Global decarbonization potential of CO2 mineralization in concrete materials.

CO2 mineralization products are often heralded as having outstanding potentials to reduce CO2-eq. emissions. However, these claims are generally undermined by incomplete consideration of the life cycle climate change impacts, material properties, supply and demand constraints, and economic viability of CO2 mineralization products. We investigate these factors in detail for ten concrete-related CO2 mineralization products to quantify their individual and global CO2-eq. emissions reduction potentials. Our results show that in 2020, 3.9 Gt of carbonatable solid materials were generated globally, with the dominant material being end-of-life cement paste in concrete and mortar (1.4 Gt y-1). All ten of the CO2 mineralization technologies investigated here reduce life cycle CO2-eq. emissions when used to substitute comparable conventional products. In 2020, the global CO2-eq. emissions reduction potential of economically competitive CO2 mineralization technologies was 0.39 Gt CO2-eq., i.e., 15% of that from cement production. This level of CO2-eq. emissions reduction is limited by the supply of end-of-life cement paste. The results also show that it is 2 to 5 times cheaper to reduce CO2-eq. emissions by producing cement from carbonated end-of-life cement paste than carbon capture and storage (CCS), demonstrating its superior decarbonization potential. On the other hand, it is currently much more expensive to reduce CO2-eq. emissions using some CO2 mineralization technologies, like carbonated normal weight aggregate production, than CCS. Technologies and policies that increase recovery of end-of-life cement paste from aged infrastructure are key to unlocking the potential of CO2 mineralization in reducing the CO2-eq. footprint of concrete materials.

Economic evaluations of assisted reproductive technologies in high-income countries: a systematic review.

STUDY QUESTION: Which assited reproductive technology (ART) interventions in high-income countries are cost-effective and which are not? SUMMARY ANSWER: Among all ART interventions assessed in economic evaluations, most high-cost interventions, including preimplantation genetic testing for aneuploidy (PGT-A) for a general population and ICSI for unexplained infertility, are unlikely to be cost-effective owing to minimal or no increase in effectiveness. WHAT IS KNOWN ALREADY: Approaches to reduce costs in order to increase access have been identified as a research priority for future infertility research. There has been an increasing number of ART interventions implemented in routine clinical practice globally, before robust assessments of evidence on economic evaluations. The extent of clinical effectiveness of some studied comparisons has been evaluated in high-quality research, allowing more informative decision making around cost-effectiveness. STUDY DESIGN, SIZE, DURATION: We performed a systematic review and searched seven databases (MEDLINE, PUBMED, EMBASE, COCHRANE, ECONLIT, SCOPUS, and CINAHL) for studies examining ART interventions for infertility together with an economic evaluation component (cost-effectiveness, cost-benefit, cost-utility, or cost-minimization assessment), in high-income countries, published since January 2011. The last search was 22 June 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two independent reviewers assessed publications and included those fulfilling the eligibility criteria. Studies were examined to assess the cost-effectiveness of the studied intervention, as well as the reporting quality of the study. The chosen outcome measure and payer perspective were also noted. Completeness of reporting was assessed against the Consolidated Health Economic Evaluation Reporting Standard. Results are presented and summarized based on the intervention studied. MAIN RESULTS AND THE ROLE OF CHANCE: The review included 40 studies which were conducted in 11 high-income countries. Most studies (n = 34) included a cost-effectiveness analysis. ART interventions included medication or strategies for controlled ovarian stimulation (n = 15), IVF (n = 9), PGT-A (n = 7), single embryo transfer (n = 5), ICSI (n = 3), and freeze-all embryo transfer (n = 1). Live birth was the mostly commonly reported primary outcome (n = 27), and quality-adjusted life years was reported in three studies. The health funder perspective was used in 85% (n = 34) of studies. None of the included studies measured patient preference for treatment. It remains uncertain whether PGT-A improves pregnancy rates compared to IVF cycles managed without PGT-A, and therefore cost-effectiveness could not be demonstrated for this intervention. Similarly, ICSI in non-male factor infertility appears not to be clinically effective compared to standard fertilization in an IVF cycle and is therefore not cost-effective. Interventions such as use of biosimilars or HMG for ovarian stimulation are cheaper but compromise clinical effectiveness. LIMITATIONS, REASONS FOR CAUTION: Lack of both preference-based and standardized outcomes limits the comparability of results across studies. The selection of efficacy evidence offered for some interventions for economic evaluations is not always based on high-quality randomized trials and systematic reviews. In addition, there is insufficient knowledge of the willingness to pay thresholds of individuals and state funders for treatment of infertility. There is variable quality of reporting scores, which might increase uncertainty around the cost-effectiveness results. WIDER IMPLICATIONS OF THE FINDINGS: Investment in strategies to help infertile people who utilize ART is justifiable at both personal and population levels. This systematic review may assist ART funders decide how to best invest to maximize the likelihood of delivery of a healthy child. STUDY FUNDING/COMPETING INTEREST(S): There was no funding for this study. E.C. and R.W. receive salary support from the National Health and Medical Research Council (NHMRC) through their fellowship scheme (EC GNT1159536, RW 2021/GNT2009767). M.D.-T. reports consulting fees from King Fahad Medical School. All other authors have no competing interests to declare. REGISTRATION NUMBER: Prospero CRD42021261537.

