The World Health Organization has developed target product profiles containing minimum and optimum targets for key characteristics for tests for tuberculosis treatment monitoring and optimization. ...Tuberculosis treatment optimization refers to initiating or switching to an effective tuberculosis treatment regimen that results in a high likelihood of a good treatment outcome. The target product profiles also cover tests of cure conducted at the end of treatment. The development of the target product profiles was informed by a stakeholder survey, a cost-effectiveness analysis and a patient-care pathway analysis. Additional feedback from stakeholders was obtained by means of a Delphi-like process, a technical consultation and a call for public comment on a draft document. A scientific development group agreed on the final targets in a consensus meeting. For characteristics rated of highest importance, the document lists: (i) high diagnostic accuracy (sensitivity and specificity); (ii) time to result of optimally less than or equal to 2 hours and no more than 1 day; (iii) required sample type to be minimally invasive, easily obtainable, such as urine, breath, or capillary blood, or a respiratory sample that goes beyond sputum; (iv) ideally the test could be placed at a peripheral-level health facility without a laboratory; and (v) the test should be affordable to low- and middle-income countries, and allow wide and equitable access and scale-up. Use of these target product profiles should facilitate the development of new tuberculosis treatment monitoring and optimization tests that are accurate and accessible for all people being treated for tuberculosis.
We describe a new middleware called GenSync that abstracts the subtleties of the state-of-the-art data synchronization protocols, allows users to choose protocols based on a comparative evaluation ...under realistic system conditions, and seamlessly integrates protocols in existing applications through a public application programming interface.
Background
Randomized controlled trials (RCTs) have demonstrated that low‐dose direct oral anticoagulants (DOACs), including rivaroxaban and apixaban, may help reduce the incidence of ...cancer‐associated venous thromboembolism (VTE).
Methods
A cost‐utility analysis was performed from the health sector perspective using a Markov state‐transition model in patients with cancer who are at intermediate‐to‐high risk for VTE. Transition probability, relative risk, cost, and utility inputs were obtained from a meta‐analysis of the RCTs and relevant epidemiology studies. Differences in cost, quality‐adjusted life‐years (QALYs), and the incremental cost‐effectiveness ratio (ICER) per patient were calculated over a lifetime horizon. One‐way, probabilistic, and scenario sensitivity analyses were conducted.
Results
In patients with cancer at intermediate‐to‐high risk for VTE, treatment with low‐dose DOAC thromboprophylaxis for 6 months, compared with placebo, was associated with 32 per 1000 fewer VTE and 11 per 1000 more major bleeding episodes over a lifetime. The incremental cost and QALY increases were $1445 and 0.12, respectively, with an ICER of $11,947 per QALY gained. Key drivers of ICER variations included the relative risks of VTE and bleeding as well as drug cost. This strategy was 94% cost effective at the threshold of $50,000 per QALY. The selection of patients with Khorana scores ≥3 yielded the greatest value, with an ICER of $5794 per QALY gained.
Conclusions
Low‐dose DOAC thromboprophylaxis for 6 months appears to be cost‐effective in patients with cancer who are at intermediate‐to‐high risk for VTE. The implementation of this strategy in patients with Khorana scores ≥3 may lead to the highest cost‐benefit ratio.
A low‐dose direct oral anticoagulant appears to be cost‐effective versus placebo for preventing cancer‐associated thrombosis. Patients with the highest risk for thrombosis according to the Khorana score derive the most incremental benefit from a preventive strategy.
This research investigates the cost-effectiveness of energy performance measures in French residential buildings. We develop an empirical approach based on a multivariate statistical approach and ...Cost-Benefit analysis. The strength of this research relies on the designing of a large cross-sectional database collected in 2013 including rich technical information of about 1,400 dwellings representative of the French residential sector as well as individual recommendations relative to the energy renovations to be implemented, their investment costs, and energy savings potential. We provide valuable information on the cost-effectiveness of energy renovation measures for the entire housing stock. Results show that low-temperature and condensing boilers, as well as floor insulation, are the most cost-effective energy efficiency measures, which could be inconsistent with actual subsidy policies. We demonstrate that the cost-effectiveness of energy renovation measures is widely dependent on dwelling initial characteristics and the value of the inputs used in the economic indicators such as energy-savings amount, energy price, and the discount rate. Moreover, we provide a classification of French dwellings, which may help policymakers, better identify their target. Finally, we show that the renovation of the entire French residential dwelling stock can lead to a great amount of energy–and CO2–reductions but requires significant financial capacity.
