Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health ...interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.
Objective: This study tested a modified cognitive processing therapy (MCPT) intervention designed as a more flexible administration of the protocol. Number of sessions was determined by client ...progress toward a priori defined end-state criteria, "stressor sessions" were inserted when necessary, and therapy was conducted by novice CPT clinicians. Method: A randomized, controlled, repeated measures, semicrossover design was utilized (a) to test the relative efficacy of the MCPT intervention compared with a symptom-monitoring delayed treatment (SMDT) condition and (b) to assess within-group variation in change with a sample of 100 male and female interpersonal trauma survivors with posttraumatic stress disorder (PTSD). Results: Hierarchical linear modeling analyses revealed that MCPT evidenced greater improvement on all primary (PTSD and depression) and secondary (guilt, quality of life, general mental health, social functioning, and health perceptions) outcomes compared with SMDT. After the conclusion of SMDT, participants crossed over to MCPT, resulting in a combined MCPT sample (n = 69). Of the 50 participants who completed MCPT, 58% reached end-state criteria prior to the 12th session, 8% at Session 12, and 34% between Sessions 12 and 18. Maintenance of treatment gains was found at the 3-month follow-up, with only 2 of the treated sample meeting criteria for PTSD. Use of stressor sessions did not result in poorer treatment outcomes. Conclusions: Findings suggest that individuals respond at a variable rate to CPT, with significant benefit from additional therapy when indicated and excellent maintenance of gains. Insertion of stressor sessions did not alter the efficacy of the therapy.
The quality of public decision making depends significantly on the quality of analysis and advice provided through public organizations. Champions of "evidence-informed" policy making claim that ...rigorous evaluation practices can significantly improve attainment of cost-effective outcomes. After decades of experience, performance information is more sophisticated, but evaluation practices and capabilities vary enormously. Public agencies gather and process vast amounts of information, but there has been little analysis of how this information is actually utilized for policy and program improvement. This article examines how government agencies use evidence about policy and program effectiveness, with attention to four themes: (1) the prospects for improving "evidence-informed" policy making, (2) the diversity of practices concerning evidence utilization and evaluation across types of public agencies and policy arenas, (3) recent attempts to "institutionalize" evaluation as a core feature of policy development and budget approval, and (4) the relationships between public agencies and nongovernmental sources of expertise.
Influencer marketing initiatives require firms to select and incentivize online influencers to engage their followers on social media in an attempt to promote the firms’ offerings. However, limited ...research considers the costs of influencer marketing when evaluating these campaigns’ effectiveness, particularly from an engagement elasticity perspective. Moreover, it is unclear whether and how marketers could enhance influencer marketing effectiveness by strategically selecting influencers, targeting their followers, or managing content. This study draws on a communication model to examine how factors related to the sender of a message (influencer), the receiver of the message (influencer's followers), and the message itself (influencer's posts) determine influencer marketing effectiveness. The findings show that influencer originality, follower size, and sponsor salience enhance effectiveness, and posts that announce new product launches diminish it. Several tensions arise when firms select influencers and manage content: Influencer activity, follower–brand fit, and post positivity all exert inverted U-shaped moderating effects on influencer marketing effectiveness, suggesting that firms that adopt a balanced approach along these dimensions can achieve greater effectiveness. These novel insights offer important implications for marketers designing influencer marketing campaigns.
Randomized controlled trials (RCTs) can provide unbiased estimates of sample average treatment effects. However, a common concern is that RCTs may fail to provide unbiased estimates of population ...average treatment effects. We derive the assumptions that are required to identify population average treatment effects from RCTs. We provide placebo tests, which formally follow from the identifying assumptions and can assess whether they hold. We offer new research designs for estimating population effects that use non-randomized studies to adjust the RCT data. This approach is considered in a cost-effectiveness analysis of a clinical intervention: pulmonary artery catheterization.