A Causal Model for Primary Prevention of Cardiovascular Disease: The Health Economic Model for the Primary Prevention of Cardiovascular Disease.

OBJECTIVES: Our objective was to design and develop an open-source model capable of simulating interventions for primary prevention of cardiovascular disease (CVD) that incorporated the cumulative effects of risk factors (eg, cholesterol years or blood-pressure years) to enhance health economic modeling in settings which clinical trials are not possible. METHODS: We reviewed the literature to design the model structure by selecting the most important causal risk factors for CVD-low-density lipoprotein-cholesterol (LDL-C), systolic blood pressure (SBP), smoking, diabetes, and lipoprotein (a) (Lp(a))-and most common CVDs-myocardial infarction and stroke. The epidemiological basis of the model involves the simulation of risk factor trajectories, which are used to modify CVD risk via causal effect estimates derived from Mendelian randomization. LDL-C, SBP, Lp(a), and smoking all have cumulative impacts on CVD risk, which were incorporated into the health economic model. The data for the model were primarily sourced from the UK Biobank study. We calibrated the model using clinical trial data and validated the model against the observed UK Biobank data. Finally, we performed an example health economic analysis to demonstrate the utility of the model. The model is open source. RESULTS: The model performed well in all validation tests. It was able to produce interpretable and plausible (consistent with expectations of the existing literature) results from an example health economic analysis. CONCLUSIONS: We have constructed an open-source health economic model capable of incorporating the cumulative effect of LDL-C (ie, cholesterol years), SBP (SBP-years), Lp(a), and smoking on lifetime CVD risk.

Cost-Effectiveness of Axicabtagene Ciloleucel for Adult Patients With Relapsed or Refractory Follicular Lymphoma in the United States.

OBJECTIVES: The results of a recent single-arm trial (ZUMA-5) of axicabtagene ciloleucel (axi-cel) for relapsed/refractory (r/r) follicular lymphoma (FL) demonstrated high rates of durable response and tolerable toxicity among treated patients. To quantify the value of axi-cel compared with standard of care (SOC) to manage r/r FL patients who have had at least 2 prior lines of systemic therapy (3L+), a cost-effectiveness model was developed from a US third-party payer perspective. METHODS: A 3-state partitioned-survival cost-effectiveness model was developed with a lifetime horizon. Patient-level analyses of the 36-month ZUMA-5 (axi-cel) and SCHOLAR-5 (SOC) studies were used to extrapolate progression-free and overall survivals. After 5 years of survival, an estimated 40% of the modeled population was assumed to experience long-term remission based on literature. Results include the incremental cost-effectiveness ratio (ICER) measured as incremental cost per quality-adjusted life year (QALY) gained. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed. All outcomes were discounted 3% per year. RESULTS: Axi-cel led to an increase of 4.28 life-years, 3.64 QALYs, and a total cost increase of $321 192 relative to SOC, resulting in an ICER of $88 300 per QALY. Across all parameters varied in the one-way sensitivity analysis, the ICER varied between $133 030 and $67 277. In the probabilistic sensitivity analysis, axi-cel had a 99% probability of being cost-effective across 5000 iterations using a $150 000 willingness-to-pay threshold. CONCLUSIONS: Given the robustness of the model results and sensitivity analyses, axi-cel is expected to be a cost-effective treatment in 3L+ r/r FL.

Detection and Coil Embolisation of Pelvic Venous Incompetence for Chronic Pain in the Female Pelvis: A Development Phase Economic Analysis.

