•COVID-19 spread dynamics with environmental compartment is proposed.•Global stability of the disease-free and endemic equilibria was obtain using Lyapunov’s function.•Global sensitivity analysis was ...studied.•A cost-effectiveness analysis presented.
COVID-19 potentially threatens the lives and livelihood of people all over the world. The disease is presently a major health concern in Ghana and the rest of the world. Although, human to human transmission dynamics has been established, not much research is done on the dynamics of the virus in the environment and the role human play by releasing the virus into the environment. Therefore, investigating the human-environment-human by use of mathematical analysis and optimal control theory is relatively necessary. The dynamics of COVID-19 for this study is segregated into compartments as: Susceptible (S), Exposed (E), Asymptomatic (A), Symptomatic (I), Recovered (R) and the Virus in the environment/surfaces (V). The basic reproduction number R0 without controls is computed. The application of Lyapunov’s function is used to analyse the global stability of the proposed model. We fit the model to real data from Ghana in the time window 12th March 2020 to 7th May 2020, with the aid of python programming language using the least-squares method. The average basic reproduction number without controls, R0a, is approximately 2.68. An optimal control is formulated based on the sensitivity analysis. Numerical simulation of the model is also done to verify the analytic results. The admissible control set such as: effective testing and quarantine when boarders are opened, the usage of masks and face shields through media education, cleaning of surfaces with home-based detergents, practising proper cough etiquette and fumigating commercial areas; health centers is simulated in MATLAB. We used forward-backward sweep Runge-Kutta scheme which gave interesting results in the main text, for example, the cost-effectiveness analysis shows that, Strategy 4 (safety measures adopted by the asymptomatic and symptomatic individuals such as practicing proper coughing etiquette by maintaining a distance, covering coughs and sneezes with disposable tissues or clothing and washing of hands after coughing or sneezing) is the most cost-effective strategy among all the six control intervention strategies under consideration.
Persistent pregnancies of unknown location are defined by abnormally trending serum human chorionic gonadotropin with nondiagnostic ultrasound. There is no consensus on optimal management.
This study ...aimed to assess the cost-effectiveness of 3 primary management strategies for persistent pregnancies of unknown location: (1) expectant management, (2) empirical 2-dose methotrexate, and (3) uterine evacuation followed by methotrexate, if indicated.
This was a prospective economic evaluation performed concurrently with the Expectant versus Active Management for Treatment of Persistent Pregnancies of Unknown Location multicenter randomized trial that was conducted from July 2014 to June 2019. Participants were randomized 1:1:1 to expectant management, 2-dose methotrexate, or uterine evacuation. The analysis was from the healthcare sector perspective with a 6-week time horizon after randomization. Costs were expressed in 2018 US dollars. Effectiveness was measured in quality-adjusted life years and the rate of salpingectomy. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were generated. Sensitivity analyses were performed to assess the robustness of the analysis.
Methotrexate had the lowest mean cost ($875), followed by expectant management ($1085) and uterine evacuation ($1902) (P=.001). Expectant management had the highest mean quality-adjusted life years (0.1043), followed by methotrexate (0.1031) and uterine evacuation (0.0992) (P=.0001). The salpingectomy rate was higher for expectant management than for methotrexate (9.4% vs 1.2%, respectively; P=.02) and for expectant management than for uterine evacuation (9.4% vs 8.1%, respectively; P=.04). Uterine evacuation, with the highest costs and the lowest quality-adjusted life years, was dominated by both expectant management and methotrexate. In the base case analysis, expectant management was not cost-effective compared with methotrexate at a willingness to pay of $150,000 per quality-adjusted life year given an incremental cost-effectiveness ratio of $175,083 per quality-adjusted life year gained (95% confidence interval, −$1,666,825 to $2,676,375). Threshold analysis demonstrated that methotrexate administration would have to cost $214 (an increase of $16 or 8%) to favor expectant management. Moreover, expectant management would be favorable in lower-risk patient populations with rates of laparoscopic surgical management for ectopic pregnancy not exceeding 4% of pregnancies of unknown location. Based on the cost-effectiveness acceptability curves, the probability of expectant management being cost-effective compared with methotrexate at a willingness to pay of $150,000 per quality-adjusted life year gained was 50%. The results were dependent on the cost of surgical intervention and the expected rate of methotrexate failure.
The management of pregnancies of unknown location with a 2-dose methotrexate protocol may be cost-effective compared with expectant management and uterine evacuation. Although uterine evacuation was dominated, expectant management vs methotrexate results were sensitive to modest changes in treatment costs of both methotrexate and surgical management.
