Although upper gastrointestinal endoscopy (EGD) remains the gold standard for detecting varices in cirrhosis, the Baveno VI criteria proposed a combination of transient elastography and platelet ...count that could rule out high-risk varices, therefore sparing the need for an endoscopy, with significant potential cost savings. We performed a cost-effectiveness analysis of the Baveno VI criteria compared with EGD in the diagnosis of high-risk varices in cirrhosis.
We built an analytical decision model to estimate the cost and benefits of using the Baveno VI criteria compared with EGD in patients with Child-Pugh A cirrhosis. The analysis was performed from the UK National Health Service perspective, over 1, 5, and 20 years. A Markov model was populated with data from published evidence. Outcomes were measured in terms of quality-adjusted life years (QALYs) and avoided deaths. The analyses were repeated for Canada and Spain, using relevant cost inputs.
The Baveno VI criteria were cost effective compared with endoscopy in all analyses. For 1000 patients, they produced 0.16 additional QALYs at an incremental cost of £326 ($443.41) over 5 years, resulting in an incremental cost of £2081 ($2830) per additional QALY gained. The incremental net monetary benefit of Baveno VI compared with EGD was £2808 ($3819) over 5 years per patient. Baveno VI criteria also were cost effective in Canada and Spain. Deterministic and probabilistic sensitivity analysis supported these findings.
The findings demonstrate that the Baveno VI criteria are cost effective, suggesting that they should be considered for widespread implementation on the basis of safety, appropriateness, and economic grounds.
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Rebeira and Nauenberg’s paper presents an exploratory analysis of a challenging question which I paraphrase as: “Were the extraordinarily costly social responses to the COVID-19 pandemic economically ...justified?” They wade bravely into the always controversial topic of assessing whether what governments spend to achieve health gain – or in this case prevent its loss – are worth it, in economic terms. They apply well-known methods of modelling incremental cost-effectiveness analysis for value of life years gained, balancing that with comparisons to value of statistical life years measures used in different sectors. They encounter and detail many uncertainties in assembling the evidence on the effects and costs of social restrictions to prevent COVID-19 infection and spread, and the economic support programs used to buffer the negative effects of the pandemic. Their conclusion, perhaps not surprisingly, is for the United States – maybe – and for Canada, with more apparent success in epidemic control, perhaps a bit better. Perhaps the greater value of their paper is not its conclusions, but rather its posing of the questions. Here are some things it led me to ponder: continued in PDF / HTML
A detailed techno-economic comparison of a chemical scrubber (CS) and a bio-filter (BF) was conducted over a 45-day time period at a municipal wastewater treatment plant (WWTP), Yazd city. The ...assessment of emissions quantity indicated that odor emissions from the Yazd WWPT mainly consist of hydrogen sulfide (H2S) and ammonia (NH3). It was also found that odor gaseous loading changes corresponding to water consumption pattern in society (R2 = 0.922) for H2S and (R2 = 0.978) for NH3. The highest level of 25 and 3 ppm for H2S and NH3, respectively were detected at specific times during the day. The BF system was continuously supplied with Yazd WWPT's off-gas treatment while the CS was only examined at the times during the day when the gas emissions are at the highest level. The removal efficiency of NH3 and H2S were found to be affected by their respective loading rate. Additionally, among the various oxidants examined in the CS, the NaOCl solution showed the best results in terms of removal efficiency and compatibility. The experiment revealed almost complete removal of NH3 while the H2S removal efficiency remained above 95% for both systems regardless of the operating conditions. This study clearly demonstrates the effectiveness of both systems in treating actual waste gases containing H2S and NH3. By comparing the gas loading rate of both systems and considering limitations of the BF system, the CS seems to be more efficient applicable odor control technology from a technical viewpoint. From the economic viewpoint, comparisons revealed that chemical usage and operating expenses were costly parts of the CS and the BF, respectively. The economic indexes of 1.58 €.m−3. h−1 and 2.57 €.m−3. h−1 were obtained for the BF and CS, respectively, reflecting cost-effectiveness of the BF system.
