Objective
Surgery for obstetric fistula is a highly effective treatment to restore continence and improve quality of life. However, a lack of data on the cost‐effectiveness of this procedure limits ...prioritization of this essential treatment. This study measures the effectiveness of fistula surgeries using disability‐adjusted life years (DALYs) averted.
Methods
In 2021 and 2022, the Fistula Foundation funded 20 179 fistula surgeries and related procedures at 143 hospitals among 27 countries. We calculated DALYs averted specifically for vesicovaginal fistula and rectovaginal fistula procedure types (n = 13 235 surgeries) by using disability weights from the 2019 Global Burden of Disease study. We based cost calculations on direct treatment expenses, including medical supplies, health provider fees, and preoperative and postoperative care. We measured effectiveness using data on the risk of permanent disability, country‐specific average life spans, and treatment outcomes.
Results
The total treatment cost was $7.6 million, and a total of 131 433 DALYs were averted. Thus, the cost per DALY averted—the cost to restore 1 year of healthy life—was $58. For this analysis, we took a cautious approach and weighted only surgeries that resulted in a closed fistula with restored continence. We calculated DALYs averted by country. Limitations of the study include data entry errors inherent in patient logs and lack of long‐term outcomes.
Conclusion
The current study demonstrates that obstetric fistula surgery, along with having a significant positive impact on maternal health outcomes, is highly cost‐effective in comparison with other interventions. The study therefore highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care.
Synopsis
Obstetric fistula treatment is highly cost‐effective. The current study highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care.
•Carbamazepine is one of the drugs that induced SJS/TEN.•Levetiracetam is an alternative drug that we used for focal epilepsy.•Our study may provide a helpful cost-effectiveness template.•Universal ...HLA-B*15:02 screening reduced SJS/TEN incidence and more cost effective.
Adverse skin reactions due to drugs such as Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) occur in 3% of people receiving anti epileptic drugs (AED). Although SJS/TEN has a low incidence, the mortality and morbidity rates are high. Indonesia has not adopted HLA-B*1502 screening prior to administration of carbamazepine (CBZ), although previous studies found a relationship between HLA-B*1502 and SJS/TEN.
A hybrid decision tree and Markov model was developed to evaluate three strategies for treating newly diagnosed focal epilepsy: CBZ direct therapy, levetiracetam (LEV) direct therapy, and therapy based on HLA-B*15:02 test results. From a societal perspective, base case and sensitivity analyses were carried out over a lifetime.
Direct administration of CBZ appears to have a slightly lower average cost than the HLA-B*15:02 allele screening strategy. The increase in quality-adjusted life year (QALY) in HLA-B*15:02 screening before treatment related to the cost difference reached 0.519 with an incremental cost-effectiveness ratio (ICER) of around USD 984 per unit of QALY acquisition. Direct treatment of LEV increased treatment costs by almost USD 2000 on average compared to the standard CBZ strategy. The increase in QALY is 0.834 in direct levetiracetam treatment, with an ICER of around USD 2230 for each QALY processing.
Calculation of the cost-effectiveness of lifetime epilepsy therapy in this study found that the initial screening strategy with the HLA-B*15:02 test was the most cost-effective.
Enhancing rural livelihoods in low to medium-income countries through innovative agricultural technologies is a critical challenge for decision-makers. Cost-effective interventions like essential oil ...extraction (EOE) technology for aromatic plants need rural adoption. The study assesses two EOE practices' economic benefits in Punjab, Pakistan, using three models: individual benefit-cost (BC), diffusion, and a Pothwar-specific BC model. Thus, analyzing results from the literature, expert insights, and indigenous knowledge can readily be employed in scenarios where data is limited in less developed economies, including Pakistan. The study findings revealed monetary costs and financial returns at both individual and zonal levels. The highest positive NPV value was recorded in the case of mint oil (267.86) followed by eucalyptus oil and wood (755.12) productivity for short-term and long-term benefits respectively. In addition, the maximum BC index (4.03) was recorded under eucalyptus oil and wood, followed by mint essential oil (3.82) production for 10 years. The model(s) further explored the key input parameters that positively impact the economic gains of the interventions and for ongoing future investments. Hence, the general application of the existing framework is also discussed, along with the limitations under different scenarios.
•EOE interventions introduced as cost-effective strategy among rural masses.•Triple BC models analyzed with computational tools, simulative modeling, and risk evaluation.•Eucalyptus and mint oils economic viability over conventional methods.•Transitioning to EOE practices offers adopters advantage.•EOE interventions yielded optimal results for future investments.
Treatment of Clostridioides difficile infection (CDI) has undergone significant change in recent years with the introduction of fidaxomicin and bezlotoxumab. This study evaluated the ...cost-effectiveness of fidaxomicin and bezlotoxumab for initial CDI compared with standard therapy with oral vancomycin.
A Markov model with eight health states was built based on transition probabilities, costs and health utilities derived from literature to evaluate the cost-effectiveness of standard fidaxomicin, bezlotoxumab plus vancomycin, and extended-pulsed fidaxomicin versus standard oral vancomycin over a lifetime horizon from the US societal perspective.