•Argentinian pediatric cost-effectiveness study: PCV20 vs PCV13/PCV15 (2 + 1 schedule)•Effectiveness estimates derived from surveillance data plus PCV13 and PCV7 studies.•PCV20 was estimated to avert ...more pneumococcal disease cases vs PCV13 and PCV15.•Greater estimated QALY and cost-savings with PCV20 vs PCV13 and PCV15.•Results were stable over a broad range of sensitivity analyses.
The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for infants in Argentina’s national immunization program (NIP) in a 2 + 1 schedule since 2012. Licensure of the 15-valent vaccine (PCV15) is anticipated soon, and the 20-valent vaccine (PCV20) recently received regulatory approval. This cost-effectiveness analysis examined the public health and economic implications of transitioning from PCV13 to either PCV15 or PCV20 in Argentina’s pediatric NIP.
A decision-analytic Markov model was used with a 10-year time horizon and a 3.0% annual discount rate for costs and benefits. Vaccine effectiveness estimates were derived from Argentinian surveillance data, PCV13 clinical effectiveness and impact studies, and PCV7 efficacy studies. Population, epidemiologic, and economic inputs were obtained from literature and Argentinian-specific data. The study adopted a healthcare system perspective; sensitivity and scenario analyses were conducted to assess input parameters and structural uncertainty.
Compared with PCV13, PCV20 was estimated to avert an additional 7,378, 42,884, and 172,389 cases of invasive pneumococcal disease (IPD), all-cause pneumonia, and all-cause otitis media (OM), respectively, as well as 3,308 deaths, resulting in savings of United States Dollars (USD) 50,973,962 in direct medical costs. Compared with PCV15, PCV20 was also estimated to have greater benefit, averting an additional 6,140, 35,258, and 142,366 cases of IPD, pneumonia, and OM, respectively, as well as 2,624 deaths, resulting in savings of USD 37,697,868 in direct medical costs. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV15. Results remained robust in sensitivity analyses and scenario assessments.
Over a 10-year horizon, vaccination with PCV20 was expected to be the dominant, cost-saving strategy versus PCV13 and PCV15 in children in Argentina. Policymakers should consider the PCV20 vaccination strategy to achieve the greatest clinical and economic benefit compared with lower-valent options.
Innovations in Mixed Methods Evaluations Palinkas, Lawrence A; Mendon, Sapna J; Hamilton, Alison B
Annual review of public health,
04/2019, Letnik:
40, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Mixed methods research-i.e., research that draws on both qualitative and quantitative methods in varying configurations-is well suited to address the increasing complexity of public health problems ...and their solutions. This review focuses specifically on innovations in mixed methods evaluations of intervention, program or policy (i.e., practice) effectiveness, and implementation. The article begins with an overview of the structure, function, and process of different mixed methods designs and then provides illustrations of their use in effectiveness studies, implementation studies, and combined effectiveness-implementation hybrid studies. The article then examines four specific innovations: procedures for transforming (or "quantitizing") qualitative data, application of rapid assessment and analysis procedures in the context of mixed methods studies, development of measures to assess implementation outcomes, and strategies for conducting both random and purposive sampling, particularly in implementation-focused evaluation research. The article concludes with an assessment of challenges to integrating qualitative and quantitative data in evaluation research.
Typhoid vaccination has been shown to be an effective intervention to prevent enteric fever and is under consideration for inclusion in the national immunization program in Lao PDR.
A cost-utility ...analysis was performed using an age-structured static decision tree model to estimate the costs and health outcomes of introducing TCV. Vaccination strategies combined with five delivery approaches in different age groups compared to no vaccination were considered from the societal perspective, using the Gavi price of 1.5 USD per dose. The vaccination program was considered to be cost-effective if the incremental cost-effectiveness ratio was less than a threshold of 1 GDP per capita for Lao PDR, equivalent to USD 2,535 in 2020.
In the model, we estimated 172.2 cases of enteric fever, with 1.3 deaths and a total treatment cost of USD 7,244, based on a birth cohort of 164,662 births without TCV vaccination that was followed over their lifetime. To implement a TCV vaccination program over the lifetime horizon, the estimated cost of the vaccine and administration costs would be between USD 470,934 and USD 919,186. Implementation of the TCV vaccination program would prevent between 14 and 106 cases and 0.1 to 0.8 deaths. None of the vaccination programs appeared to be cost-effective.