•We examine the cost-effectiveness of energy efficiency renovation measures.•We develop a cost-benefit and simulation approach based on a rich data set.•We provide key insights on the profitability of the energy renovation measures.•Low temperature and condensing boilers appear to be the most cost-effective measures.•The renovation of the entire housing stock may lead to a significant CO2 reduction.
Economic instrument is indubitably perceived as effective for encouraging or forcing contractors to conduct environmentally friendly construction practices. Previous studies in relation to this topic ...mainly put emphasis on economic analysis of construction and demolition (C&D) waste management from a static point of view, which failed to consider its dynamics nature by integrating all essential activities throughout the waste chain. This paper is thus intended to highlight the dynamics and interrelationships of C&D waste management practices and analyze the cost–benefit of this process using a system dynamics approach. Data related to concrete and aggregate of a construction project in Shenzhen was collected for the application of the proposed model. The findings reveal that net benefits from conducting C&D waste management will occur, but a higher landfill charge will lead to a higher net benefit, as well as an earlier realization of the net benefit. In addition, the general public under a higher landfill charge will suffer from a higher environmental cost caused by illegal dumping. The simulation results also suggest that current regulation in Shenzhen should be promoted to facilitate a dramatic increase in net benefit from the implementation of C&D waste management. This research is of value in facilitating better understanding on the dynamics of C&D waste management activities throughout the waste chain, as well as providing a tool for simulating the cost–benefit of C&D waste management practices over the project duration.
The growing interest in the equity dimensions of transport planning has resulted in increasing criticism on the dominant assessment methodology of transport projects: cost-benefit analysis (CBA). In ...this paper, we focus on travel time savings, given their importance in the assessment of transport projects and the sometimes fierce equity-related citicism on their inclusion in project appraisal. We identify five equity effects related to the use of travel time savings in CBA. Each of these equity effects implies that transport projects serving the majority population are highly likely to perform better in CBA than comparable projects serving disadvantaged population groups. We subsequently explore whether the replacement of travel time savings by accessibility gains can address the identified equity effects. We observe that this only holds for two of the five equity effects, while a third effect can be mitigated through the introduction of the notion of diminishing marginal return in the valuation of accessibility gains. We conclude that the mere introduction of accessibility gains is in itself insufficient to address all equity effects related to the application of travel time savings within the CBA framework.
Coproduction, a collaborative model of research that includes stakeholders in the research process, has been widely advocated as a means of facilitating research use and impact. We summarise the ...arguments in favour of coproduction, the different approaches to establishing coproductive work and their costs, and offer some advice as to when and how to consider coproduction.
Despite the multiplicity of reasons and incentives to coproduce, there is little consensus about what coproduction is, why we do it, what effects we are trying to achieve, or the best coproduction techniques to achieve policy, practice or population health change. Furthermore, coproduction is not free risk or cost. Tensions can arise throughout coproduced research processes between the different interests involved. We identify five types of costs associated with coproduced research affecting the research itself, the research process, professional risks for researchers and stakeholders, personal risks for researchers and stakeholders, and risks to the wider cause of scholarship. Yet, these costs are rarely referred to in the literature, which generally calls for greater inclusion of stakeholders in research processes, focusing exclusively on potential positives. There are few tools to help researchers avoid or alleviate risks to themselves and their stakeholders.
First, we recommend identifying specific motivations for coproduction and clarifying exactly which outcomes are required for whom for any particular piece of research. Second, we suggest selecting strategies specifically designed to enable these outcomes to be achieved, and properly evaluated. Finally, in the absence of strong evidence about the impact and process of coproduction, we advise a cautious approach to coproduction. This would involve conscious and reflective research practice, evaluation of how coproduced research practices change outcomes, and exploration of the costs and benefits of coproduction. We propose some preliminary advice to help decide when coproduction is likely to be more or less useful.
