The creation of a flexible, efficient, digitized, dependable and resilient power grid may well be the best route to increasing energy efficiency and security, as well as boosting the potential of ...renewable and distributed power sources. This book covers smart grids from A-Z, providing a complete treatment of the topic, covering both policy and technology, explaining the most recent innovations supporting its development, and clarifying how the smart grid can support the integration of renewable energy resources. Among the most important topics included are smart metering, renewable energy storage, plug-in hybrids, flexible demand response, strategies for offsetting intermittency issues, micro-grids for off-grid communities, and specific in-depth coverage of wind and solar power integration. The content draws lessons from an international panel of contributors, whose diverse experiences implementing smart grids will help to provide templates for success.
Provides critical information on the technological, design and policy issues that must be taken into account to ensure that the smart grid is implemented successfully
Demonstrates how smart grids can help utilities adhere to increased renewable portfolio standards
Provides examples of successful microgrid/smart metering projects from around the world that can act as templates for developers, operators and investors embarking upon similar projects
Abstract Objective To demonstrate how the optimal decision and level of uncertainty associated with that decision, can be presented when assessing the cost-effectiveness of multiple options. To ...explore and explain potentially counterintuitive results that can arise when analyzing multiple options. Methods A template was created, based on the assumption of multivariate normality, in order to replicate a previous analysis that compared the cost-effectiveness of multiple options. We used this template to explain some of the different shapes that the cost-effectiveness acceptability curve (CEAC), cost-effectiveness acceptability frontier (CEAF), and expected value of perfection information (EVPI) may take, with changing correlation structure and variance between the multiple options. Results We show that it is possible for 1) an option that is subject to extended dominance to have the highest probability of being cost-effective for some values of the cost-effectiveness threshold; 2) the most cost-effective (optimal) option to never have the highest probability of being cost-effective; and 3) the EVPI to increase when the probability of making the wrong decision decreases. Changing the correlation structure between multiple options did not change the presentation of results on the cost-effectiveness plane. Conclusion The cost-effectiveness plane has limited use in representing the uncertainty surrounding multiple options as it cannot represent correlation between the options. CEACs can represent decision uncertainty, but should not be used to determine the optimal decision. Instead, the CEAF shows the decision uncertainty surrounding the optimal choice and this can be augmented by the EVPI to show the potential gains to further research.
Retaking rationality Revesz, Richard L; Livermore, Michael A
2008, 2008-04-17, 20080101
eBook, Book
Written in a clear and non-technical manner, Retaking Rationality gives progressive groups and the public the tools they need both to understand and to engage in the debate over the economic analysis ...of environmental, public health, and safety regulation. Since the Reagan presidency, the most important regulations affecting every American have been required to pass a "cost-benefit" test, but most Americans-including many professionals working for progressive institutions or elected officials-do not understand how economic analysis works. The result is that industry and conservative ideologues have twisted economic analysis so that good regulations seem to fail the cost-benefit test. This book argues that the public, and progressive institutions, must take up the fight over how economic analysis is conducted, and gives them the knowledge they need to engage industry and conservatives about when and how economic analysis of regulation should be carried out.
Background and Aims
In this follow‐up study to a randomized controlled trial of a chronic disease management (CDM) model in cirrhosis, our aim was to assess the relative cost‐effectiveness of this ...model compared with usual care during the 12‐month study period, using incremental costs per death avoided as the primary outcome.
Methods
Mean differences in hospitalization costs, deaths avoided, and change in Chronic Liver Disease Questionnaire (CLDQ) total scores were presented with 95% non‐parametric bootstrapped confidence intervals. Results were also presented using a cost‐effectiveness plane (CEP) and cost‐effectiveness acceptability curve.
Results
The CDM intervention was more expensive, by 18 521 AUD per participant, but more effective (% of deaths at 12 months: 10% vs 15% and 0.67 units increase per patient in CLDQ total scores). The resultant incremental cost‐effectiveness ratios were 370 425 AUD per death avoided (95% confidence interval: −14 564 AUD to 2 059 373 AUD) and 27 547 AUD per unit improvement in the CLDQ total score (95% CI: 7455 AUD to 143 874 AUD). The CEPs demonstrated some uncertainty around cost‐effectiveness. The cost‐effectiveness acceptability curves demonstrated that at willingness to pay values of 400 000 AUD per additional death avoided and 40 000 AUD per unit improvement in the CLDQ, there was at least a 70% probability of CDM being more cost‐effective than usual care. At 24 months, CDM was much more effective (12% less deaths but now also cheaper by 985 AUD per patient).
Conclusions
The analysis of data from a randomized controlled trial suggests that the CDM intervention used is likely to be cost‐effective, relative to usual care, due to fewer patient deaths.
A blood-based colorectal cancer (CRC) screening test may increase screening participation. However, blood tests may be less effective than current guideline-endorsed options. The Centers for Medicare ...& Medicaid Services (CMS) covers blood tests with sensitivity of at least 74% for detection of CRC and specificity of at least 90%. In this study, we investigate whether a blood test that meets these criteria is cost-effective.
Three microsimulation models for CRC (MISCAN-Colon, CRC-SPIN, and SimCRC) were used to estimate the effectiveness and cost-effectiveness of triennial blood-based screening (from ages 45 to 75 years) compared to no screening, annual fecal immunochemical testing (FIT), triennial stool DNA testing combined with an FIT assay, and colonoscopy screening every 10 years. The CMS coverage criteria were used as performance characteristics of the hypothetical blood test. We varied screening ages, test performance characteristics, and screening uptake in a sensitivity analysis.