For overall CDI treatment, oral vancomycin had a cost of $39 178 and was associated with a gain of 11.64 quality-adjusted life-years (QALYs). Extended-pulsed fidaxomicin had a higher QALY gain of 11.65 at a lower cost of $37 613, and therefore was dominant over vancomycin. Standard fidaxomicin had a QALY gain of 11.94 versus vancomycin at an incremental cost of $495 per QALY. Bezlotoxumab plus vancomycin led to a QALY gain of 11.77 at an incremental cost of $17 746 per QALY. At the willingness-to-pay (WTP) threshold of $150 000 per QALY, extended-pulsed fidaxomicin, bezlotoxumab plus vancomycin and standard fidaxomicin were more cost-effective compared with vancomycin alone, yielding incremental net monetary benefits of $3248, $17 011 and $44 308, respectively. One-way sensitivity analysis suggested that the probabilities of sustained cure from the initial episode were the most sensitive inputs, and results were overall not particularly sensitive to any drug costs.
Based on a WTP threshold of $150 000, standard fidaxomicin was estimated to be the most cost-effective treatment. Standard-of-care vancomycin was dominated by extended-pulsed fidaxomicin for treating an episode of CDI and preventing further recurrence, and the addition of bezlotoxumab to vancomycin was dominated by standard fidaxomicin.
We use data from the Head Start Impact Study (HSIS) to evaluate the cost-effectiveness of Head Start, the largest early childhood education program in the United States. Head Start draws roughly a ...third of its participants from competing preschool programs, many of which receive public funds. We show that accounting for the fiscal impacts of such program substitution pushes estimates of Head Start’s benefit-cost ratio well above one under a wide range of assumptions on the structure of the market for preschool services and the dollar value of test score gains. To parse the program’s test score impacts relative to home care and competing preschools, we selection-correct test scores in each care environment using excluded interactions between experimental assignments and household characteristics. We find that Head Start generates larger test score gains for children who would not otherwise attend preschool and for children who are less likely to participate in the program.
The Dyslexia Pilot Project provided funding to school districts to implement a multitiered system of support (MTSS) framework for the prevention, early identification, and early intervention of ...reading difficulties. This article describes the evaluation of the multiyear Dyslexia Pilot Project for students in kindergarten through Grade 2. The evaluation extended a conceptual model for evaluating the systems effects of an MTSS for reading by including a cost‐effectiveness analysis. The results indicate that mean rates of improvement on Dynamic Indicators for Basic Early Literacy Skills Next curriculum‐based measures for students in participating schools exceeded the expected rates of improvement based on benchmark norms. This reduction in risk precluded the need for more intensive, individualized, and costly interventions and specialized educational services. Implications of the findings and future directions are discussed.
•Consequences of happiness and unhappiness among software developers detailed.•More positive consequences of happiness are experienced related to the self.•More negative consequences of unhappiness ...are experienced for external factors.•Results based on qualitative analysis of more than 300 developers’ experiences.•Category scheme of consequences usable for further studies and as guidelines.
The growing literature on affect among software developers mostly reports on the linkage between happiness, software quality, and developer productivity. Understanding happiness and unhappiness in all its components – positive and negative emotions and moods – is an attractive and important endeavor. Scholars in industrial and organizational psychology have suggested that understanding happiness and unhappiness could lead to cost-effective ways of enhancing working conditions, job performance, and to limiting the occurrence of psychological disorders. Our comprehension of the consequences of (un)happiness among developers is still too shallow, being mainly expressed in terms of development productivity and software quality. In this paper, we study what happens when developers are happy and unhappy while developing software. Qualitative data analysis of responses given by 317 questionnaire participants identified 42 consequences of unhappiness and 32 of happiness. We found consequences of happiness and unhappiness that are beneficial and detrimental for developers’ mental well-being, the software development process, and the produced artifacts. Our classification scheme, available as open data enables new happiness research opportunities of cause-effect type, and it can act as a guideline for practitioners for identifying damaging effects of unhappiness and for fostering happiness on the job.
To assess the cost-effectiveness of a cardiac rehabilitation (CR) program specifically designed for cardiac patients with obesity vs standard CR.
Cost-effectiveness analysis based on observations in ...a randomized controlled trial.
Three regional CR centers in the Netherlands.
Cardiac patients (N=201) with obesity (BMI≥30 kg/m2) referred to CR.
Participants were randomized to a CR program specifically designed for patients with obesity (OPTICARE XL; N=102) or standard CR. OPTICARE XL included aerobic and strength exercise and behavioral coaching on diet and physical activity during 12 weeks, followed by a 9-month after-care program with “booster” educational sessions. Standard CR consisted of a 6- to 12-week aerobic exercise program, supplemented with cardiovascular lifestyle education.
An economic evaluation, with an 18-month time horizon, in terms of quality-adjusted life years (QALYs) and costs from the societal perspective was performed. Costs were reported in 2020 Euros, discounted at a 4% annual rate, and health effects were discounted at a 1.5% annual rate.
OPTICARE XL CR and standard CR resulted in comparable health gain per patient (0.958 vs 0.965 QALYs, respectively; P=.96). Overall, OPTICARE XL CR saved costs (-€4542) compared with the standard CR group. The direct costs for OPTICARE XL CR were higher than for standard CR (€10,712 vs €9951), whereas indirect costs were lower (€51,789 vs €57,092), but these differences were not significant.
This economic evaluation showed no differences between OPTICARE XL CR and standard CR in health effects and costs in cardiac patients with obesity.
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