OBJECTIVE: Unexplained chronic pain in the female pelvis (CPFP) affects 7% of people indicating female sex in the UK. Evidence suggests that pelvic venous incompetence (PVI) could explain CPFP and that coil embolisation could provide relief. The aims of this study were to indicate (1) the cost effectiveness of detecting and treating PVI in people experiencing unexplained CPFP, and (2) the maximum value of further research, suggesting suitable areas. METHODS: A decision tree compared standard care (regular prescribed analgesia) with an intervention comprising transvaginal duplex ultrasound to screen for PVI, venography to confirm the diagnosis, and coil embolisation treatment. The population was people experiencing unexplained CPFP. A UK National Health Service perspective and 2021 - 22 price year were used. Ten years of health costs and health related quality of life (HRQoL) effects for eligible 40 year olds were simulated. Evidence reviews informed diagnostic accuracy, health service usage, and unit costs. A single centre randomised controlled trial informed all other parameters. Probabilistic analysis incorporated parameter uncertainty in cost effectiveness estimates. Deterministic sensitivity analysis indicated drivers of uncertainty. Value of information methods measured the value of eliminating all relevant uncertainties, given uptake predictions. The main outcome measures were incremental cost and quality adjusted life years (QALYs) for the intervention compared with analgesia, the incremental cost effectiveness ratio (ICER), and expected value of perfect information. RESULTS: The mean ICER for the intervention was £4 558/QALY gained, and the probability that the ICER was within the UK cost effectiveness threshold (£20 000/QALY gained) was 90%. The expected value of perfect information about all model parameters was £46 M. All deterministic sensitivity analysis scenarios met the threshold, except the smallest plausible HRQoL effect of (resolving) CPFP. CONCLUSION: Detecting and treating PVI causing CPFP appears cost effective, but more primary research would be valuable to reduce decision uncertainty. Uncertainty in the HRQoL estimate for unexplained CPFP appeared to contribute most to decision uncertainty.

Techno-Economic Analysis of Gas Fermentation for the Production of Single Cell Protein.

Despite the large carbon footprint of livestock production, animal protein consumption has grown over the past several decades, necessitating new approaches to sustainable animal protein production. In this techno-economic analysis, single cell protein (SCP) produced via gas fermentation of carbon dioxide, oxygen, and hydrogen is studied as an animal feed source to replace fishmeal or soybean meal. Using wind-powered water electrolysis to produce hydrogen and oxygen with carbon dioxide captured from corn ethanol, the minimum selling price (MSP) of SCP is determined to be $2070 per metric ton. An emissions comparison between SCP, fishmeal, and soybean meal shows that SCP has a carbon intensity as low as 0.73 kg CO2-equiv/kg protein, while fishmeal and soybean meal have an average carbon intensity of 2.72 kg CO2-equiv/kg protein and 0.85 kg CO2-equiv/kg protein, respectively. Moreover, SCP production would occupy 0.4% of the land per ton of protein produced compared to soybean meal and would disturb less than 0.1% of the marine ecosystem currently disturbed by fishmeal harvesting practices. These results show promise for the future economic viability of SCP as a protein source in animal feed and indicate significant environmental benefits compared to other animal feed protein sources.

Technical, Environmental, and Economic Analysis Comparing Low-Carbon Industrial Process Heat Options in U.S. Poly(vinyl chloride) and Ethylene Manufacturing Facilities.

Electrification and clean hydrogen are promising low-carbon options for decarbonizing industrial process heat, which is an essential target for reducing sector-wide emissions. However, industrial processes with heat demand vary significantly across industries in terms of temperature requirements, capacities, and equipment, making it challenging to determine applications for low-carbon technologies that are technically and economically feasible. In this analysis, we develop a framework for evaluating life cycle emissions, water use, and cost impacts of electric and clean hydrogen process heat technologies and apply it in several case studies for plastics and petrochemical manufacturing industries in the United States. Our results show that industrial heat pumps could reduce emissions by 12-17% in a typical poly(vinyl chloride) (PVC) facility in certain locations currently, compared to conventional natural gas combustion, and that other electric technologies in PVC and ethylene production could reduce emissions by nearly 90% with a sufficiently decarbonized electric grid. Life cycle water use increases significantly in all low-carbon technology cases. The levelized cost of heat of viable low-carbon technologies ranges from 15 to 100% higher than conventional heating systems, primarily due to energy costs. We discuss results in the context of relevant policies that could be useful to manufacturing facilities and policymakers for aiding the transition to low-carbon process heat technologies.

A Novel Sustainable and Self-Sufficient Biotechnological Strategy for Directly Transforming Sewage Sludge into High-Value Liquid Biochemicals.

