Abstract Background Elicitation can be used to characterize structural uncertainty within a decision analytic model. This allows the value of acquiring further evidence to resolve these uncertainties ...to be established. Aim This article demonstrated the use of expert elicitation for this purpose and also compared the elicited results with the results from alternative assumptions previously used to characterize the uncertainties. Materials and Methods Distributions for two unknown parameters were elicited. These were used within a model developed to assess the cost-effectiveness of infliximab and etanercept for the treatment of active psoriatic arthritis (PsA), compared with palliative care. The experts’ distributions were synthesized using two approaches: linear pooling and random effects meta-analysis. Weighting of experts is also explored. Results The four methods produce broadly similar results, and in each, the choice of optimum strategy is between etanercept and palliative care (incremental cost-effective ratio for etanercept is between £29,021 and £39,259 per costs and quality adjusted life years). Decision uncertainty, at a £30,000 threshold, is high in all of the synthesis models thus generating high values of further research at between £141 and £634 million. In each model, the greatest value of further research was for the short-term effectiveness of treatment (£47–£406 million). Discussion Although the cost-effectiveness results do not differ substantially between the models using the elicited values and the original scenarios, there are some stark contrasts in terms of the values of further research generated. Conclusion Elicitation offers a feasible method to generate evidence for the missing information but there are a number of key issues for which further research is required.
Fannia Robineau-Desvoidy, 1830 is the most diverse genus in the family Fanniidae (Diptera), with 288 species, many of which are include many of sanitary, economic and legal interest. The ...morphological homogeneity within the genus often makes species determination difficult. The best option for correct identification is to combine molecular and morphological analyses. The variation in the shape of a selection of body characters can be assessed by Geometric Morphometrics using the head as an innovative structure. Sex must be accounted for as a key covariate in this kind of study, since Fannia, as many other Diptera, has a sexually dimorphic head structure, with holoptic males and dicoptic females. Firstly, we analysed a set of Fannia sp. specimens sampled across the Iberian Peninsula (2012-2015), of which Fannia pusio (Wiedemann, 1830) was found to be the most abundant species. Our analyses provide significant morphological information. Fannia pusio exhibits clear intraspecific morphometric variation along an Iberian-wide East-West axis. A similar pattern emerged when comparing a laboratory-bred colony and wild samples.
Light Detection and Ranging (LIDAR) is a remote sensing technique that measures properties of backscattered light in order to obtain information of a distant target. This work presents a method to ...improve the signal-to-noise ratio by 8 dB with respect to the direct detection of the backscattered signal of a LIDAR system. This method consists of the measurement of the Fourier coefficients of the LIDAR signal, which is possible thanks to the novel coupling of a sequential equivalent time base sampling (SETS) circuit and a conventional lock-in amplifier that allows to measure the Fourier coefficients of the LIDAR signal, the results are comparable to noise elimination using Empirical Mode Decomposition. The feasibility of the proposal is demonstrated experimentally with mist. The method can be used to different applications of elastic-scattering LIDAR under the conditions of the devices for applied the phase sensitive detection.
En primer lugar, se ofrece una breve explicación de los fundamentos teóricos de la inteligencia empresarial y sus productos, haciendo énfasis en los perfiles estratégicos, y dentro de ellos, en los ...perfiles de sector. También, se hace énfasis en los estudios de mercado y sus características. En segundo lugar, se presentan dos casos de estudio (un perfil de sector y un estudio de mercado), que demuestran la importancia de estos productos y servicios de inteligencia competitiva, para la toma de decisiones lo más acertada posible, en las organizaciones.
IntroductionNeuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation ...techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke.Methods and analysisThis is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months).Ethics and disseminationThis protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke.Trial registration numberClinicalTrials.gov (NCT04163666).