Without screening, the models predicted 77–88 CRC cases and 32–36 CRC deaths per 1000 individuals, costing $5.3–$5.8 million. Compared to no screening, blood-based screening was cost-effective, with an additional cost of $25,600–$43,700 per quality-adjusted life-year gained (QALYG). However, compared to FIT, triennial stool DNA testing combined with FIT, and colonoscopy, blood-based screening was not cost-effective, with both a decrease in QALYG and an increase in costs. FIT remained more effective (+5–24 QALYG) and less costly (–$3.2 to –$3.5 million) than blood-based screening even when uptake of blood-based screening was 20 percentage points higher than uptake of FIT.
Even with higher screening uptake, triennial blood-based screening, with the CMS-specified minimum performance sensitivity of 74% and specificity of 90%, was not projected to be cost-effective compared with established strategies for colorectal cancer screening.
Current test performance characteristics of blood-based colorectal cancer screening tests are insufficient to justify their high costs compared with less expensive and more effective alternatives such as fecal immunochemical testing, triennial stool DNA testing combined with a fecal immunochemical testing assay, and colonoscopy.
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.
Cost effectiveness analysis (CEA) has been increasingly used to inform cancer treatment coverage policy making worldwide. The primary objective of this study was to assess the association between ...industry sponsorship and CEA results in oncology.
All CEAs in oncology used incremental cost per quality-adjusted life year (QALY) as health effect identified from the Tufts CEA Registry since 1976 was analyzed. Descriptive analyses were performed to present and compare the characteristics of CEA funded by industry and non-industry. Robust logistic regression was performed to assess the relationship between the industry sponsorship and cost effective conclusion over a wide range of threshold values.
A total of 1537 CEAs in oncology published from 1976 to 2021 were included. There were 387 (25.2%) with the industry sponsorship. CEAs sponsored by the industry were more likely to report ICERs below $50,000/QALY (adjusted odds ratio (OR), 1.91, 95% confidence interval (CI), 1.45-2.51, P < 0.001), $100,000/QALY (2.74, 1.98-3.79, P < 0.001), and $150,000/QALY (3.53, 2.37-5.27, P < 0.001) than studies without industry sponsorship.
Our study suggests that there has been a significant sponsorship bias in CEAs in oncology. This bias could have a profound implication on drug pricing and coverage policy making.
Environmental protection is now an integral part of public policies, at local, national and global levels. In all instances, the cost and benefits of policies and projects must be carefully weighed ...using a common monetary measuring rod. Yet, many different categories of benefits and cost must be evaluated, such as health impacts, property damage, ecosystem losses and other welfare effects. Furthermore, many of these benefits or damages occur over the long term, sometimes over several generations, or are irreversible ( e.g. global warming, biodiversity losses). . How can we evaluate these elements and give them a monetary value? How should we take into account impacts on future generations and of irreversible losses? How to deal with equity and sustainability issues? This book presents an in-depth assessment of the most recent conceptual and methodological developments in this area. It should provide a valuable reference and tool for environmental economists and policy analysts.
Five biologicals have been approved for severe eosinophilic asthma, a well‐recognized phenotype. Systematic reviews (SR) evaluated the efficacy and safety of benralizumab, dupilumab, mepolizumab, ...omalizumab and reslizumab (alphabetical order) compared to standard of care for severe eosinophilic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma‐related outcomes were evaluated for each of the biologicals. The risk of bias and the certainty of the evidence were assessed using GRADE. 19 RCTs (three RCTs for benralizumab, three RCTs for dupilumab, three RCTs for mepolizumab, five RCTs for omalizumab and five RCTs for reslizumab), including subjects 12 to 75 years old (except for omalizumab including also subjects 6‐11 years old), ranging from 12 to 56 weeks were evaluated. All biologicals reduce exacerbation rates with high certainty of evidence: benralizumab incidence rate ratio (IRR) 0.53 (95% CI 0.39 to 0.72), dupilumab (IRR) 0.43 (95% CI 0.32 to 0.59), mepolizumab IRR 0.49 (95% CI 0.38 to 0.66), omalizumab (IRR) 0.56 (95% CI 0.40 to 0.77) and reslizumab (IRR) 0.46 (95% CI 0.37 to 0.58). Benralizumab, dupilumab and mepolizumab reduce the daily dose of oral corticosteroids (OCS) with high certainty of evidence. All evaluated biologicals probably improve asthma control, QoL and FEV1, without reaching the minimal important difference (moderate certainty). Benralizumab, mepolizumab and reslizumab slightly increase drug‐related adverse events (AE) and drug‐related serious AE (low to very low certainty of evidence). The incremental cost‐effectiveness ratio per quality‐adjusted life year value is above the willingness to pay threshold for all biologicals (moderate certainty). Potential savings are driven by decrease in hospitalizations, emergency and primary care visits. There is high certainty that all approved biologicals reduce the rate of severe asthma exacerbations and for benralizumab, dupilumab and mepolizumab for reducing OCS. There is moderate certainty for improving asthma control, QoL, FEV1. More data on long‐term safety are needed together with more efficacy data in the paediatric population.
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