Sewage sludge, as a carbon-rich byproduct of wastewater treatment, holds significant untapped potential as a renewable resource. Upcycling this troublesome waste stream represents great promise in addressing global escalating energy demands through its wide practice of biochemical recovery concurrently. Here, we propose a biotechnological concept to gain value-added liquid bioproducts from sewage sludge in a self-sufficient manner by directly transforming sludge into medium-chain fatty acids (MCFAs). Our findings suggest that yeast, a cheap and readily available commercial powder, would involve ethanol-type fermentation in chain elongation to achieve abundant MCFA production from sewage sludge using electron donors (i.e., ethanol) and acceptors (i.e., short-chain fatty acids) produced in situ. The enhanced abundance and transcriptional activity of genes related to key enzymes, such as butyryl-CoA dehydrogenase and alcohol dehydrogenase, affirm the robust capacity for the self-sustained production of MCFAs. This is indicative of an effective metabolic network established between yeast and anaerobic microorganisms within this innovative sludge fermentation framework. Furthermore, life cycle assessment and techno-economic analysis evidence the sustainability and economic competitiveness of this biotechnological strategy. Overall, this work provides insights into sewage sludge upgrading independent of additional carbon input, which can be applied in existing anaerobic sludge fermentation infrastructure as well as to develop new applications in a diverse range of industries.

Temperature-Pressure Swing Process for Reactive Carbon Capture and Conversion to Methanol: Techno-Economic Analysis and Life Cycle Assessment.

A model was developed to conduct techno-economic analysis (TEA) and life cycle assessment (LCA) for reactive carbon capture (RCC) and conversion of carbon dioxide (CO2) to methanol. This RCC process is compared to a baseline commercialized flue gas CO2 hydrogenation process. An ASPEN model was combined with existing TEA and LCA models into a larger TEA/LCA framework in Python. From preliminary experimental data, the model found a levelized cost of $0.79/kg methanol for the baseline process and $0.99/kg for the RCC process. The cradle-to-gate carbon intensity of the baseline process was 0.50 kg-CO2e/kg-methanol, compared to 0.55 kg-CO2e/kg-methanol for the RCC process. However, water consumption for RCC (10.21 kg-H2O/kg-methanol) is greatly reduced compared to the baseline (12.89 kg-H2O/kg-methanol). Future improvements in hydrogen electrolysis costs will benefit the RCC. A target H2/methanol mass ratio of 0.26 was developed for RCC laboratory experiments to reduce methanol cost below the baseline. If a ratio of 0.24 can be achieved, a levelized cost of $0.76/kg methanol is projected, with a carbon intensity of 0.42 kg-CO2e/kg-methanol.

Determinants of Willingness to Pay for Fecal Sludge Management Services and Knowledge Gaps: A Scoping Review.

Achieving universal access to safely managed sanitation services is one of the Sustainable Development Goal 6 targets (SDG6.2). The cost and availability of services to ensure the safe management of on-site sanitation, such as pit latrines and septic tanks, can be major barriers for poor households. Particularly, fecal sludge emptying services have become increasingly important due to the growing urban population. This review aims to scope the literature on stated and revealed willingness to pay (WTP) for emptying on-site sanitation systems and to identify determinants of WTP and gaps in knowledge. We performed electronic searches of six databases. After deduplication, 1846 records were identified, of which 14 were included in the review. In these studies, we identified 26 distinct scenarios that reported mean or median WTP values for emptying services and their market price (i.e., price at which the services were provided). Among the 26 scenarios, 77% (n = 20) reported that WTP was lower than the market price. We identified 20 statistically significant determinants of WTP, which can be leveraged when developing or improving manual and mechanical emptying services to attract more customers. Future research should consider services that adopt flexible pricing or mobile money payment and optimize their emptying operations to increase WTP. Validating the effectiveness of such services in solving the WTP-market price imbalance is a significant knowledge gap.

Characterizing the Opportunity Space for Sustainable Hydrothermal Valorization of Wet Organic Wastes.

Resource recovery from wet organic wastes can support circular economies by creating financial incentives to produce renewable energy and return nutrients to agriculture. In this study, we characterize the potential for hydrothermal liquefaction (HTL)-based resource recovery systems to advance the economic and environmental sustainability of wastewater sludge, FOG (fats, oils, and grease), food waste, green waste, and animal manure management through the production of liquid biofuels (naphtha, diesel), fertilizers (struvite, ammonium sulfate), and power (heat, electricity). From the waste management perspective, median costs range from -193 $·tonne-1 (FOG) to 251 $·tonne-1 (green waste), and median carbon intensities range from 367 kg CO2 eq·tonne-1 (wastewater sludge) to 769 kg CO2 eq·tonne-1 (green waste). From the fuel production perspective, the minimum selling price of renewable diesel blendstocks are within the commercial diesel price range (2.37 to 5.81 $·gal-1) and have a lower carbon intensity than petroleum diesel (101 kg CO2 eq·MMBTU-1). Finally, through uncertainty analysis and Monte Carlo filtering, we set specific targets (i.e., achieve wastewater sludge-to-biocrude yield >0.440) for the future development of hydrothermal waste management system components. Overall, our work demonstrates the potential of HTL-based resource recovery systems to reduce the costs and carbon intensity of resource-rich organic wastes.

