The trouble with radicalization NEUMANN, PETER R.
International affairs (London),
07/2013, Letnik:
89, Številka:
4
Journal Article
Recenzirano
Though widely used by academics and policy-makers in the context of the 'war on terror', the concept of radicalization lacks clarity. This article shows that while radicalization is not a myth, its ...meaning is ambiguous and the major controversies and debates that have sprung from it are linked to the same inherent ambiguity. The principal conceptual fault-line is between notions of radicalization that emphasize extremist beliefs ('cognitive radicalization') and those that focus on extremist behavior ('behavioural radicalization'). This ambiguity explains the differences between definitions of radicalization; it has driven the scholarly debate, which has revolved around the relationship between cognition and behavior; and it provides the backdrop for strikingly different policy approaches—loosely labeled 'European' and 'Anglo-Saxon'—which the article delineates and discusses in depth. Rather than denying its validity, the article calls on scholars and policy-makers to work harder to understand and embrace a concept which, though ambiguous, is likely to dominate research and policy agendas for years to come.
The ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has long served as a benchmark for the value of U.S. health care. But evidence suggests ...that it is too low and might best be thought of as an implied lower boundary.
For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. Critics, meanwhile, have argued that the ratio is misunderstood and misused.
The fact that the $50,000-per-QALY yardstick has persisted attests to the medical community's need for a value threshold and to the advantages enjoyed by incumbents. It has endured even . . .
A laboratory investigation was conducted to determine whether colloidal suspensions of inorganic nanoparticulate materials of natural or industrial origin in the external water supplied to the ...primary root of maize seedlings (Zea mays L.) could interfere with water transport and induce associated leaf responses. Water flow through excised roots was reduced, together with root hydraulic conductivity, within minutes of exposure to colloidal suspensions of naturally derived bentonite clay or industrially produced TiO₂ nanoparticles. Similar nanoparticle additions to the hydroponic solution surrounding the primary root of intact seedlings rapidly inhibited leaf growth and transpiration. The reduced water availability caused by external nanoparticles and the associated leaf responses appeared to involve a rapid physical inhibition of apoplastic flow through nanosized root cell wall pores rather than toxic effects. Thus: (1) bentonite and TiO₂ treatments also reduced the hydraulic conductivity of cell wall ghosts of killed roots left after hot alcohol disruption of the cell membranes; and (2) the average particle exclusion diameter of root cell wall pores was reduced from 6.6 to 3.0 nm by prior nanoparticle treatments. Irrigation of soil-grown plants with nanoparticle suspensions had mostly insignificant inhibitory effects on long-term shoot production, and a possible developmental adaptation is suggested.
QALYs in 2018—Advantages and Concerns Neumann, Peter J; Cohen, Joshua T
JAMA : the journal of the American Medical Association,
06/2018, Letnik:
319, Številka:
24
Journal Article
Recenzirano
The article discusses the positive aspects and advantages offered by the quality-adjusted life-year (QALYs), a health metric to help inform policy makers about coverage and reimbursement decisions. ...Some of the reasons as to why QALYs is considered to be controversial are highlighted.
To explore the use of data dashboards to convey information about a drug’s value, and reduce the need to collapse dimensions of value to a single measure.
Review of the literature on US Drug Value ...Assessment Frameworks, and discussion of the value of data dashboards to improve the manner in which information on value is displayed.
The incremental cost per quality-adjusted life-year ratio is a useful starting point for conversation about a drug’s value, but it cannot reflect all of the elements of value about which different audiences care deeply. Data dashboards for drug value assessments can draw from other contexts. Decision makers should be presented with well-designed value dashboards containing various metrics, including conventional cost per quality-adjusted life-year ratios as well as measures of a drug’s impact on clinical and patient-centric outcomes, and on budgetary and distributional consequences, to convey a drug’s value along different dimensions.
The advent of US drug value frameworks in health care has forced a concomitant effort to develop appropriate information displays. Researchers should formally test different formats and elements.
•Some value frameworks incorporate elements of multi-criteria decision analysis into their communication of drug value, but there is much room for growth.•The potential for value assessment dashboards to present information in a clear manner to stakeholders is discussed.
