to avoid catastrophic health expenditure. CONCLUSIONS: Our data demonstrate that clinical management of COVID-19 patients incurs a great financial burden to national health insurance. The cost for drug acquisition is the major contributor to the medical cost, whereas the risk factors for higher cost are pre-existing diseases and severity of COVID-19. Improvement of insurance coverage will need to address the barriers of rural patients to avoid the occurrence of catastrophic health expenditure.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , China , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Programas Nacionais de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , População Rural , Adulto Jovem
20.
PLoS One ; 15(7): e0236178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716945

RESUMO

Despite active research on trading systems based on reinforcement learning, the development and performance of research methods require improvements. This study proposes a new action-specialized expert ensemble method consisting of action-specialized expert models designed specifically for each reinforcement learning action: buy, hold, and sell. Models are constructed by examining and defining different reward values that correlate with each action under specific conditions, and investment behavior is reflected with each expert model. To verify the performance of this technique, profits of the proposed system are compared to those of single trading and common ensemble systems. To verify robustness and account for the extension of discrete action space, we compared and analyzed changes in profits of the three actions to our model's results. Furthermore, we checked for sensitivity with three different reward functions: profit, Sharpe ratio, and Sortino ratio. All experiments were conducted with S&P500, Hang Seng Index, and Eurostoxx50 data. The model was 39.1% and 21.6% more efficient than single and common ensemble models, respectively. Considering the extended discrete action space, the 3-action space was extended to 11- and 21-action spaces, and the cumulative returns increased by 427.2% and 856.7%, respectively. Results on reward functions indicated that our models are well trained; results of the Sharpe and Sortino ratios were better than the implementation of profit only, as in the single-model cases. The Sortino ratio was slightly better than the Sharpe ratio.


Assuntos
Algoritmos , Comércio , Aprendizado Profundo , Bases de Dados como Assunto , Investimentos em Saúde , Modelos Econômicos , Redes Neurais de Computação , Reforço Psicológico , Fatores de Tempo
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