Biofiltration and chemical scrubbing are comparatively evaluated in treating actual waste gases containing H2S and NH3 during a 45-day time period at a municipal WWTP in terms of environmental performance and process economics. Display omitted
•Developing a chemical scrubber and a biofilter for simultaneous removal of H2S and NH3.•Using the effluent of municipal wastewater treatment plant to evaluate the systems capability.•A detailed techno-economic comparison of a scrubber and a biofilter over a 45-day time period.•Suggestion of NaOCl with flow rate of 7 L/min as the best scrubbing liquid.•Achievement of high removal efficiency regardless of gas loading rate used.
Capability wellbeing can potentially provide a holistic outcome for health economic evaluation and the capability approach seems promising for African countries. As yet there is no work that has ...explored the evaluative space needed for health and care decision making at the whole population level and procedures that merely translate existing measures developed in the global north to contexts in the global south risk embedding structural inequalities. This work seeks to elicit the concepts within the capability wellbeing evaluative space for general adult populations in Tanzania and Malawi. Semi-structured interviews with 68 participants across Tanzania and Malawi were conducted between October 2021 and July 2022. Analysis used thematic coding frames and the writing of analytic accounts. Interview schedules were common across the two country settings, however data collection and analysis were conducted independently by two separate teams and only brought together once it was clear that the data from the two countries was sufficiently aligned for a single analysis. Eight common attributes of capability wellbeing were found across the two countries: financial security; basic needs; achievement and personal development; attachment, love and friendship; participation in community activities; faith and spirituality; health; making decisions without unwanted interference. These attributes can be used to generate outcome measures for use in economic evaluations comparing alternative health interventions. By centring the voices of Tanzanians and Malawians in the construction of attributes that describe a good life, the research can facilitate greater equity within economic evaluations across different global settings.
•Capability wellbeing provides a valuable evaluative space for economic evaluation.•People in Tanzania and Malawi spoke about what they value in their lives.•Eight conceptual attributes were important to people living in Tanzania and Malawi.•Provides a basis for developing capability wellbeing measures in these countries.•Centring local voices can facilitate greater equity across global settings.
Bio-based 2,3-butanediol (2,3-BD) has attracted more and more attention due to the relatively high cost of its petro-based production and the emerging economic advantages of bio-based 2,3-BD ...production processes. 2,3-BD has wide applications in the chemical, food, cosmetics, agriculture, pharmaceutical, and aerospace area, especially producing the monomer of the polybutadiene synthetic rubber. Thus, recent advances on the properties, production, and application of bio-based 2, 3-BD were critically reviewed. With great efforts in the screening of 2, 3-BD producing bacteria and factors affecting the productivity of 2,3-BD, the concentration of 2,3-BD in the fermentation broth can be greater than 150 g/L, even up to 178 g/L. On the other hand, the high boiling point and high hydrophilicity of 2,3-BD and the complex composition and low product concentration in the fermentation broth made the conventional distillation extremely challenging for the industrial production of 2.3-BD by the biological method. It is crucial to develop an efficient and low-cost separation process for 2,3-BD. The recent advances in the development of separation processes for the in-situ or ex-situ recovery of 2, 3-BD from the fermentation broth or aqueous solutions are thoroughly reviewed. Some emerging separation technologies, including vacuum evaporation/distillation, solvent extraction, reactive extraction, adsorption, salting-out extraction, salting-out, sugaring-out extraction, and pervaporation, were developed to simplify the separation process. After the techno-economic evaluation of the hybrid process with the emerging techniques, it is demonstrated that the novel methods can greatly reduce energy consumption(up to 54.8%) and downstream separation cost(25.8–61.2%).
•Recent advances on bio-based 2, 3-BD:properties, production, and application.•Recent advances on the recovery of 2, 3-BD were reviewed.•Emerging techniques greatly reduce energy consumption and downstream separation cost.•Salting-out extraction and reactive extraction are superior to other methods.