Kraft lignin fast (catalytic) pyrolysis for the production of high value-added chemicals (HVACs): A techno-economic screening of valorization pathways.

This paper presents a techno-economic analysis (TEA) of six (6) scenarios of the kraft lignin catalytic (CFP) and thermal (TFP) fast pyrolysis towards the production of high value-added chemicals (HVACs) and electric energy, based on experimental data from our previous work. ASPEN PLUS was used to simulate the proposed plants/scenarios and retrofitted custom-based economic models that were developed in Microsoft EXCEL. The results showed that scenarios 1 and 2 in which the produced bio-oil is used as fuel for electricity production are the most cost-deficient. On the other hand, scenarios 3 and 6 that utilize the light bio-oil fraction to recover distinct HVACs, along with the use of heavier fractions for electricity production, have showed a significant investment viability, since profitability measures are high. Furthermore, scenarios 4 and 5 that refer to the recovery of mixtures (fractions) of HVACs, are considered an intermediate investment option due to the reduced cost of separation. All the proposed scenarios have a substantial total capital investment (TCI) which ranges from 135 MM€ (scenario 4) to 380 MM€ (scenario 6) with a Lang factor of 6.08, which shows that the CAPEX results are within reason. As far as the comparison of lignin CFP and TFP goes, it is shown that lignin CFP leads to the production of aromatic and phenolic monomers which have a substantial market value, while TFP can lead to important value-added chemicals with a lower OPEX than CFP. A target of return of investment (ROI) of 32% has been set for the selling prices of the HVACs. In summary, this study aims at listing and assessing a set of economic indicators for industrial size plants that use lignin CFP and TFP towards the production of high value-added chemicals and energy production and to provide simulation data for comparative analysis of three bio-oil separation methods, i.e. distillation, liquid-liquid extraction and moving bed chromatography.

Biochar as a sustainable alternative to carbon black in agricultural mulch films.

Examples of biochar as an alternative to traditional plastic fillers, like carbon black, are numerous and growing. However, in the agricultural mulch film application, both the polymer and its fillers are pushed to their mechanical limit to obtain an effective product, using the least amount of plastic. Through a combined techno-economic analysis (TEA) and life cycle assessment (LCA), this study characterizes the use of carbon-negative biochar as an opacity filler in mulch film applications. Due to its larger particle size, the biochar demands additional thickness to achieve equivalent opacity as carbon black in films. A thicker film translates to additional polymer demand, and a significant increase in price and environmental impact. A comparable formulation for an equal price ($623 per mulched ha) as a 2.6 wt % carbon black with 25 µm thickness was derived, needing 15 wt % biochar and a thickness of 30 µm. The biochar formulation resulted in a slightly higher global warming potential (3% increase), but much larger impact in the land use category (+339%), and the sample was deemed not fit for use in the intended mulch application. These results indicate that in applications where the polymeric matrix and its fillers are pushed to their mechanical limit, the displacement of traditional fillers by biochar is challenging. However, biochar derived from waste biomass (thus reducing land use impact) remains a valid, environmentally beneficial solution to displace traditional fillers for non-extreme plastic uses (commodity plastics) and thicker composites.

Assessing the American public's preferences for reforms to teen driving licensure systems: a discrete choice experiment.

OBJECTIVES: To analyse factors influencing the American public's preferences for changes to teenage driver licensing requirements. METHODS: We employed a discrete choice experiment (DCE) with 808 participants from National Opinion Research Center's AmeriSpeak panel to assess preferences for two existing elements (on-road testing and intermediate licensure period) and a new feature (driver monitoring with telematics during the intermediate licensure period) of licensing system. Multinomial and mixed logit models were used to estimate preference weights, marginal rates of substitution and the relative importance of each attribute. RESULTS: Among 730 respondents who completed all DCE choice tasks, we found robust support for changes to teenage driver licensing requirements, with preferences varying by individual characteristics. Respondents expressed a high baseline support for changes to teen driving licensure policies. They favoured testing, prioritising easy tests and opposed prolonged driver monitoring and extended intermediate licensure periods. Baseline preference weights exhibited substantial heterogeneity, emphasising the diversity of public preferences. The marginal rates of substitution revealed a preference for extended driver monitoring over an extended intermediate licensure period. An easy test was valued at 2.85 times more than a hard one. The most influential attributes were the length of intermediate licence period and testing requirements, with the former twice as important. CONCLUSIONS: Our study found robust support for reforms to teenage driver licensing requirements, favouring easier on-road driving tests over an extended period of intermediate licensure and driver monitoring. Public preferences for licensing systems need to be balanced with the broader policy objectives including optimising mobility and maximising safety.