Inclusion of TCV in the national vaccination program in Lao PDR would only be cost-effective if the true typhoid incidence is 25-times higher than our current estimate.
The smart factory is a representative element reshaping conventional computer-aided industry to data-driven smart industry, while it is nontrivial to achieve cost effectiveness, reliability, ...mobility, and scalability of smart industrial systems. Data-driven industrial systems mainly rely on sensory data collected from statically deployed sensors. However, the spatial coverage of industrial sensor networks is constrained due to the high deployment and maintenance cost. Recently, mobile crowd sensing (MCS) has become a new sensing paradigm owing to its merits, such as cost effectiveness, mobility, and scalability. Nevertheless, traditional MCS systems are vulnerable to malicious attacks and single point of failure due to the centralized architecture. To this end, in this article we integrate MCS with industrial systems without introducing any additional dedicated devices. To overcome the drawbacks of traditional MCS systems, we propose a blockchain-based MCS system (BMCS). In particular, we exploit miners to verify the sensory data and design a dynamic reward ranking incentive mechanism to mitigate the imbalance of multiple sensing tasks. Meanwhile, we also develop a sensory data quality detection scheme to identify and mitigate the data anomaly. We implement a prototype of the BMCS on top of Ethereum and conduct extensive experiments on a realistic factory workroom. Both experimental results and security analysis demonstrate that the BMCS can secure industrial systems and improve the system reliability.
Aims
Advanced therapy medicinal products (ATMPs) represent a new category of medicinal products with a potential for transformative improvements in health outcomes but at exceptionally high prices. ...Routine adoption of ATMPs requires robust evidence of their cost‐effectiveness.
Methods
A systematic literature review of economic evaluations of ATMPs, including gene therapies, somatic cell therapies and tissue‐engineered products, was conducted. Literature was searched using MedLine, Embase, PubMed, Cochrane Register, the NHS Economic Evaluation Database and the grey literature of health technology assessment organisations with search terms relating to ATMPs and economic evaluations. Titles were screened independently by 2 reviewers. Articles deemed to meet the inclusion criteria were screened independently on , and full texts reviewed. Study findings were appraised critically.
Results
4514 articles were identified, of which 23 met the inclusion criteria. There was some evidence supporting the cost‐effectiveness of: chimeric antigen receptor T‐cell therapy axicabtagene–ciloleucel (Yescarta), embryonic neural stem cells, tumour infiltrating lymphocytes, in vitro expanded myoblast, autologous chondrocyte implantation, ex vivo gene therapy (Strimvelis) and voretigene neparvovec (Luxturna). However, estimates of cost‐effectiveness were associated with significant uncertainty and high likelihood of bias, resulting from largely unknown long‐term outcomes, a paucity of evidence on health state utilities and extensive modelling assumptions.
Conclusion
There are critical limitations to the economic evidence for ATMPs, most notably in relation to evidence on the durability of treatment effect, and the reliability of opinion‐based assumptions necessary when evidence is absent.
Protected areas are considered to be essential shelters for wildlife species and their habitats. At present, approximately 17 % of the world's land areas are under protection, but large conservation ...gaps still exist. Moreover, to fulfil the global commitment of protecting 30 % of land areas by 2030, identifying potential habitats and conservation priorities for threatened species are urgently required. Therefore, this study aims to assess the habitat suitability of five species of cranes, which are internationally recognized flagship species across critical wetlands in northeast China, and to identify gaps in the current PAs network using a combination of field-based investigation and a species distribution modelling approach. Line transects were repeatedly conducted at monthly intervals to cover the entire migratory and breeding seasons, with a total length of 4622 km. Information on crane occurrences and habitat conditions were recorded during the fieldwork. Results showed that distance from lakes predominantly determined the distribution of the cranes. Winter precipitation affected stopover determination of migratory cranes, and temperature affected the distribution of breeding cranes. The analysis showed that the current PA network could not cover the entire suitable habitat for all crane species, with >50 % of suitable migratory crane habitat and approximately 20 % of suitable breeding crane habitat remaining outside of the PAs. Correspondingly, two conservation priority areas were identified that require effective conservation measures. This study provides critical information on the habitat requirements of five crane species and identifies conservation priorities so that flagship species and critical wetlands can be effectively protected.
•A regional conservation assessment was carried out for five crane species•Distance from lake was the most influential factor for the cranes’ distribution•Winter precipitation affected stopover determination of migratory cranes•Temperature affected the distribution of breeding cranes•Over 50% of suitable migratory crane habitat and around 20% of suitable breeding crane habitat were not covered by PAs
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