•HAdV leads to ARD outbreaks among military recruits.•Current vaccine fails against HAdV in Korean military; targeted vaccine needed.•Vaccine benefit-cost ratio: 0.71 in the sixth year, increasing to ...1.32 thereafter.•The cumulative benefit-cost ratio over 10 years was 2.72.
Human adenovirus (HAdV) is a prevalent causative agent of acute respiratory disease (ARD) and is frequently responsible for outbreaks, particularly in military environments. Current vaccines do not effectively cover HAdV subtypes commonly found among Korean military personnel, highlighting the need for a new targeted vaccine. This study presents a cost-benefit analysis to evaluate the economic viability of developing and implementing such a vaccine within a military context.
We adopted a societal perspective for this cost-benefit analysis, which included estimating costs associated with vaccine development, production, and distribution over a projected timeline. We assumed a development period of five years, after which vaccine production and administration were initiated in the sixth year. The cost associated with vaccine development, production, and dispensation was considered. The benefits were calculated based on both direct and indirect cost savings from preventing HAdV infections through vaccination. All financial figures were expressed in 2023 US dollars. A sensitivity analysis was conducted to explore the impact of varying factors such as vaccination rate, incidence of infection, vaccine efficacy, and discount rate.
For the base case scenario, we assumed a vaccination rate of 100 %, an incidence rate of 0.02, and a vaccine efficacy of 95 %, applying a 3 % discount rate. Initially, in the sixth year, the benefit-cost ratio stood at 0.71, suggesting a cost disadvantage at the onset of vaccination. However, this ratio improved to 1.32 in the following years, indicating a cost benefit from the seventh year onward. The cumulative benefit-cost ratio over a decade reached 2.72. The outcomes from the sensitivity analysis were consistent with these findings.
Our cost-benefit analysis demonstrates that the introduction of an HAdV vaccine for the Korean military is economically advantageous, with substantial cost benefits accruing from the seventh year after the commencement of vaccination.
OBJECTIVES: To determine the actual cost and drivers of the cost of an extracorporeal cardiopulmonary resuscitation (E-CPR) care cycle. PERSPECTIVE: A time-driven activity-based costing study ...conducted from a healthcare provider perspective. SETTING: A quaternary care ICU providing around-the-clock E-CPR service for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in Australia. METHODS: The E-CPR care cycle was defined as the time from initiating E-CPR to hospital discharge or death of the patient. Detailed process maps with discrete steps and probabilistic decision nodes accounting for the complex trajectories of E-CPR patients were developed. Data about clinical and nonclinical resources and timing of activities was collected multiple times for each process . Total direct costs were calculated using the time estimates and unit costs per resource for all clinical and nonclinical resources. The total direct costs were combined with indirect costs to obtain the total cost of E-CPR. RESULTS: From 10 E-CPR care cycles observed during the study period, a minimum of 3 observations were obtained per process. The E-CPR care cycle’s mean (95% CI) cost was $75,014 ($66,209–83,222). Initiation of extracorporeal membrane oxygenation (ECMO) and ECMO management constituted 18% of costs. The ICU management (35%) and surgical costs (20%) were the primary cost determinants. IHCA had a higher mean (95% CI) cost than OHCA ($87,940 75,372–100,570 vs. 62,595 53,994–71,890, p < 0.01), mainly because of the increased survival and ICU length of stay of patients with IHCA. The mean cost for each E-CPR survivor was $129,503 ($112,422–147,224). CONCLUSIONS: Significant costs are associated with E-CPR for refractory cardiac arrest. The cost of E-CPR for IHCA was higher compared with the cost of E-CPR for OHCA. The major determinants of the E-CPR costs were ICU and surgical costs. These data can inform the cost-effectiveness analysis of E-CPR in the future.
OBJECTIVES: To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory ...failure. PERSPECTIVE: Publicly funded healthcare payer. SETTING: Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice. METHODS: We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year. RESULTS: In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios. CONCLUSIONS: It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.
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