Cost-effectiveness of the 'Stay One Step Ahead' Home Safety programme for the prevention of injuries among children under 5 years.

BACKGROUND: Unintentional injuries are a common cause of morbidity and mortality in the under-5s, but undertaking home safety practices can reduce injury risk. Stay One Step Ahead (SOSA) is an evidence-based standardised home safety programme. This study evaluates the cost-effectiveness of SOSA versus usual care in Nottingham, UK. METHODS: Cost-effectiveness analysis from a National Health Service and personal social services perspective. SOSA activity data, injury occurrence and associated short-term healthcare costs were collected within a controlled before-and-after study from 2017 to 2020. The primary outcome was the incremental cost-effectiveness ratio (ICER) per additional home adopting three key safety practices (working smoke alarm, safe poisons storage and fitted stair gate). Secondary outcomes were ICERs per injury avoided and quality-adjusted life-years (QALYs) gained. RESULTS: SOSA costs £30 per child but reduces short-term healthcare expenditure by £42. SOSA increased the number of homes with three key safety practices by 0.02 per child, reduced injuries per child by 0.15 and gained 0.0036 QALYs per child. SOSA was dominant as it was cheaper and more effective than current practice. ICERs were -£590 per additional home deemed safe, -£77 per injury avoided and -£3225 per QALY gained. Focusing on healthcare expenditure alone, SOSA saved £1.39 for every pound spent. CONCLUSIONS: SOSA is a cost-saving intervention. Commissioners should consider implementing SOSA.

Economic impact on local businesses of road safety improvements in Seattle: implications for Vision Zero projects.

BACKGROUND: Local transportation agencies implementing Vision Zero road safety improvement projects often face opposition from business owners concerned about the potential negative impact on their sales. Few studies have documented the economic impact of these projects. METHODS: We examined baseline and up to 3 years of postimprovement taxable sales data for retail, food and service-based businesses adjacent to seven road safety projects begun between 2006 and 2014 in Seattle. We used hierarchical linear models to test whether the change in annual taxable sales differed between the 7 intervention sites and 18 nearby matched comparison sites that had no road safety improvements within the study time frame. RESULTS: Average annual taxable sales at baseline were comparable at the 7 intervention sites (US$44.7 million) and the 18 comparison sites (US$56.8 million). Regression analysis suggests that each additional year following baseline was associated with US$1.20 million more in taxable sales among intervention sites and US$1.14 million more among comparison sites. This difference is not statistically significant (p=0.64). Sensitivity analyses including a random slope, using a generalised linear model and an analysis of variance did not change conclusions. DISCUSSION: Results suggest that road safety improvement projects such as those in Vision Zero plans are not associated with adverse economic impacts on adjacent businesses. The absence of negative economic impacts associated with pedestrian and bicycle road safety projects should reassure local business owners and may encourage them to work with transportation agencies to implement Vision Zero road safety projects designed to eliminate traffic-related injuries.

Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation.

INTRODUCTION: Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy. METHODS: A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. RESULTS: Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country. CONCLUSION: Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS.

The TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD): economic analysis.

BACKGROUND: Indigenous populations have increased risk of developing diabetes and experience poorer treatment outcomes than the general population. The FORGE AHEAD program partnered with First Nations communities across Canada to improve access to resources by developing community-driven primary healthcare models. METHODS: This was an economic assessment of FORGE AHEAD using a payer perspective. Costs of diabetes management and complications during the 18-month intervention were compared to the costs prior to intervention implementation. Cost-effectiveness of the program assessed incremental differences in cost and number of resources utilization events (pre and post). Primary outcome was all-cause hospitalizations. Secondary outcomes were specialist visits, clinic visits and community resource use. Data were obtained from a diabetes registry and published literature. Costs are expressed in 2023 Can$. RESULTS: Study population was ~ 60.5 years old; 57.2% female; median duration of diabetes of 8 years; 87.5% residing in non-isolated communities; 75% residing in communities < 5000 members. Total cost of implementation was $1,221,413.60 and cost/person $27.89. There was increase in the number and cost of hospitalizations visits from 8/$68,765.85 (pre period) to 243/$2,735,612.37. Specialist visits, clinic visits and community resource use followed this trend. CONCLUSION: Considering the low cost of intervention and increased care access, FORGE AHEAD represents a successful community-driven partnership resulting in improved access to resources.