Objective: In England, primary care organizations (primary care trusts, PCTs) have scope to influence the provision of health care at the margin. However, when faced with difficult commissioning ...choices, restriction of services potentially leaves them vulnerable to legal challenge. PCTs are developing different approaches to priority setting but there is a need to develop processes that lead to more consistent, accountable and fair decision-making. Our objective was to describe recent local developments on prioritization decision-making. Methods: Rationing policies in PCTs in West Yorkshire and North & East Yorkshire and North Lincolnshire (NEYNL) Strategic Health Authority areas in 2003 were examined. To evaluate priority setting, we compared the descriptive findings with an internationally recognized ethical framework for priority setting, 'accountability for reasonableness' (AFR). Results: PCTs varied as regards the stage of policy development they had reached. Rationing by exclusion was the most common approach to prioritization, but in general PCTs failed to make the rationale for their decisions explicit and accessible. The importance of an appeals process was recognized by the majority of PCTs. Those that had developed a formal process to address difficult commissioning decisions were an exception. Conclusions: Adopting AFR as a prioritization framework can serve to improve the fairness and consistency of the decision-making process, reducing the vulnerability of PCTs to legal challenge. Characteristics of rationing policies already in place fulfil some of the AFR conditions but there remains scope for further improvements in their design and dissemination.
This is a work about football. In it, we depart from two well-known approaches to forecast the outcome of a football match (or even a full tournament) and take advantage of their strengths to develop ...a new method of prediction. We illustrate the Élö–Runyan rating system and the Poisson technique in the English Premier League and we analyze their accuracies with respect to the actual results. We obtained an accuracy of 84.37% for the former, and 79.99% for the latter in this first exercise. Then, we present a criticism of these methods and use it to complement the aforementioned procedures, and hence, introduce the so-called Élö–Runyan–Poisson–Pearson method, which consists of adopting the distribution that best fits the historical distribution of goals to simulate the score of each match. Finally, we obtain a Monte Carlo-based forecast of the result. We test our mechanism to backcast the World Cup of Russia 2018, obtaining an accuracy of 87.09%; and forecast the results of the World Cup of Qatar 2022.
Abstract Objectives To assess the value for money of alternative chemotherapy strategies for managing advanced colorectal cancer using irinotecan or oxaliplatin, either in sequence or in combination ...with fluorouracil. Methods A cost-effectiveness model was developed using data from the UK fluorouracil, oxaliplatin, and CPT11 (irinotecan) – use and sequencing (FOCUS) trial. The analysis adopted the perspective of the UK National Health Service. Input parameters were derived using a system of risk equations (for probabilities), count data regression models (for resource use), and generalized linear models (for utilities). Parameter estimates were obtained using Markov chain Monte Carlo methods, propagating the simulation values through the state-transition model to characterize appropriately the joint distributions of expected cost, survival and quality-adjusted life years for each treatment strategy. An acceptability frontier was used to represent the probability that the optimal option is cost-effective at different values of the cost-effectiveness threshold. Results The base-case analysis used drug unit costs provided by a typical English hospital. First-line doublet therapy combination therapy fluorouracil (5FU) plus irinotecan was the most cost-effective strategy at standard thresholds, with an incremental cost-effectiveness ratio (ICER) of £14,877 (pound sterling) compared with first-line 5FU until treatment failure followed by single agent irinotecan. Other strategies were all subject to extended dominance. A sensitivity analysis using published drug (list) prices found the most cost-effective strategy would be first-line fluorouracil until failure followed by 5FU plus irinotecan (ICER: £19,753). Conclusions The combination of 5FU and irinotecan (whether used first or second line) appears to be more cost-effective than the single agent sequential therapies used in the FOCUS trial, or 5FU plus oxaliplatin.
Quality-adjusted life years Bravo Vergel, Yolanda; Sculpher, Mark
Practical neurology,
06/2008, Letnik:
8, Številka:
3
Journal Article
Recenzirano
Many health systems now use cost-effectiveness analysis to decide which interventions and programmes to fund. A key issue for such decision making is how to measure health outcomes from interventions ...to reflect changes in both health-related quality of life and life expectancy. For some decision makers, including the National Institute for Health and Clinical Excellence in the UK, the quality-adjusted life-year (QALY) is central to health measurement. This article describes the concept of the QALY, its derivation, and its strengths and weaknesses.
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