Taking account of future technology in cost effectiveness analysis.
Ontology highlight
ABSTRACT:
SUBMITTER: Salomon JA
PROVIDER: S-EPMC518904 | biostudies-literature | 2004 Sep
REPOSITORIES: biostudies-literature
Publications
Taking account of future technology in cost effectiveness analysis.
Salomon Joshua A JA Weinstein Milton C MC Goldie Sue J SJ
BMJ (Clinical research ed.) 20040901 7468
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Project description:New medical technology is expensive and we are introducing it in services in an unplanned manner. A significant proportion of our resources are wasted through inefficiency in the selection and production of health care strategies. We should choose new technologies which are 'need based' and 'cost effective'.
| S-EPMC5530383 | biostudies-other
Project description:BackgroundNew 15- and 20-valent pneumococcal vaccines (PCV15, PCV20) are available for both children and adults, while PCV21 for adults is in development. However, their cost-effectiveness for older adults, taking into account indirect protection and serotype replacement from a switch to PCV15 and PCV20 in childhood vaccination, remains unexamined.MethodsWe used a static model for the Netherlands to assess the cost-effectiveness of different strategies with 23-valent pneumococcal polysaccharide vaccine (PPV23), PCV15, PCV20, and PCV21 for a 65-year-old cohort from a societal perspective, over a 15-year time horizon. Childhood vaccination was varied from PCV10 to PCV13, PCV15, and PCV20. Indirect protection was assumed to reduce the incidence of vaccine serotypes in older adults by 80% (except for serotype 3, no effect), completely offset by an increase in non-vaccine serotype incidence due to serotype replacement.ResultsIndirect effects from childhood vaccination reduced the cost-effectiveness of vaccination of older adults, depending on the serotype overlap between the vaccines. With PCV10, PCV13, or PCV15 in children, PCV20 was more effective and less costly for older adults than PPV23 and PCV15. PCV20 costs approximately €10,000 per quality-adjusted life year (QALY) gained compared to no pneumococcal vaccination, which falls below the conventional Dutch €20,000/QALY gained threshold. However, with PCV20 in children, PCV20 was no longer considered cost-effective for older adults, costing €22,550/QALY gained. As indirect effects progressed over time, the cost-effectiveness of PCV20 for older adults further diminished for newly vaccinated cohorts. PPV23 was more cost-effective than PCV20 for cohorts vaccinated 3 years after the switch to PCV20 in children. PCV21 offered the most QALY gains, and its cost-effectiveness was minimally affected by indirect effects due to its coverage of 11 different serotypes compared to PCV20.ConclusionsFor long-term cost-effectiveness in the Netherlands, the pneumococcal vaccine for older adults should either include invasive serotypes not covered by childhood vaccination or become more affordable than its current pricing for individual use.
| S-EPMC10870576 | biostudies-literature
Project description:Introduction: In Europe, women can expect to live on average 82 years and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle 'epidemics'. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee-Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001).
| S-EPMC8337079 | biostudies-literature
Project description:BackgroundA critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided.MethodsA simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed.ResultsVaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination further improved effectiveness and cost effectiveness.ConclusionsThe effectiveness and cost effectiveness consequences of the time-critical interplay of pandemic dynamics, vaccine availability and intervention timing has been quantified. For moderate and extreme pandemics, vaccination combined with rapidly activated antiviral and social distancing interventions of sufficient duration is cost effective from the perspective of life years saved.
| S-EPMC3637125 | biostudies-literature
Project description:BackgroundStrong evidence for a causal role of environmental factors in a congenital anomaly is still difficult to produce. The collection of statistical data is crucial for gaining a better understanding of the epidemiology and pathophysiology of these anomalies. We aimed to evaluate spatial variations in hypospadias within our region and it's association to socioeconomic and ecological factors, taking clinical data into account.MethodsAll boys with hypospadias born in northern France and seen in Lille University Medical Center (Lille, France) between 1999 and 2012 were included in the analysis. We retrospectively collected geographic data, clinical data (especially known confounding factors associated with an elevated risk of hypospadias), and demographic, socio-economic and ecological data. We analyzed the entire study population and subsequently the subset of boys lacking confounding factors.ResultsThe study sample of 975 cases of hypospadias over the 13-year period resulted in an incidence of 25.4/10,000 male births, and was characterized by significant spatial heterogeneity (p < 0.005) and autocorrelation (p < 0.001). We detected two high-incidence clusters that differed with regard to their land use. After the exclusion of 221 patients with confounding factors, two high-incidence clusters with significant disease risks (1.65 and 1.75, respectively; p < 0.001) and a significant difference in land use (p < 0.001) again appeared. The first cluster contained a higher median [interquartile range] proportion of artificialized land (0.40 [0.22;0.47]) than the remaining "neutral areas" (0.19 [0.08;0.53]) did (p < 0.001). Conversely, the second cluster contained a higher median proportion of rural land (0.90 [0.78;0.96]) than the "neutral areas" (0.81 [0.47;0.92]) did (p < 0.001). The median deprivation index was significantly lower in the urban cluster (0.47 [0.42;0.55]) and significantly higher in the rural cluster (0.69 [0.56;0.73]) (p < 0.001).ConclusionsOur results evidenced the heterogeneous spatial distribution of cases of hypospadias in northern France. We identified two clusters with different environmental and social patterns - even after the exclusion of known confounding factors.