Impact and economic analysis of human T-cell lymphotropic virus type 1 (HTLV-1)-targeted antenatal screening, England and Wales, 2021.

BackgroundHuman T-cell lymphotropic virus type 1 (HTLV-1) is a neglected virus that can cause severe disease and be transmitted from mother to child through breastfeeding. Avoidance of breastfeeding prevents 80% of vertical transmission. The United Kingdom (UK) is currently assessing whether HTLV-1-targeted antenatal screening should be implemented.AimWe aimed to assess the impact and cost-effectiveness of a targeted programme to prevent HTLV-1 vertical transmission in England and Wales.MethodsWe estimated the number of pregnant women who have high risk of HTLV-1 infection based on their or their partner's country of birth. With data from 2021, we used a mathematical model to assess cost-effectiveness of HTLV-1 antenatal screening. We also estimated the annual number of infant infections and the number that could be prevented with screening and intervention.ResultsWe estimate that ca 99,000 pregnant women in England and Wales have high risk of HTLV-1 infection. In the absence of screening, 74 (range: 25-211) HTLV-1 infections in infants would be expected to occur every year in England and Wales. Implementation of targeted screening would prevent 58 (range: 19-164) infant infections annually. The intervention is effective (incremental 0.00333 quality-adjusted life years (QALY)) and cost-saving (GBP -57.56 (EUR -66.85)).ConclusionOur findings support implementation of HTLV-1 targeted antenatal screening to reduce vertical transmission from mothers to infants in the UK.

Veterinary Services'use of the Global Burden of Animal Diseases to prioritise interventions, monitor impact and develop critical competencies.

Attracting and sustaining investment in Veterinary Services and animal health programmes from national government budgets, development aid and grants, and philanthropic donors requires economic rationale using relevant, reliable and validated analytical approaches. The complex interwoven relationships between animal health, livestock husbandry systems, national food security, global health security and environmental sustainability emphasise the importance of improving data governance and stewardship and applying economic analysis to understand animal disease burdens. These efforts should enable prioritised investment of limited resources and effective monitoring of the impact of programmes over time. Data governance and stewardship capacities are fundamental to development, implementation and performance monitoring of evidence-based policies in animal health. There are challenges in data availability for national and subnational livestock populations in different sectors, for disease incidence and prevalence, and for animal health expenditure in support of optimised allocation of scarce resources, be they finance, land, labour, or management attention and policy focus. Animal health data systems governance and stewardship and economic analysis are core skills for Veterinary Services in developing and applying evidence-based policy, but capability probably varies among World Organisation for Animal Health (WOAH) Members. The WOAH Performance of Veterinary Services programme has several critical competencies that are relevant to economics of animal health and to data governance and stewardship, but these have not yet been targeted for coordinated capacity development. Implementation of publicâ€"private partnership approaches for animal health programmes creates increasing expectations of robust data and methods for prioritisation, options analysis, and assessing impacts and costs. Experience and examples from national systems in New Zealand, Australia, Ethiopia and Indonesia illustrate current challenges associated with prioritisation of animal health programmes using economic analysis. The Global Burden of Animal Diseases programme intends to support WOAH Members and partners to develop capacities for and standardise approaches to economic analysis and prioritisation in animal health programmes.