Several statistical models for predicting suicide risk have been developed, but how accurate such models must be to warrant implementation in clinical practice is not known.
To identify threshold ...values of sensitivity, specificity, and positive predictive value that a suicide risk prediction method must attain to cost-effectively target a suicide risk reduction intervention to high-risk individuals.
This economic evaluation incorporated published data on suicide epidemiology, the health care and societal costs of suicide, and the costs and efficacy of suicide risk reduction interventions into a novel decision analytic model. The model projected suicide-related health economic outcomes over a lifetime horizon among a population of US adults with a primary care physician. Data analysis was performed from September 19, 2019, to July 5, 2020.
Two possible interventions were delivered to individuals at high predicted risk: active contact and follow-up (ACF; relative risk of suicide attempt, 0.83; annual health care cost, $96) and cognitive behavioral therapy (CBT; relative risk of suicide attempt, 0.47; annual health care cost, $1088).
Fatal and nonfatal suicide attempts, quality-adjusted life-years (QALYs), health care sector costs and societal costs (in 2016 US dollars), and incremental cost-effectiveness ratios (ICERs) (with ICERs ≤$150 000 per QALY designated cost-effective).
With a specificity of 95% and a sensitivity of 25%, primary care-based suicide risk prediction could reduce suicide death rates by 0.5 per 100 000 person-years (if used to target ACF) or 1.6 per 100 000 person-years (if used to target CBT) from a baseline of 15.3 per 100 000 person-years. To be cost-effective from a health care sector perspective at a specificity of 95%, a risk prediction method would need to have a sensitivity of 17.0% or greater (95% CI, 7.4%-37.3%) if used to target ACF and 35.7% or greater (95% CI, 23.1%-60.3%) if used to target CBT. To achieve cost-effectiveness, ACF required positive predictive values of 0.8% for predicting suicide attempt and 0.07% for predicting suicide death; CBT required values of 1.7% for suicide attempt and 0.2% for suicide death.
These findings suggest that with sufficient accuracy, statistical suicide risk prediction models can provide good health economic value in the US. Several existing suicide risk prediction models exceed the accuracy thresholds identified in this analysis and thus may warrant pilot implementation in US health care systems.
Objective
Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically‐refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The ...objective was to evaluate cost‐effectiveness of dupilumab versus ESS for patients with CRSwNP.
Study Design
Cohort‐style Markov decision‐tree economic model with a 36‐year time horizon.
Methods
A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS‐24 and SINUS‐52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT‐22 instrument in both cohorts. Decision‐tree analysis and a 10‐state Markov model utilized published event probabilities and primary data to calculate long‐term costs and utility. The primary outcome measure was incremental cost per quality‐adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One‐way and probabilistic sensitivity analyses were performed.
Results
The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One‐way sensitivity analyses showed ESS to be cost‐effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855.
Conclusions
The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost‐effective manner.
Level of Evidence
2C Laryngoscope, 131:E26–E33, 2021
•The total net profit of V2G services is positive in Shanghai.•The benefit of power plants is bigger than that of EV users while that of grid companies are negative.•A fair market distribution ...mechanism of V2G profits should be built among three participants.
The costs and benefits of the participants including electric vehicle users, power grid companies and power plants were analyzed when four brands of electric vehicles participated in V2G peak shaving service in Shanghai. Sensitivity analysis was conducted to determine the key parameters that affected the costs and benefits of electric vehicle users and power grid companies. The results show that the total net profit of V2G services is greater than zero under the appropriate set of parameters. The net incomes of electric vehicles users are greater than zero in V2G peak shaving services when the peak price of electricity fed into the grid is more than three times the valley price. The lower the cost of electric vehicle battery, the more the net income of single user. The net incomes of power grid companies are always very negative and the higher the peak shaving load, the greater the net loss of the power company. The benefits of power plants are the biggest among three participants and are far greater than those of electric vehicle users. A fair market distribution mechanism of V2G profits should be built among three participants in order to promote the healthy development of V2G applications.
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