| S-EPMC7504625 | biostudies-literature
Project description:Day-to-day variability in microarray experiments is a recognized source of variation that can impede the analysis of large microarray studies where samples are processed on different days. In this study, we have applied an algorithm, called D2Dsum, which is based on a log-linear fixed effect model to cope with this kind of issues on a data set of 45 microarrays. Keywords: time course
2007-12-12 | GSE9826 | GEO
Project description:Simulations are used to generate plausible realisations of soil and climatic variables for input into an enterprise land suitability assessment (LSA). Subsequently we present a case study demonstrating a LSA (for hazelnuts) which takes into account the quantified uncertainties of the biophysical model input variables. This study is carried out in the Meander Valley Irrigation District, Tasmania, Australia. It is found that when comparing to a LSA that assumes inputs to be error free, there is a significant difference in the assessment of suitability. Using an approach that assumes inputs to be error free, 56% of the study area was predicted to be suitable for hazelnuts. Using the simulation approach it is revealed that there is considerable uncertainty about the 'error free' assessment, where a prediction of 'unsuitable' was made 66% of the time (on average) at each grid cell of the study area. The cause of this difference is that digital soil mapping of both soil pH and conductivity have a high quantified uncertainty in this study area. Despite differences between the comparative methods, taking account of the prediction uncertainties provide a realistic appraisal of enterprise suitability. It is advantageous also because suitability assessments are provided as continuous variables as opposed to discrete classifications. We would recommend for other studies that consider similar FAO (Food and Agriculture Organisation of the United Nations) land evaluation framework type suitability assessments, that parameter membership functions (as opposed to discrete threshold cutoffs) together with the simulation approach are used in concert.
| S-EPMC4627905 | biostudies-literature
Project description:Currently, food waste is estimated at more than one-third of all food produced, and the primary responsibility for this phenomenon is attributed to households. Therefore, it seems reasonable to take action to limit food waste and to raise awareness about this link in the chain. To develop and implement educational programs addressed at consumers it is necessary to understand the factors determining food waste in households. Segmentation is a tool that can help effectively reach consumers who are to the greatest extent wasting food which identifies homogeneous clusters of consumers. The aim of this study was to perform segmentation to identify consumer groups with similar behaviors in relation to food, with particular emphasis on food wastage. We carried out segmentation on a representative sample of Polish people over 18 years of age and to identified three clusters of consumers. The three consumer segments diagnosed differed in sociodemographic terms, i.e., number of adults, number of children, subjective assessment of the financial situation, and percentage of spending on food. The segment exhibiting a high frequency of discarding food due to too large package size included single and double households.
| S-EPMC7230927 | biostudies-literature
Project description:Personalized medicine is health care that tailors interventions to individual variation in risk and treatment response. Although medicine has long strived to achieve this goal, advances in genomics promise to facilitate this process. Relevant to present-day practice is the use of genomic information to classify individuals according to disease susceptibility or expected responsiveness to a pharmacologic treatment and to provide targeted interventions. A symposium at the annual meeting of the Society for Medical Decision Making on 23 October 2007 highlighted the challenges and opportunities posed in translating advances in molecular medicine into clinical practice. A panel of US experts in medical practice, regulatory policy, technology assessment, and the financing and organization of medical innovation was asked to discuss the current state of practice and research on personalized medicine as it relates to their own field. This article reports on the issues raised, discusses potential approaches to meet these challenges, and proposes directions for future work. The case of genetic testing to inform dosing with warfarin, an anticoagulant, is used to illustrate differing perspectives on evidence and decision making for personalized medicine.
| S-EPMC4598076 | biostudies-other
Project description:AimsThis study aimed to determine HIV incidence and prevalence in Turkey and to estimate the cost-effectiveness of improving testing and diagnosis in the next 20 years.BackgroundHIV incidence in Turkey has been rapidly increasing in the last decade with a particularly high rate of infection for younger populations, which underscores the urgent need for a robust prevention program and improved testing capacity for HIV.MethodsWe developed a dynamic compartmental model of HIV transmission and progression among the Turkish population aged 15-64 and assessed the effect of improving testing and diagnosis. The model generated the number of new HIV cases by transmission risk and CD4 level, HIV diagnoses, HIV prevalence, continuum of care, the number of HIV-related deaths, and the expected number of infections prevented from 2020 to 2040. We also explored the cost impact of HIV and the cost-effectiveness of improving testing and diagnosis.ResultsUnder the base case scenario, the model estimated an HIV incidence of 13,462 cases in 2020, with 63% undiagnosed. The number of infections was estimated to increase by 27% by 2040, with HIV incidence in 2040 reaching 376,889 and HIV prevalence 2,414,965 cases. Improving testing and diagnosis to 50%, 70%, and 90%, would prevent 782,789, 2,059,399, and 2,336,564 infections-32%, 85%, and 97% reduction in 20 years, respectively. Improved testing and diagnosis would reduce spending between $1.8 and $8.8 billion.ConclusionsIn the case of no improvement in the current continuum of care, HIV incidence and prevalence will significantly increase over the next 20 years, placing a significant burden on the Turkish healthcare system. However, improving testing and diagnosis could substantially reduce the number of infections, ameliorating the public health and disease burden aspects.
| S-EPMC10313051 | biostudies-literature