We show that female directors have a significant impact on board inputs and firm outcomes. In a sample of US firms, we find that female directors have better attendance records than male directors, ...male directors have fewer attendance problems the more gender-diverse the board is, and women are more likely to join monitoring committees. These results suggest that gender-diverse boards allocate more effort to monitoring. Accordingly, we find that chief executive officer turnover is more sensitive to stock performance and directors receive more equity-based compensation in firms with more gender-diverse boards. However, the average effect of gender diversity on firm performance is negative. This negative effect is driven by companies with fewer takeover defenses. Our results suggest that mandating gender quotas for directors can reduce firm value for well-governed firms.
Abstract
Cost-effectiveness thresholds are important decision rules that determine whether health interventions represent good value for money. In low- and middle-income countries, the World Health ...Organization (WHO) one to three times per capita gross domestic product (GDP) per disability-adjusted life years (DALYs) averted has been the most widely used threshold for informing resource allocation decisions. However, in 2016, the WHO withdrew recommendations for using this threshold, creating a significant vacuum in South Africa and many countries that rely on results of cost-effectiveness analyses for making resource allocation decisions. This study estimates a cost-effectiveness threshold that reflects the health opportunity cost of health spending in South Africa using a three-step approach. First, marginal returns to health spending was estimated as health spending elasticity for crude death rates using a fixed effect estimation approach. Second, the opportunity cost of health spending was estimated as DALYs averted. Finally, a cost per DALY averted threshold was estimated as the inverse of the marginal product of health spending. We show that 1% of total health spending in 2015 (equivalent to approximately ZAR 1.54 billion/USD 120.7 million) averted 1050 deaths, 34 180 years of life lost, 5880 years lived with disability and 40 055 DALYs. The cost-effectiveness threshold was estimated at approximately ZAR 38 500 (USD 3015) per DALY averted, ∼53% of South Africa’s per capita GDP in 2015 (ZAR 72 700/USD 5700) and lower than the previously recommended one to three times per capita GDP. As South Africa moves towards implementing universal health coverage reforms through National Health Insurance by 2025, the adoption of a threshold that reflects health opportunity costs will be crucial for ensuring efficiency in the allocation of scarce resources. This study provides useful insight into the magnitude of the health opportunity cost of health spending in South Africa and highlights the need for further research.
To better understand the effectiveness of Environmental Impact Assessment (EIA) and to support improvement efforts aimed at enhancing its genuine effectiveness, this study proposes a novel approach ...to evaluating EIA effectiveness. The proposed framework was applied to the EIA system of Espírito Santo state, Southeastern Brazil. Unlike previous research, which often examined EIA effectiveness in isolation, this study introduces a comprehensive framework for a multifactorial analysis of EIA effectiveness (procedural, substantive, transactive, and legitimacy). By integrating various dimensions of EIA effectiveness and conducting a systematic longitudinal analysis from 2007 to 2016, this research provides insights into the effectiveness of the EIA process in the analyzed context. Grounded in multidimensional aspects of EIA effectiveness, our heuristic methodological framework facilitates an in-depth examination of the complexity of analyzing the effectiveness of EIA, aiming to provide efficient and adaptive responses. We analyzed forty-seven case studies through a combination of fieldwork and desk analysis, employing documentary research and interviews for data collection, and document analysis, discourse analysis, and statistical analysis for data analysis. Additionally, a meticulous quality review of all Environmental Impact Statements (EIS) produced during the study period significantly enhances our understanding of the EIA system's effectiveness. Our analysis reveals a notable gap in EIS quality, particularly regarding impact identification and analysis. These gaps, along with the subsequent need for supplementary information, contribute to prolonged durations and increased costs in EIA processes. Weaknesses were also identified in the screening and scoping phases of the EIA process. Despite these challenges, we identified knowledge repositories, instances of learning, and benefits that the EIA has brought to projects. Overall, this research represents a significant advancement in understanding EIA effectiveness, offering valuable insights for policymakers, practitioners, and researchers in the field. Additionally, the framework's adaptability to other contexts enhances its utility and relevance beyond the study area.
•The adopted framework facilitated a comprehensive analysis of EIA effectiveness.•The pursuit of effectiveness is an ongoing process of improvement, unveiling interconnections among its dimensions.•Overall effectiveness can be perceived as a maturation process.
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