Les investissements dans les Services vétérinaires et dans les programmes de santé animale à partir des budgets publics nationaux, des aides et subventions au développement et des fonds alloués par des donateurs philanthropiques peuvent être encouragés et pérennisés au moyen d'une argumentation économique solide fondée sur des méthodes analytiques pertinentes, fiables et validées. La complexité et l'imbrication des relations entre la santé animale, les systèmes d'élevage, la sécurité de l'approvisionnement alimentaire à l'échelle nationale, la sécurité sanitaire mondiale et la durabilité environnementale imposent d'améliorer la gouvernance et la gestion des données et de recourir à des analyses économiques pour mieux comprendre l'impact des maladies animales. Ces efforts devraient permettre de définir les investissements prioritaires dans un contexte de ressources limitées et d'assurer un suivi efficace de l'impact des programmes dans le temps. L'existence de capacités de gouvernance et de gestion des données est donc une condition essentielle pour concevoir et mettre en oeuvre des politiques de santé animale fondées sur des données factuelles et pour suivre leurs performances. Les données disponibles sur les populations d'animaux d'élevage des différentes filières aux niveaux national ou infranational, sur l'incidence et la prévalence des maladies ou sur les dépenses de santé animale sont parfois insuffisantes pour étayer une utilisation optimale de ressources limitées, qu'il s'agisse de moyens financiers, des terres, de la main-d'oeuvre, voire des efforts de gestion ou de la volonté politique. La gouvernance et la gestion des systèmes de données de santé animale et la conduite d'analyses économiques sont des compétences cruciales des Services vétérinaires, que ceux-ci mobilisent pour concevoir et mettre en oeuvre des politiques fondées sur des données factuelles ; il est néanmoins peu probable que ces capacités soient d'un niveau homogène parmi tous les Membres de l'Organisation mondiale de la santé animale (OMSA). Le Processus d'évaluation de la Performance des Services vétérinaires mis en place par l'OMSA définit un certain nombre de compétences critiques dans le domaine de l'économie de la santé animale et de la gouvernance et gestion des données, mais ces compétences n'ont pas encore été intégrées dans un effort coordonné de renforcement des capacités. Les stratégies consistant à confier la mise en oeuvre de programmes de santé animale à des partenariats public-privé suscitent des besoins accrus en données et en méthodes robustes pour l'établissement des priorités, l'analyse des options et l'évaluation des impacts et des coûts. Les auteurs mentionnent les expériences et exemples de systèmes nationaux en Nouvelle-Zélande, en Australie, en Ethiopie et en Indonésie pour illustrer les enjeux actuels liés à l'utilisation des analyses économiques pour définir les priorités des programmes de santé animale. Le programme " Impact mondial des maladies animales " vise à aider les Membres et les partenaires de l'OMSA à renforcer leurs capacités dans le domaine de l'analyse économique et de la définition des priorités des programmes de santé animale et à normaliser leurs approches en la matière.

Para atraer y mantener las inversiones en los Servicios Veterinarios y los programas de sanidad animal procedentes de los presupuestos de los gobiernos nacionales, la ayuda para el desarrollo y las subvenciones, así como de donantes filántropos, se requiere un razonamiento económico en el que se utilicen enfoques analíticos pertinentes, fiables y validados. Las complejas relaciones entre la sanidad animal, los sistemas de ganadería, la seguridad alimentaria nacional, la seguridad sanitaria mundial y la sostenibilidad ambiental ponen de relieve la importancia de mejorar la gobernanza y la gestión de datos y de aplicar el análisis económico para comprender el impacto de las enfermedades animales. Estos esfuerzos deberían permitir establecer prioridades para la inversión de los limitados recursos y realizar un seguimiento eficaz de las repercusiones de los programas a lo largo del tiempo. Las capacidades de gobernanza y gestión de datos son fundamentales para el desarrollo y la implementación de políticas de sanidad animal con una base empírica y para el seguimiento de sus resultados. Existen dificultades en cuanto a la disponibilidad de datos sobre las cabañas ganaderas nacionales y subnacionales de los distintos sectores, la incidencia y prevalencia de las enfermedades y el gasto en sanidad animal que plantean problemas a la hora de optimizar la asignación de unos recursos que son escasos, ya sean los recursos financieros, las tierras, la mano de obra o la atención a la gestión y la orientación de las políticas. La gobernanza y la gestión de los sistemas de datos zoosanitarios y el análisis económico son competencias esenciales para que los Servicios Veterinarios elaboren y apliquen políticas con base empírica, pero es probable que la capacidad varíe entre los Miembros de la Organización Mundial de Sanidad Animal (OMSA). El Proceso de Prestaciones de los Servicios Veterinarios de la OMSA abarca varias competencias esenciales que son relevantes para la economía de la sanidad animal y para la gobernanza y la gestión de datos, pero que aún no han sido objeto de actividades coordinadas de desarrollo de capacidades. La aplicación de enfoques de asociación público-privada para los programas de sanidad animal aumenta aún más las expectativas de datos y métodos sólidos para el establecimiento de prioridades, el análisis de opciones y la evaluación de las repercusiones y los costos. La experiencia y los ejemplos de los sistemas nacionales de Nueva Zelanda, Australia, Etiopía e Indonesia ilustran los retos actuales asociados al establecimiento de prioridades en los programas de sanidad animal mediante el análisis económico. El programa sobre el impacto global de las enfermedades animales pretende ayudar a los Miembros y socios de la OMSA a desarrollar capacidades y armonizar enfoques para el análisis económico y el establecimiento de prioridades en los programas de sanidad animal.