This study examines what study authors consider to be appropriate cost-effectiveness analysis thresholds as reflected in the referenced thresholds in their published cost-effectiveness analyses.
Escalating drug prices have spawned a flurry of initiatives designed to help physicians, payers, and patients understand the value of new therapies and make better choices about their use. But these ...efforts have revealed numerous analytic and implementation challenges.
Escalating drug prices have alarmed physicians and the American public
1
,
2
and led to calls for government price controls. Less visibly, they have also spawned a flurry of private-sector initiatives designed to help physicians, payers, and patients understand the value of new therapies and thus make better choices about their use. Programs recently introduced or advanced by nonprofit organizations, including leading medical professional societies, represent an important innovation in the United States, but they have also revealed numerous analytic and implementation challenges.
The most prominent players include the American College of Cardiology and the American Heart Association (ACC–AHA), the American . . .
Cost-Effectiveness Analysis 2.0 Neumann, Peter J; Sanders, Gillian D
The New England journal of medicine,
01/2017, Letnik:
376, Številka:
3
Journal Article
Recenzirano
As prominent groups in U.S. health care ramp up use of cost-effectiveness analysis to measure and communicate the value of new drugs and other interventions, an expert panel has released updated ...guidelines for such analysis.
Cost-effectiveness analysis in U.S. health care seems poised for a second act of sorts. Although it has never actually gone away, efforts to apply it have encountered resistance, and the federal government and some health care organizations have sometimes prohibited its use or relegated it to a minor role. But several developments are helping to recharge the field. One is the embrace of its methods by prominent groups that are using it to measure and communicate the value of new drugs and other interventions. Another is the publication of new guidelines for such analysis from a national panel that is . . .
Objective: Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children in the United States and often persists into adulthood with associated ...symptomatology and impairments. This article comprehensively reviews studies reporting ADHD-related incremental (excess) costs for children/adolescents and adults and presents estimates of annual national incremental costs of ADHD. Method: A systematic search for primary United States-based studies published from January 1, 1990 through June 30, 2011 on costs of children/adolescents and adults with ADHD and their family members was conducted. Only studies in which mean annual incremental costs per individual with ADHD above non-ADHD controls were reported or could be derived were included. Per-person incremental costs were adjusted to 2010 U.S. dollars and converted to annual national incremental costs of ADHD based on 2010 U.S. Census population estimates, ADHD prevalence rates, number of household members, and employment rates by age group. Results: Nineteen studies met the inclusion criteria. Overall national annual incremental costs of ADHD ranged from $143 to $266 billion (B). Most of these costs were incurred by adults ($105B-$194B) compared with children/adolescents ($38B-$72B). For adults, the largest cost category was productivity and income losses ($87B-$138B). For children, the largest cost categories were health care ($21B-$44B) and education ($15B-$25B). Spillover costs borne by the family members of individuals with ADHD were also substantial ($33B-$43B). Conclusion: Despite a wide range in the magnitude of the cost estimates, this study indicates that ADHD has a substantial economic impact in the United States. Implications of these findings and future directions for research are discussed. (Contains 3 figures and 3 tables.)
Calculating the cost per disability-adjusted life years (DALYs) averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve ...population health. However, there has been no systematic attempt to characterize the literature and its evolution.
We conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA) Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases "disability-adjusted" or "DALY". Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000-2009 and 2010-2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low) to 7 (high), and examined the correlation between diseases researched and the burden of disease in different world regions.
We identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%), followed by non-communicable diseases (28%). A high proportion of studies evaluated primary prevention strategies (59%). Pharmaceutical interventions were commonly assessed (32%) followed by immunizations (28%). Adherence to good practices for conducting and reporting cost-effectiveness analysis varied considerably. Studies mainly included formal healthcare sector costs. A large number of the studies in Sub-Saharan Africa addressed high-burden conditions such as HIV/AIDS, tuberculosis, neglected tropical diseases and malaria, and diarrhea, lower respiratory infections, meningitis, and other common infectious diseases.
The Global Health Cost-Effectiveness Analysis Registry reveals a growing and diverse field of cost-per-DALY averted studies. However, study methods and reporting practices have varied substantially.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
